Publication: Infecciones osteoarticulares en pediatría : diagnóstico, tratamiento y evaluación del abordaje conservador
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2023-03-27
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Universidad Complutense de Madrid
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Abstract
Las infecciones osteoarticulares (IOA) son relativamente comunes. No obstante, pueden ser potencialmente severas. Tradicionalmente, el manejo de esta patología estaba basado en antibioterapia prolongada, inicialmente intravenosa, asociando cirugía en caso de afectación articular o mala evolución. Sin embargo, en los últimos años, se ha descrito como opción igual de segura y eficaz disminuir la duración de tratamiento intravenoso a 2-4 días, especialmente en pacientes menores de 3 años sin factores de riesgo y fuera del periodo neonatal. Además, de manera progresiva, se han ido publicando nuevas series de pacientes con compromiso articular que presentaban buena evolución clínica habiendo sido abordados mediante artroscopia, artrocentesis con lavado articular o incluso únicamente con actitud expectante, reservando la cirugía únicamente para aquellos casos con evolución tórpida días después de haber iniciado antibioterapia. Asimismo, la implementación progresiva de las técnicas de detección molecular ha permitido la detección de gérmenes de crecimiento difícil en métodos de cultivo convencionales, como Kingella kingae. De hecho, actualmente este germen se ha descrito como el principal agente etiológico en pacientes entre 6 meses y 4 años de edad. La poca repercusión clínica y analítica que suele acompañar a este microorganismo, cuestiona si los pacientes con sospecha de IOA por K. kingae, o con bajo riesgo de secuelas, deberían ser manejados siguiendo las recomendaciones clásicas o si un abordaje mínimamente invasivo podría ser suficiente...
Osteoarticular infections (OAI) are relatively common. However, they can be potentially serious. Traditionally, the management of this pathology was based on prolonged antibiotic therapy, initially intravenous, followed by surgery in case of joint involvement or poor evolution. However, recently, reducing the duration of intravenous treatment to 2-4 days has been described as an equally safe and effective option, especially in patients younger than 3 years without risk factors and outside the neonatal period. In addition, progressively, new series of patients with joint involvement who presented good clinical evolution have been published. Those patients had been approached by arthroscopy, arthrocentesis with joint lavage or even only with an expectant attitude, reserving surgery only for those cases with torpid evolution days after having started antibiotic therapy.Likewise, the progressive implementation of molecular detection techniques has allowed the detection of difficult-to-grow germs in conventional culture methods, such as Kingella kingae. In fact, this germ has now been described as the main etiological agent in patients between 6 months and 4 years of age.The subtle clinical and analytical repercussion that usually accompanies this microorganism, questions whether patients with suspected OAI due to K. kingae or with low risk of sequelae should be managed following the classic recommendations or if a minimally invasive approach could be sufficient...
Osteoarticular infections (OAI) are relatively common. However, they can be potentially serious. Traditionally, the management of this pathology was based on prolonged antibiotic therapy, initially intravenous, followed by surgery in case of joint involvement or poor evolution. However, recently, reducing the duration of intravenous treatment to 2-4 days has been described as an equally safe and effective option, especially in patients younger than 3 years without risk factors and outside the neonatal period. In addition, progressively, new series of patients with joint involvement who presented good clinical evolution have been published. Those patients had been approached by arthroscopy, arthrocentesis with joint lavage or even only with an expectant attitude, reserving surgery only for those cases with torpid evolution days after having started antibiotic therapy.Likewise, the progressive implementation of molecular detection techniques has allowed the detection of difficult-to-grow germs in conventional culture methods, such as Kingella kingae. In fact, this germ has now been described as the main etiological agent in patients between 6 months and 4 years of age.The subtle clinical and analytical repercussion that usually accompanies this microorganism, questions whether patients with suspected OAI due to K. kingae or with low risk of sequelae should be managed following the classic recommendations or if a minimally invasive approach could be sufficient...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, leída el 03-06-2022