226. Clinical and Epidemiological Aspects Related to Infection of Orthopedic Prostheses in Argentinean Children. A Ten-years Period Study.
Session: Poster Abstract Session: Clinical: Bone and Joint Infection
Thursday, October 5, 2017
Room: Poster Hall CD
Posters
  • IMG_0787.PNG (698.2 kB)
  • Background: Management of orthopedic prostheses infections (PI) in children is a main challenge, not only for the complexity of the disease but also for the scarce of evidence in this field. Objectives: to describe the burden of PI and to analyze clinical and epidemiological aspects in pediatric patients.

    Methods: retrospective study in a tertiary pediatric hospital. Clinical charts of patients <18yrs who underwent surgery for bone and/or joint implantation at “R. Gutierrez” Children’s Hospital in Buenos Aires from Jan2007 to Dec2016 were reviewed, and all PI cases were analized. PI was defined as early (E) when presentation was within 3mo of prothesis implantation, delayed (D) when presenting between 3-24mo and late (L) if presenting beyond 2yrs.

    Results: 811 surgeries performed; 89 PI detected: E(n=63); D(n=9), L(n=17); 58% male; median(m) age: 13yrs (range[r] 4-20); m hospital stay 30d (r 6-180). Annual incidence: 11% (CI95%: 8.9-13.1). Fig. 1. Underlying conditions: scoliosis (58.4%), malignancy (16.8%). Clinical features are detailed in Fig. 2. Bacterial isolation in 63 (70.8%) cases, 51(57.3%) with a single microorganism (Fig. 3). Gram(+) bacteria were isolated in 58% of E PI, 86% of D PI and  49% of L PI. Gram(-) pathogens in 49% of E PI and in 38% of L PI. Three febrile PI (3,4%) had Gram(+) bacteremia, 2 of them L PI. No differences were seen in white blood cell count(WBC) and C-reactive protein(CRP) levels  on admission in children with and without bacteremia, nor among the different types of PI; m WBC 9000/mm3 (r3200-25550), m CRP 37mg/L (r1-270). WBC on admission in MRSA PI was significantly higher, p<0,01. Duration of EV treatment was different according to type of microorganism (p 0.03), higher in PI by Gram(-). Forty-eight (53,9%) cases continued with trimethoprim-sulfamoxazole orally, without side effects requiring  its discontinuation. Total treatment duration (m): 189d (r28-756). Eighty-two children (92.1%) underwent surgical toilette, 37 (45.1%) required more than one. Six (6.7%) presented relapse and 8 (9%) reinfection.

    Conclusion:

    ·              PI in children is a considerable burden, with high morbidity.

    ·              Incidence of bacteremia was low.

    ·              Results of the study could help to delineate preventive strategies and improve decision making in PI in children.

               

    Carlos Mauricio Vergara Lobo, MD1, Fausto M Ferolla, MD2, Elen Contreras, MD3, Carolina Carballo, MD4, Walter Yfran, MD5, Eugenia Pannunzio, MD6, Eliana Anteliz, MD3, Juan Reviriego, MD7, Maria Escalada, MD7, Gabriel Rositto, MD7, Carlos Legarreta, MD8, Claudia I. Cazes, MD9, María M. Contrini, MD10 and Eduardo L Lopez, MD11, (1)Infectologia, Hospital de Niños "Ricardo Gutierrez", Universidad de Buenos Aires, Buenos aires, Argentina, (2)Pediatric Infectious Disease, Hospital de Niños "Dr. Ricardo Gutiérrez", Buenos Aires, Argentina, (3)Infectious Diseases, Hospital de Niños "Ricardo Gutierrez", Universidad de Buenos Aires, Buenos Aires, Argentina, (4)Infectious Diseases, Hospital Gutierrez, Buenos Aires, Argentina, (5)Infectious Diseases, Hospital de Niños Ricardo Gutierez, Buenos Aires, Argentina, (6)Hospital de Niños Ricardo Gutierez, Buenos Aires, Argentina, (7)Traumatology and Orthopedics, Hospital de Niños "Dr. Ricardo Gutierrez", Buenos Aires, Argentina, (8)Hospital de Niños, Buenos Aires, Argentina, (9)Hospital de Niños Dr. Ricardo Gutiérez, Ciudad Autónoma de Buenos Aires, Argentina, (10)Infectious Disease Department, Hospital de Niños "Ricardo Gutiérrez", Buenos Aires, Argentina, (11)Department of Medicine, Hospital de Niños "Ricardo Gutiérrez", Buenos Aires, Argentina

    Disclosures:

    C. M. Vergara Lobo, None

    F. M. Ferolla, None

    E. Contreras, None

    C. Carballo, None

    W. Yfran, None

    E. Pannunzio, None

    E. Anteliz, None

    J. Reviriego, None

    M. Escalada, None

    G. Rositto, None

    C. Legarreta, None

    C. I. Cazes, None

    M. M. Contrini, None

    E. L. Lopez, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 4th with the exception of research findings presented at the IDWeek press conferences.