Nonbacterial and bacterial osteomyelitis in children: a case–control retrospective study
PurposeOsteomyelitis is a group of bone infectious (bacterial osteomyeilitis—BO) and noninfectious inflammatory diseases (nonbacterial osteomyelitis—NBO) with similar clinical, radiology, and laboratory features. Many patients with NBO are misdiagnosed as BO and receive unnecessary antibiotics and s...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2023-05-01
|
| Series: | Frontiers in Pediatrics |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fped.2023.1067206/full |
| _version_ | 1797834742616293376 |
|---|---|
| author | Mikhail M. Kostik Alexey S. Maletin Veronika V. Petukhova Veronika V. Petukhova Alexander Yu. Mushkin Alexander Yu. Mushkin |
| author_facet | Mikhail M. Kostik Alexey S. Maletin Veronika V. Petukhova Veronika V. Petukhova Alexander Yu. Mushkin Alexander Yu. Mushkin |
| author_sort | Mikhail M. Kostik |
| collection | DOAJ |
| description | PurposeOsteomyelitis is a group of bone infectious (bacterial osteomyeilitis—BO) and noninfectious inflammatory diseases (nonbacterial osteomyelitis—NBO) with similar clinical, radiology, and laboratory features. Many patients with NBO are misdiagnosed as BO and receive unnecessary antibiotics and surgery. Our study aimed to compare clinical and laboratory features of NBO and BO in children, to define key discriminative criteria, and to create an NBO diagnostic score (NBODS).MethodsThe retrospective multicenter cohort study included clinical, laboratory, and instrumental information about histologically confirmed NBO (n = 91) and BO (n = 31). The variables allowed us to differentiate both conditions used to construct and validate the NBO DS.ResultsThe main differences between NBO and BO are as follows: onset age—7.3 (2.5; 10.6) vs. 10.5 (6.5; 12.7) years (p = 0.03), frequency of fever (34.1% vs. 90.6%, p = 0.0000001), symptomatic arthritis (67% vs. 28.1%, p = 0.0001), monofocal involvement (28.6% vs. 100%, p = 0.0000001), spine (32% vs. 6%, p = 0.004), femur (41% vs. 13%, p = 0.004), foot bones (40% vs. 13%, p = 0.005), clavicula (11% vs. 0%, p = 0.05), and sternum (11% vs. 0%, p = 0.039) involvement. The following four criteria are included in the NBO DS: CRP ≤ 55 mg/l (56 points), multifocal involvement (27 points), femur involvement (17 points), and neutrophil bands ≤ 220 cell/μl (15 points). The sum > 17 points allowed to differentiate NBO from BO with a sensitivity of 89.0% and a specificity of 96.9%.ConclusionThe diagnostic criteria may help discriminate NBO and BO and avoid excessive antibacterial treatment and surgery. |
| first_indexed | 2024-04-09T14:42:20Z |
| format | Article |
| id | doaj.art-6cdc02f11bdd47b4889fa1ccc58f8ffd |
| institution | Directory Open Access Journal |
| issn | 2296-2360 |
| language | English |
| last_indexed | 2024-04-09T14:42:20Z |
| publishDate | 2023-05-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pediatrics |
| spelling | doaj.art-6cdc02f11bdd47b4889fa1ccc58f8ffd2023-05-03T04:56:22ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602023-05-011110.3389/fped.2023.10672061067206Nonbacterial and bacterial osteomyelitis in children: a case–control retrospective studyMikhail M. Kostik0Alexey S. Maletin1Veronika V. Petukhova2Veronika V. Petukhova3Alexander Yu. Mushkin4Alexander Yu. Mushkin5Hospital Pediatrics Department, Saint-Petersburg State Pediatric Medical University, Saint-Petersburg, RussiaPediatric Orthopedics and Surgery Department, Saint-Petersburg Research Institute of Phthisiopulmonology, Saint-Petersburg, RussiaHospital Pediatrics Department, Saint-Petersburg State Pediatric Medical University, Saint-Petersburg, RussiaPediatric Orthopedics and Surgery Department, Saint-Petersburg Research Institute of Phthisiopulmonology, Saint-Petersburg, RussiaPediatric Orthopedics and Surgery Department, Saint-Petersburg Research Institute of Phthisiopulmonology, Saint-Petersburg, RussiaTraumatology and Orthopedic Department, Pavlov First Saint Petersburg State Medical University, Saint-Petersburg, RussiaPurposeOsteomyelitis is a group of bone infectious (bacterial osteomyeilitis—BO) and noninfectious inflammatory diseases (nonbacterial osteomyelitis—NBO) with similar clinical, radiology, and laboratory features. Many patients with NBO are misdiagnosed as BO and receive unnecessary antibiotics and surgery. Our study aimed to compare clinical and laboratory features of NBO and BO in children, to define key discriminative criteria, and to create an NBO diagnostic score (NBODS).MethodsThe retrospective multicenter cohort study included clinical, laboratory, and instrumental information about histologically confirmed NBO (n = 91) and BO (n = 31). The variables allowed us to differentiate both conditions used to construct and validate the NBO DS.ResultsThe main differences between NBO and BO are as follows: onset age—7.3 (2.5; 10.6) vs. 10.5 (6.5; 12.7) years (p = 0.03), frequency of fever (34.1% vs. 90.6%, p = 0.0000001), symptomatic arthritis (67% vs. 28.1%, p = 0.0001), monofocal involvement (28.6% vs. 100%, p = 0.0000001), spine (32% vs. 6%, p = 0.004), femur (41% vs. 13%, p = 0.004), foot bones (40% vs. 13%, p = 0.005), clavicula (11% vs. 0%, p = 0.05), and sternum (11% vs. 0%, p = 0.039) involvement. The following four criteria are included in the NBO DS: CRP ≤ 55 mg/l (56 points), multifocal involvement (27 points), femur involvement (17 points), and neutrophil bands ≤ 220 cell/μl (15 points). The sum > 17 points allowed to differentiate NBO from BO with a sensitivity of 89.0% and a specificity of 96.9%.ConclusionThe diagnostic criteria may help discriminate NBO and BO and avoid excessive antibacterial treatment and surgery.https://www.frontiersin.org/articles/10.3389/fped.2023.1067206/fullnonbacterial osteomyelitischronic recurrent multifocal osteomyelitisbacterial osteomyelitishematogenous osteomyelitisdiagnostic criteria |
| spellingShingle | Mikhail M. Kostik Alexey S. Maletin Veronika V. Petukhova Veronika V. Petukhova Alexander Yu. Mushkin Alexander Yu. Mushkin Nonbacterial and bacterial osteomyelitis in children: a case–control retrospective study Frontiers in Pediatrics nonbacterial osteomyelitis chronic recurrent multifocal osteomyelitis bacterial osteomyelitis hematogenous osteomyelitis diagnostic criteria |
| title | Nonbacterial and bacterial osteomyelitis in children: a case–control retrospective study |
| title_full | Nonbacterial and bacterial osteomyelitis in children: a case–control retrospective study |
| title_fullStr | Nonbacterial and bacterial osteomyelitis in children: a case–control retrospective study |
| title_full_unstemmed | Nonbacterial and bacterial osteomyelitis in children: a case–control retrospective study |
| title_short | Nonbacterial and bacterial osteomyelitis in children: a case–control retrospective study |
| title_sort | nonbacterial and bacterial osteomyelitis in children a case control retrospective study |
| topic | nonbacterial osteomyelitis chronic recurrent multifocal osteomyelitis bacterial osteomyelitis hematogenous osteomyelitis diagnostic criteria |
| url | https://www.frontiersin.org/articles/10.3389/fped.2023.1067206/full |
| work_keys_str_mv | AT mikhailmkostik nonbacterialandbacterialosteomyelitisinchildrenacasecontrolretrospectivestudy AT alexeysmaletin nonbacterialandbacterialosteomyelitisinchildrenacasecontrolretrospectivestudy AT veronikavpetukhova nonbacterialandbacterialosteomyelitisinchildrenacasecontrolretrospectivestudy AT veronikavpetukhova nonbacterialandbacterialosteomyelitisinchildrenacasecontrolretrospectivestudy AT alexanderyumushkin nonbacterialandbacterialosteomyelitisinchildrenacasecontrolretrospectivestudy AT alexanderyumushkin nonbacterialandbacterialosteomyelitisinchildrenacasecontrolretrospectivestudy |