Methods: In a retrospective case-control study children aged 1 month to 18 years seen at Texas Children’s Hospital from 2010 to 2017 with NTS MSK infections were compared to patients with SA MSK infections. Date of infection matched controls were selected 3:1. Patients with known hemoglobinopathies, immunodeficiencies or infections due to penetrating trauma or related to prosthetic devices were excluded. Logistic regression was used to evaluate associations between historical, clinical and laboratory variables and NTS or SA MSK infection.
Results: From 2010 to 2017, 27 cases of NST MSK infections were identified, 12 of which occurred in healthy children. The control group had 37 patients. The case and control groups had similar baseline demographics. Predictors of NTS MSK infection included exposure to reptiles (odds ratio [OR], 6.86; 95% confidence interval [CI], 1.03-45.60) and a history of preceding diarrhea (OR, 7.25; 95% CI, 1.12-47). No presenting signs or laboratory markers were identified as predictors of NTS MSK infection. Blood cultures were positive in 8 (66.7%) of the NTS MSK cases. Length of hospital stay, duration of fever or complications did not differ significantly between the two groups and children with NTS MSK infections had a low rate of complications (16.7%). Six (50%) patients with NTS infections had unremarkable evaluations for hemoglobinopathies and immunodeficiencies.
Conclusion: Healthy children with NTS MSK infections often report a history of reptile exposure and preceding diarrhea compared to children with MSK infections due to SA. If such history is obtained, addition of a third generation cephalosporin to empirically cover for NST should be considered pending blood and tissue cultures. In contrast to previous case reports and case series, children with NTS MSK infections had a lower rate of complications.
G. Lamb, None
S. L. Kaplan, None