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Efficacy of daptomycin has been recorded in adult Gram-positive bone and joint infections OAI (1) and daptomycin has been used as secondary or tertiary agent when primary agents have failed (1, 2) in the treatment of osteoarticular infections caused by Staphylococcus aureus.
We report a 16-year-old schoolboy with Panton-Valentine Leucocidin (PVL) p...
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One hundred (100) staphylococci were isolated from several Egyptian hospitals and laboratories which include 85 clinical isolates and 15 from hospital surroundings. The isolates were identified by conventional and molecular techniques. Fifty (50) isolates were identified as Staphylococcus aureus (SA), 40 were Staphylococcus epidermidis (SE) while 1...
Citations
... Otros antibióticos utilizados fueron rifampicina (7 %), vancomicina (2 %) y eritromicina (1 %) 19,20 . Sin embargo, estos datos contrastan con el presente estudio, debido a que la antibioticoterapia empírica más frecuentemente utilizada fue clindamicina y ciprofloxacina (24 %) como terapia combinada, esto puede ser debido a que en el Hospital Universitario de Caracas se reciben pacientes que ya han sido previamente medicados con múltiples antibióticos, presumiéndose como agentes causales microorganismos potencialmente resistentes 27,39,40 . En este estudio esto se confirma, ya que de los 54 pacientes evaluados, 63 % ya habían cumplido tratamiento antibiótico previo a su ingreso al hospital y de los pacientes cuyo aislamiento reportó Staphylococcus aureus (39,5 %), el 58,8 % de estos fueron resistentes a meticilina 40 . ...
SUMMARY
Objective: To describe the characteristics of the pediatric hospitalized patients with diagnosis of osteomyelitis between 2013 and 2018 in the Hospital Universitario de Caracas. Methods: A transversal, retrospective, descriptive study was performed, in which every patient with diagnosis of acute and chronic osteomyelitis who met with all the inclusion criteria, were included. All data was collected in an instrument, designed for that matter, and then was analyzed with frequency, percentages, mean and standard deviation. Variables were compared in acute and chronic osteomyelitis with X2 calculation. Results: Male predominance was found, and average age between 5.7 years ± 3.5 standard deviation.
Chronic osteomyelitis was the most frequent (68.5 % of all cases). The most predisposing underlying pathology was sickle cell disease. The most important risk factor was trauma. The most common clinical manifestations were fever and pain in both study groups. The most affected bones: tibia in 27.8 % and femur in 20.4 % of patients.
The predominant microorganism was Staphylococcus aureus in 31.5 % of the cases, both in acute and chronic osteomyelitis, being methicillin resistant in 16.3 % of the isolates and in 23.3 % methicilline sensitive. The antibiotic treatment indicated in most cases was combined, followed by surgical treatment. 94 % of the patients were
discharged with good outcome, no deaths were registered.
Conclusions: The early suspicion of osteomyelitis is important, becoming aware of the clinical manifestations, so as to promptly apply the ideal diagnostic method and contribute to early treatment, in this way improve the patients’ prognosis.
Key words: Acute osteomyelitis; Chronic osteomyelitis; Osteoarticular infection; Children;
Epidemiology
... Since 2010, we have identified 15 reported cases of paediatric PVL-SA severe infections and Table 1 summarizes the main results of these reports regarding the clinical presentations, radiological findings, treatment and outcome [2][3][4][5][15][16][17][18][19][20][21][22][23]. ...
... In a recent retrospective study of Syrogiannopoulos et al. it was observed that in children with complicated staphylococcal infections, daptomycin administration alone or in combination with other antimicrobial agents was efficacious and well tolerated [31]. Furthermore, daptomycin was successfully used in 14-year-old boy with tibial osteomyelitis, multilobar pneumonia, pericardial effusion, and septicaemia [16]. In our case, it was an off label use of this antimicrobial agent, introduced due to the severity of the infection. ...
Background
Panton-Valentine leukocidin (PVL) is one of the major virulence factor of Staphylococcus aureus (SA) that might be associated with invasive life-threating infections. A prompt diagnosis and adequate treatment are essential in achieving the best outcome and avoiding serious sequelae. We describe a case of severe invasive PVL-SA infection in an infant. A literature review starting from 2010 was also performed in order to discuss clinical presentations, radiological findings, treatment and outcome.
Case presentation
This is a case of a 6-month-old boy who rapidly developed high fever and poor general condition. He was diagnosed as having multiple muscular abscesses, multiple foci of osteomyelitis and bloodstream infections caused by Panton-Valentine leukocidin Methicillin-resistant Staphylococcus aureus . He received intravenous antibiotics and surgical drainage of the abscess with progressive recovery.
Conclusion
Our report highlights the importance of improving awareness of this severe infection, as a prompt diagnosis and adequate manage is essential in order to save life and to prevent serious complications.
... A number of case reports and series describe using daptomycin to successfully treat MRSA AHO in children. 72,73 In one recent pediatric multicenter randomized controlled trial, there were no statistically significant differences in outcomes between children with AHO treated with daptomycin compared to comparator agents; however, non-inferiority endpoints were not achieved. 74 Ceftaroline, an anti-MRSA cephalosporin has the theoretical advantage of providing additional coverage for streptococci, K. kingae and some Enterobacteriaceae. ...
Acute hematogenous osteomyelitis (AHO) is a common invasive infection encountered in the pediatric population. In addition to the acute illness, AHO has the potential to create long-term morbidity and functional limitations. While a number of pathogens may cause AHO, Staphylococcus aureus is the most common organism identified. Despite the frequency of this illness, little high-quality data exist to guide providers in the care of these patients. The literature is reviewed regarding the epidemiology, microbiology and management of AHO in children. A framework for empiric therapy is provided drawing from the available literature and published guidelines.
... In one study [39], higher rates of adverse effects were observed, but further description of their relation to daptomycin was not provided; CPK increase was noted in 10 patients (3.8%), 9 of whom were in the high dosage groups (9 and 10 mg/kg per day). The concern that high daptomycin doses may be associated with high CPK levels has been previously raised [4], but, with the exception of the aforementioned study and a case report [25,39], no adverse effects were reported in the majority of patients who received at least 8 mg/kg per day of daptomycin [15,17,21,23,24,26,28,38]. ...
Infections by Gram-positive pathogens pose a public health risk, especially due to increasing antibiotic resistance. Daptomycin has efficacy against most clinically important Gram-positive bacteria. Although experience regarding use of daptomycin in adults is increasing, studies on pediatric populations are limited. We aimed to evaluate the efficacy, safety, and pharmacokinetics of daptomycin in pediatric settings. We searched MEDLINE and Clinicaltrials.gov (through April 2016) and included 29 original studies in the final analysis. Available evidence suggests that daptomycin in pediatric patients has a favorable safety and tolerability profile and is an efficacious alternative for treatment of Gram-positive bacteremia, endocarditis, and infections of the skin, soft tissues, joints, and bones, especially when resistant strains are involved. However, future studies need to address several issues to determine the optimal dose and various pharmacokinetic parameters in different pediatric age groups.
... The use of fluoxacillin, clindamycin or linezolid is recommended in these cases, with daptomycin considered as a second-line antibiotic. Daptomycin was successfully used in a recent case report of a child with PVL-positive staphylococcal osteomyelitis [39]. ...
Acute osteomyelitis and septic arthritis are two infections whose frequencies are increasing in pediatric patients. Acute osteomyelitis and septic arthritis need to be carefully assessed, diagnosed, and treated to avoid devastating sequelae. Traditionally, the treatment of acute osteoarticular infection in pediatrics was based on prolonged intravenous anti-infective therapy. However, results from clinical trials have suggested that in uncomplicated cases, a short course of a few days of parenteral antibiotics followed by oral therapy is safe and effective. The aim of this review is to provide clinicians an update on recent controversies and advances regarding the management of acute osteomyelitis and septic arthritis in children. In recent years, the emergence of bacterial species resistant to commonly used antibiotics that are particularly aggressive highlights the necessity for further research to optimize treatment approaches and to develop new molecules able to fight the war against acute osteoarticular infection in pediatric patients.
... 10 To our knowledge there is currently 1 case report, albeit for methicillinsusceptible Staphylococcus aureus (MSSA), and 1 retrospective study including 2 pediatric patients receiving daptomycin for osteomyelitis that have been published. 11,12 pain, with difficulty walking, frequent fevers up to 39.7°C, nausea, and vomiting. At the onset of symptoms, the patient was traveling on a family vacation, and no history of trauma was noted. ...
Staphylococcus aureus is the most common bacteria associated with the development of osteomyelitis in pediatric patients. Osteomyelitis caused by methicillin-resistant Staphylococcus aureus (MRSA) can be difficult to safely and effectively treat. Vancomycin, linezolid, and clindamycin are commonly used to treat osteomyelitis caused by MRSA. While adult studies suggest intravenous (IV) daptomycin may by beneficial for the treatment of MRSA osteomyelitis, it is not Food and Drug Administration approved for use in pediatrics, and minimal data are available related to its use in this population. This case report describes the successful use of daptomycin (8 mg/kg/dose IV daily) combined with rifampin for 5 weeks, followed by 5 weeks of oral sulfamethoxazole/trimethoprim, for treatment of acute bilateral osteomyelitis caused by MRSA in an 8-year-old male. The patient did not initially respond to the combination of vancomycin plus rifampin and gentamicin, nor did he respond to ceftaroline treatment. After initiation of daptomycin, his fevers quickly subsided, his pain rapidly improved, and his inflammatory markers significantly decreased. While daptomycin was effective in this patient, additional research is needed to determine the true safety and efficacy of this drug for treatment of osteomyelitis caused by MRSA in pediatric patients.
... The experience of daptomycin in children is very limited and the paediatric dosing regimen remains to be determined [30][31][32][33][34][35]. According to the latest Infectious Diseases Society of America (IDSA) guidelines on the management of MRSA infections, daptomycin should be administered at 6-10 mg/kg every 24 h in children with bacteraemia, osteomyelitis and septic arthritis [36]. ...
New initiatives have been introduced in Europe and the USA to encourage more rapid development of antibiotics. The need to ensure these new antibiotics can be safely used in children, and especially neonates, is important owing to high antimicrobial resistance in these patient groups. This review aims to determine what lessons can be learnt from the recent regulatory processes to speed up access to new medicines for children, focusing on antibiotics licensed for adults by the EMA since 2000. For the 11 newly approved antibiotics, 31 clinical trials enrolling children in Europe were identified. However, many of these trials included both adults and children but did not provide a subset analysis for paediatrics, limiting the relevance of their findings. Some studies have been prematurely terminated and others are apparently active but are still not yet recruiting patients. Among paediatric-specific studies, 18 evaluate safety and efficacy of new compounds, 4 are pharmacokinetic studies, but only 2 focus on neonates. Nearly all studies with an agreed Paediatric Investigation Plan have just started or are not yet recruiting. For most antibiotics, despite adult phase 3 studies being completed, with specific concerns for particular drugs already noted, it will take another 3-5 years before adequate prescribing information becomes available for paediatricians. Evidence from this review suggests that we could do better. Lessons should be learnt from paediatric antiretroviral development, with neonatal and paediatric pharmacokinetic, clinical trial and pharmacovigilance drug development programmes being run directly in parallel with adult studies-not a decade behind.
Musculoskeletal infections represent a diverse group of diseases which may cause substantial morbidity in children. While most cases are caused by Staphylococcus aureus, the microbiology varies with epidemiology, patient age, pathogenesis, and individualized clinical risk factors. Antimicrobial therapy is a cornerstone in the management of these infections. Awareness of the potential causative agents of pediatric musculoskeletal infections is essential in the selection of appropriate antibiotics. This chapter will review the microbiology and antibiotic management of musculoskeletal infections in children.KeywordsPediatricsOsteomyelitisSeptic arthritisOral antibioticsMicrobiology
Flucloxacillin (FLU) administered by the oral route is widely used for treating various infections, but there are no published retrospective or prospective trials of its efficacy, or its advantages or disadvantages compared to parenteral treatment or other antibiotics for treating osteomyelitis. Based on published in vitro data and expert opinions, other non-β-lactam oral antibiotics that have better bone penetration are generally preferred over oral FLU. We reviewed the literature for studies of oral FLU as therapy of osteomyelitis (OM), stratified by acute versus chronic and pediatric versus adult cases. In striking contrast to the prevailing opinions and the few descriptive data available, we found that treatment of OM with oral FLU does not appear to be associated with more clinical failures compared to other oral antibiotic agents. Because of its narrow antibiotic spectrum, infrequent severe adverse effects, and low cost, oral FLU is widely used in clinical practice. We therefore call for investigators to conduct prospective trials investigating the effectiveness and potential advantages of oral FLU for treating OM.
Flucloxacillin (FLU) administered by the oral route is widely used for treating various infections, but there are no published retrospective or prospective trials of its efficacy, or its advantages or disadvantages compared to parenteral treatment or other antibiotics for treating osteomyelitis. Based on published in vitro data and expert opinions, other non-β-lactam oral antibiotics that have better bone penetration are generally preferred over oral FLU. We reviewed the literature for studies of oral FLU as therapy of osteomyelitis (OM), stratified by acute versus chronic and pediatric versus adult cases. In striking contrast to the prevailing opinions and the few descriptive data available, we found that treatment of OM with oral FLU does not appear to be associated with more clinical failures compared to other oral antibiotic agents. Because of its narrow antibiotic spectrum, infrequent severe adverse effects, and low cost, oral FLU is widely used in clinical practice. We therefore call for investigators to conduct prospective trials investigating the effectiveness and potential advantages of oral FLU for treating OM.
