Musculoskeletal infection in children

Purpose of review: Musculoskeletal infection in children is evolutionary. The emergence of new causative organisms, the development of antibiotic resistance among common organisms and an increased incidence of unusual clinical presentations of infection contribute to this evolution. Early, accurate diagnosis and prompt initiation of appropriate treatment remain central principles in the evaluation and treatment of acute orthopedic infections. This review summarizes the recent literature regarding musculoskeletal infection in children. Recent findings: Kingella kingae has been identified as a causative organism of septic arthritis and osteomyelitis in children between the ages of 6 months and 2 years. Improved culture techniques allow more reliable detection of this gram-negative coccobacillus, which is otherwise difficult to isolate. There is a rising incidence of community-acquired methicillin-resistant Staphylococcus aureus as the cause of invasive musculoskeletal infection in children. Specific genetically encoded virulence factors may play a role in the occurrence of complications of chronic osteomyelitis and deep venous thrombosis in some children. The differentiation of septic arthritis from transient synovitis may be facilitated by an evidence-based clinical prediction algorithm. Variation of population characteristics from region to region may limit the application of such guidelines in general practice. Careful clinical judgment remains necessary. Summary: Improved methods of evaluation of musculoskeletal infection including culture techniques for isolating Kingella kingae, genetic mapping of community-acquired methicillin-resistant S. aureus virulence factors, and magnetic resonance imaging to evaluate pelvic pyomyositis may lead to more accurate diagnosis and early administration of appropriate treatment for invasive musculoskeletal infections in children.