Infecciones osteoarticulares en pediatría.Diagnóstico, tratamiento y evaluación del abordaje conservador

Abstract

Osteoarticular infections (OAI) are relatively common. However, they can be potentially serious. Traditionally, the management of this pathology was based on prolonged antibiotic therapy, initially intravenous, followed by surgery in case of joint involvement or poor evolution. However, recently, reducing the duration of intravenous treatment to 2-4 days has been described as an equally safe and effective option, especially in patients younger than 3 years without risk factors and outside the neonatal period. In addition, progressively, new series of patients with joint involvement who presented good clinical evolution have been published. Those patients had been approached by arthroscopy, arthrocentesis with joint lavage or even only with an expectant attitude, reserving surgery only for those cases with torpid evolution days after having started antibiotic therapy.Likewise, the progressive implementation of molecular detection techniques has allowed the detection of difficult-to-grow germs in conventional culture methods, such as Kingella kingae. In fact, this germ has now been described as the main etiological agent in patients between 6 months and 4 years of age.The subtle clinical and analytical repercussion that usually accompanies this microorganism, questions whether patients with suspected OAI due to K. kingae or with low risk of sequelae should be managed following the classic recommendations or if a minimally invasive approach could be sufficient...