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Bacterial bone and joint infections in children with leukaemia or following haematopoietic cell transplant: A systematic review of published cases

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Titel: Bacterial bone and joint infections in children with leukaemia or following haematopoietic cell transplant: A systematic review of published cases
Autoren: Natalie Yap, Shu Ki Tsoi, Alison Boast, Gabrielle M. Haeusler
Quelle: EJC Paediatric Oncology, Vol 2, Iss , Pp 100118- (2023)
Verlagsinformationen: Elsevier, 2023.
Publikationsjahr: 2023
Bestand: LCC:Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Schlagwörter: Childhood leukaemia, Osteomyelitis, Septic arthritis, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Beschreibung: Background: Bone and joint infections (BJI) are common in immunocompetent children, however in children with acute leukaemia the epidemiology, optimal diagnostic pathway and medical and surgical treatment is poorly described. We review the presentation, management and outcomes of BJI in this special population. Methods: Systematic literature review of BJI in children with acute leukaemia was performed using Medline, EMBASE and PubMed databases from 1946 to June, 2023. Titles and abstracts were independently screened by 3 reviewers. Studies were included if they reported data on children (≤18 years) with leukaemia who had a diagnosis of osteomyelitis (radiological diagnosis) or septic arthritis (culture proven or managed as infection by treating clinician). Results: Twenty-two articles describing 33 episodes of confirmed or suspected bacterial BJI were included. Of these, microbiological diagnosis was confirmed in 27 episodes (82%) and included Gram-positive (9/33), Gram-negative (8/33), mycobacterial (5/33), Mycoplasmatota (1/33) and polymicrobial (4/33). The femur was the most common site of infection (33%) and there were 18 episodes (55%) of multifocal disease. Duration of treatment varied from 3 weeks to 2.5 years in patients with culture confirmed infection (82%) and from 3 to 8 weeks in patients with culture-negative infection (18%). Clinical cure was documented in 31 episodes (94%). Conclusion: Bone and joint infections in children with acute leukaemia are often caused by atypical pathogens, with a higher predilection for multifocal disease and/or involvement of unusual sites in comparison with immunocompetent children. It is unclear whether this population requires prolonged antibiotic treatment due to periods of intensive chemotherapy or neutropenia. Monitoring response to therapy may be challenging as inflammatory markers such as CRP and ESR may take longer to normalise, making it difficult to assess for clinical cure.
Publikationsart: article
Dateibeschreibung: electronic resource
Sprache: English
ISSN: 2772-610X
Relation: http://www.sciencedirect.com/science/article/pii/S2772610X23001162; https://doaj.org/toc/2772-610X
DOI: 10.1016/j.ejcped.2023.100118
Zugangs-URL: https://doaj.org/article/6e566041122f41b8ac90cb2369c36bdb
Dokumentencode: edsdoj.6e566041122f41b8ac90cb2369c36bdb
Datenbank: Directory of Open Access Journals
Beschreibung
Abstract:Background: Bone and joint infections (BJI) are common in immunocompetent children, however in children with acute leukaemia the epidemiology, optimal diagnostic pathway and medical and surgical treatment is poorly described. We review the presentation, management and outcomes of BJI in this special population. Methods: Systematic literature review of BJI in children with acute leukaemia was performed using Medline, EMBASE and PubMed databases from 1946 to June, 2023. Titles and abstracts were independently screened by 3 reviewers. Studies were included if they reported data on children (≤18 years) with leukaemia who had a diagnosis of osteomyelitis (radiological diagnosis) or septic arthritis (culture proven or managed as infection by treating clinician). Results: Twenty-two articles describing 33 episodes of confirmed or suspected bacterial BJI were included. Of these, microbiological diagnosis was confirmed in 27 episodes (82%) and included Gram-positive (9/33), Gram-negative (8/33), mycobacterial (5/33), Mycoplasmatota (1/33) and polymicrobial (4/33). The femur was the most common site of infection (33%) and there were 18 episodes (55%) of multifocal disease. Duration of treatment varied from 3 weeks to 2.5 years in patients with culture confirmed infection (82%) and from 3 to 8 weeks in patients with culture-negative infection (18%). Clinical cure was documented in 31 episodes (94%). Conclusion: Bone and joint infections in children with acute leukaemia are often caused by atypical pathogens, with a higher predilection for multifocal disease and/or involvement of unusual sites in comparison with immunocompetent children. It is unclear whether this population requires prolonged antibiotic treatment due to periods of intensive chemotherapy or neutropenia. Monitoring response to therapy may be challenging as inflammatory markers such as CRP and ESR may take longer to normalise, making it difficult to assess for clinical cure.
ISSN:2772610X
DOI:10.1016/j.ejcped.2023.100118