Infectious complications in pediatric traumatology and orthopedics (analysis of clinical series)

Abstract

BACKGROUND: Infectious complications in pediatric traumatology and orthopedics are relatively rare. Publications on this issue are less common than in the adult population. However, the resulting complications often lead to a persistent anatomical and functional defect, bearing the economic burden and legal consequences.

AIM: To analyze a clinical series of pediatric patients with infectious complications of injuries and surgical interventions in the skeletal system.

MATERIALS AND METHODS: A retrospective analysis of the clinical series of patients over 5 years was conducted. The study involved children aged <18 years. A sample of 34 children was included. The average age was 13.5 (min–max, 4–17 years). Patients with infectious and inflammatory complications after mechanical and/or surgical trauma, availability of a complete data archive (anamnesis, radiation therapy, and medical documentation), traced relief of inflammatory phenomena, and achievement of remission of the chronic process for more than 6 months were included.

RESULTS: Infectious complications of injuries were noted in 26 (76%) patients, complications of orthopedic interventions in 8 (24%), and open injuries in 9 (34%). The injuries were isolated in 11 (42%) children, multiple trauma in 5 (19%), and combined in 10 (39%) patients. Defects of large skeletal segments were common: the thigh in 8 (24%) patients, humerus in 5 (15%), shin in 5 (15%), and spine in 4 (12%). Five (15%) had infection of the pelvic bones, and one patient had infectious complications in the lower jaw, collarbone, elbow joint, knee joint arthritis, and foot bones. Superficial infection of the surgical intervention area was noted in 3 cases (9%), deep infection in 27 (79%), and posttraumatic osteomyelitis in 4 (12%). The average duration of the diagnostic pause was 33 days, and the therapeutic pause was 36 days. Antibacterial prophylaxis before surgery for closed injuries and orthopedic operations was carried out in only 17 patients. Bacteriological verification was not performed in 8 (23.5%) patients with complications. In 9 (26%) patients, it was not possible to identify a microbial agent in the presence of a clinical picture. The structure of pathogens correlates with the literature data on the problem in the adult population. In 10 out of 25 positive bacteriological studies, polyresistant strains were isolated. Thirty-three children underwent surgery, and the basic principle is radical surgical rehabilitation. The average number of interventions performed was 3 (min–max, 1–12). Stable relief of the infectious and inflammatory process has been achieved in all cases. The average period of inpatient treatment was 39 days, recovery was achieved in 24 (71%) children, and persistent anatomical and functional defect and disability were noted in 10 (29%) children.

CONCLUSIONS: Infectious complications in pediatric traumatology should be considered a complex multidisciplinary problem, and part of the solutions largely lies in the field of healthcare organization, specifically with an adequate choice of indications, compliance with the osteosynthesis technique, compliance with the principles of antibiotic prophylaxis, patient routine, and training of pediatric surgeons and orthopedic traumatologists on surgical infections, using modern principles and technologies for the treatment of these complications.

Keywords

osteomyelitis / osteosynthesis / infection of the surgical intervention area / surgical infection / fracture / wounds / anatomical defect

References

[1] García Del Pozo E, Collazos J, Cartón JA, et al. Bacterial osteomyelitis: microbiological, clinical, therapeutic, and evolutive characteristics of 344 episodes. Rev Esp Quimioter. 2018;31(3):217–225.

[2] García Del Pozo E., Collazos J., Cartón J.A., et al. Bacterial osteomyelitis: microbiological, clinical, therapeutic, and evolutive characteristics of 344 episodes // Rev. Esp. Quimioter. 2018. Vol. 31. No. 31. C. 217–225.

[3] Kazaryan AM, Akopov AL, Rosok B, et al. Rossiiskaya redaktsiya klassifikatsii oslozhnenii v khirurgii. Vestnik khirurgii imeni I.I. Grekova. 2014;173(2):86–91. (In Russ.) DOI: 10.24884/0042-4625-2014-173-2-86-91

[4] Казарян А.М., Акопов А.Л., Росок Б., и др. Российская редакция классификации осложнений в хирургии // Вестник хирургии. 2014. Т. 173. № 2. С. 86–91. DOI: 10.24884/0042-4625-2014-173-2-86-91

[5] Bucher BT, Guth RM, Elward AM. Risk factors and outcomes of surgical site infection in children. J Am Coll Surg. 2011;212(6):1033–1038.e1. DOI: 0.1016/j.jamcollsurg.2011.01.065

[6] Bucher B.T., Guth R.M., Elward A.M. Risk factors and outcomes of surgical site infection in children // J. Am. Coll. Surg. 2011. Vol. 212. No. 6. P. 1033–1038.e1. DOI: 0.1016/j.jamcollsurg.2011.01.065

[7] Walter N, Bärtl S, Alt V, et al. The epidemiology of osteomyelitis in children. Children (Basel). 2021;8(11):1000. DOI: 10.3390/children8111000

[8] Walter N., Bärtl S., Alt V., et al. The epidemiology of osteomyelitis in children // Children (Basel). 2021. Vol. 11. No. 8. P. 1000. DOI: 10.3390/children8111000

[9] Subramanyam R, Schaffzin J, Cudilo EM, et al. Systematic review of risk factors for surgical site infection in pediatric scoliosis surgery. Spine J. 2015;15(6):1422–1431. DOI: 10.1016/j.spinee.2015.03.005

[10] Subramanyam R., Schaffzin J., Cudilo E.M., et al. Systematic review of risk factors for surgical site infection in pediatric scoliosis surgery // Spine J. 2015. Vol. 15. No. 6. P. 1422–1431. DOI: 10.1016/j.spinee.2015.03.005

[11] Metsemakers WJ, Morgenstern M, Senneville E, et al. General treatment principles for fracture-related infection: recommendations from an international expert group. Arch Orthop Trauma Surg. 2020;140(8):1013–1027. DOI: 10.1007/s00402-019-03287-4

[12] Metsemakers W.J., Morgenstern M., Senneville E., et al. General treatment principles for fracture-related infection: recommendations from an international expert group // Arch. Orthop. Trauma. Surg. 2020. Vol. 140. No. 8. P. 1013–1027. DOI: 10.1007/s00402-019-03287-4

[13] Morgenstern M, Kuehl R, Zalavras CG, et al. The influence of duration of infection on outcome of debridement and implant retention in fracture-related infection. Bone Joint J. 2021;103-B(2):213–221. DOI: 10.1302/0301-620X.103B2.BJJ-2020-1010.R1

[14] Morgenstern M., Kuehl R., Zalavras C.G., et al. The influence of duration of infection on outcome of debridement and implant retention in fracture-related infection // Bone Joint J. 2021. Vol. 103-B. No. 2. P. 213–221. DOI: 10.1302/0301-620X.103B2.BJJ-2020-1010.R1

[15] Volotovski PA, Sitnik AA, Beletsky AV. Infections after osteosynthesis of lower extremity long bones: etiology, classification and diagnosis. Voennaya meditsina. 2018;(1):83–89. (In Russ.)

[16] Волотовский П.А., Ситник А.А., Белецкий А.В. Инфекционные осложнения после остеосинтеза длинных трубчатых костей нижних конечностей: этиология, классификация и диагностика // Военная медицина. 2018. № 1. С. 83–89.

[17] Khvostov DL, Privolnev VV. Prophylaxis of infections in trauma and orthopedic patients. Clinical Microbiology and Antimicrobial Chemotherapy. 2014;16(3):168–175. (In Russ.)

[18] Хвостов Д.Л., Привольнев В.В. Профилактика инфекционных осложнений в травматологии и ортопедии // Клиническая микробиология и антимикробная химиотерапия. 2014. Т. 16. № 3. C. 168–175.

[19] Metsemakers WJ, Morgenstern M, Senneville E, et al. General treatment principles for fracture-related infection: recommendations from an international expert group. Arch Orthop Trauma Surg. 2020;140(8):1013–1027. DOI: 10.1007/s00402-019-03287-4

[20] Metsemakers W.J., Morgenstern M., Senneville E., et al. General treatment principles for fracture-related infection: recommendations from an international expert group // Arch. Orthop. Trauma Surg. 2020. Vol. 140. No. 8. P. 1013–1027. DOI: 10.1007/s00402-019-03287-4

[21] Lake J., Gordon O. Implant-associated spinal infections in children: how can we improve diagnosis and management? Infect Dis Clin North Am. 2022;36(1):101–123. DOI: 10.1016/j.idc.2021.11.005

[22] Lake J., Gordon O. Implant-associated spinal infections in children: how can we improve diagnosis and management? // Infect. Dis. Clin. North Am. 2022. Vol. 36. No. 1. P. 101–123. DOI: 10.1016/j.idc.2021.11.005

[23] Serbanescu MA, Apple CG, Fernandez-Moure JS. Role of resident microbial communities in biofilm-related implant infections: recent insights and implications. Surg Inf. 2023;24(3):258–264. DOI: 10.1089/sur.2023.009

[24] Serbanescu M.A., Apple C.G., Fernandez-Moure J.S. Role of resident microbial communities in biofilm-related implant infections: recent insights and implications // Surg. Infect. (Larchmt). 2023. Vol. 24. No. 3. P. 258–264. DOI: 10.1089/sur.2023.009

[25] Polyakova EM, Bozhkova SA. PCR in traumatology and orthopaedics: method description and applicability. Traumatology and Orthopedics of Russia. 2014;20(3):104–114. (In Russ.) DOI: 10.21823/2311-2905-2014-0-3-104-114

[26] Полякова Е.М., Божкова С.А. ПЦР в области травматологии и ортопедии: суть метода и возможности применения // Травматология и ортопедия России. 2014. Т. 20. № 3. С. 104–114. DOI: 10.21823/2311-2905-2014-0-3-104-114

[27] Bozhkova SA, Kasimova AR, Tikhilov RM, et al. Adverse trends in the etiology of orthopedic infection: results of 6-year monitoring of the structure and resistance of leading pathogens. Traumatology and Orthopedics of Russia. 2018;24(4):20–31. (In Russ.) DOI: 10.21823/2311-2905-2018-24-4-20-31

[28] Божкова С.А., Касимова А.Р., Тихилов Р.М., и др. Неблагоприятные тенденции в этиологии ортопедической инфекции: результаты 6-летнего мониторинга структуры и резистентности ведущих возбудителей // Травматология и ортопедия России. 2018. Т. 24. № 4. С. 20–31. DOI: 10.21823/2311-2905-2018-24-4-20-31

[29] Antimicrobial Resistance Collaborators. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet. 2022;10325(399):629–655. DOI: 10.1016/S0140-6736(21)02724-0

[30] Antimicrobial Resistance Collaborators. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis // Lancet. 2022. Vol. 10325. No. 399. C. 629–655. DOI: 10.1016/S0140-6736(21)02724-0

[31] Morgenstern M, Kuehl R, Zalavras CG, et al. The influence of duration of infection on outcome of debridement and implant retention in fracture-related infection. Bone Joint J. 2021;103-B(2):213–221. DOI: 10.1302/0301-620X.103B2.BJJ-2020-1010.R1

[32] Morgenstern M., Kuehl R., Zalavras C.G., et al. The influence of duration of infection on outcome of debridement and implant retention in fracture-related infection // Bone Joint J. 2021. Vol. 103-B. No. 2. P. 213–221. DOI: 10.1302/0301-620X.103B2.BJJ-2020-1010.R1

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