Embedded Files
breaks down. The researchers suggest that blocking the production of this molecule could lead to better OA pain treatments, but additional support is needed to advance this research. A long time researcher at Pfizer, AnneMarie Malfait, MD, PhD, is breaking new ground in the study of osteoarthritis pain. 1 Introduction The ESPID Bone and Joint Infection Guidelines (ESPID Guidelines) are intended for use by health providers who take care of children with bone and joint infection (BJI or osteoarticular infection), including general paediatricians and family practice physicians. Although BJI can include a diverse range of presentations, these guidelines will focus on acute, haematogenous BJI in children, with an emphasis on bacterial infections. ESPID Guidelines are consensus-based practice recommendations developed in a systematic manner that aim to be clear, valid and reliable, and presented with clinical applicability. Since evidence from large randomized controlled trials is rare or lacking, practice statements and recommendations provided here frequently reflect our expert consensus process based on best current practice. Although these guidelines include evidence-based and opinion-based recommendations for the diagnosis and management of children with BJI, these guidelines may not provide the best clinical solution and are not intended to serve as a substitute for the clinical judgment of physicians in individual cases or to establish a protocol valid for all children with these infections. Consequently, they do not represent the only appropriate approach for children with this kind of infection. The ESPID Guidelines are based on medical scientific literature, existing practice guidelines and regional best-practice standards. All available sources were used in the guidelines to develop a balanced approach for providing optimal care to paediatric patients with BJI in the average European health practice. The chosen methodology for ESPID Guidelines was based on consensus development among experts at the highest possible level of evidence. The ESPID Review Team (RT) for this guideline comprised a panel of clinical experts, including specialists in paediatric infectious diseases, paediatric rheumatology and surgery. The RT members were required to disclose any financial or other interest to avoid any actual, potential, or apparent conflict. See the Appendix for relevant information on the individual RT members. Literature searches were performed monthly and delivered to the RT members as alerts. Based on the alerts, the RT scanned the literature and identified new insights and evidence for the next guideline update. Revisions were made on an ‘as needed’ basis and were determined by the guideline chair. The authors of these ESPID Guidelines have made considerable efforts to ensure the information upon which they are based is accurate and up-to-date. Users of these guidelines are strongly recommended to confirm that the information contained within them, especially drug doses, is correct by way of independent sources. ESPID and the authors of these guidelines accept no responsibility for any inaccuracies, information perceived as misleading, or the outcome of any treatment regimen detailed in the guidelines. © ESPID 2017 – Practice Guideline – Bone and Joint Infections page 4 2 Summary of BJI recommendations 2.1 Main practice statements There is a paucity of clinical trial or prospective cohort study data to inform the diagnosis and management of BJI in children. Most data is derived from retrospective, observational studies of variable quality. Therefore, ESPID decided to apply a simple grading of the practice statements in this guideline (see notes below). Future versions will address evidence quality as new trial results are published. 1. BJI more frequently affects children younger than 5 years of age, and the infection more often involves joints of the lower extremities. [IIA] 2. Staphylococcus aureus is the most prevalent microorganism involved in BJI in children at all ages. In addition, Kingella kingae is a common causative pathogen in children < 5 years old in some regions. [IIA] 3. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) have a high sensitivity for the diagnosis of BJI, which is slightly increased by combining the two tests, whereas the specificity is low. [IIB] 4. Ultrasound has a high sensitivity for the diagnosis of septic arthritis whereas magnetic resonance imaging (MRI) is the most reliable imaging study for the diagnosis of BJI overall. [IIA] 5. The isolation of a microorganism from the bone, joint or blood with a clinical or radiological syndrome compatible with BJI is the gold standard for diagnosis in children. [IIA] 6. Empirical antibiotic therapy should be started as soon as possible after collecting appropriate samples for microbiological analysis upon suspecting BJI in children. [IIA] 7. Empirical therapy should include an antibiotic with appropriate coverage against methicillin sensitive S. aureus (MSSA), and against methicillin resistant S. aureus (MRSA) in geographical areas with more than 10-15% prevalence of this bacterium. [IIA] 8. Empirical therapy in young children needs to include appropriate coverage for K. kingae in relevant areas. [IIA] 9. First generation cephalosporins, anti-staphylococcal penicillins and clindamycin are the antibiotics most studied in BJI in
Google Sites
Report abuse