Department of Pediatrics and Pediatric Infectious Diseases, Manipal Hospitals, Bangalore, Karnataka, India. Correspondence to: Dr. Bhaskar Shenoy, Department of Pediatrics and Pediatric Infectious Diseases, Manipal Hospitals, Bengaluru, Karnataka, India.
Department of Pediatrics and Infectious Diseases, Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India.
Indian Pediatr. 2024 Mar 15;61(3):209-218.
Osteoarticular infections are fairly common in children but often these are associated with underdiagnosis, delayed diagnosis and improper management. This leads to an increased incidence of complications and poor outcomes. Given the paucity of standard protocols for the management of these children in the Indian context, Indian Academy of Pediatrics (IAP) has taken the initiative to formulate guidelines for the early diagnosis and rational management of bone and joint infections (BJIs).
To critically evaluate the current evidence and formulate consensus guidelines for the diagnosis and management of BJIs in children.
A committee comprising of eminent national faculty from different parts of the country who are experts in the field of Pediatric Infectious Diseases, Pediatric Orthopedics and Musculoskeletal Radiology was constituted and duly approved by the IAP. On Jan 16, 2021, a virtual meeting was held and a detailed discussions were carried out regarding the need to formulate these guidelines. Subsequently, the expert group defined the key questions in the first stage followed by collection and review of scientific evidences including available national and international recommendations or guidelines. This was followed by detailed deliberation among group members and presentation of their recommendations. The same were finalized in an online meeting on Aug 01, 2021, and a consensus statement was developed and adopted by the group.
BJIs are medical emergencies that need early diagnosis and appropriate therapy to prevent long term sequelae like limb deformities. Bacterial infections like Staphylococcus aureus is the most common etiological agent. Nonspecific and subtle clinical manifestations make the diagnosis of pediatric BJIs more challenging. Diagnosis of BJIs is primarily clinical, supplemented by laboratory and radiological investigations. The choice of antibiotic(s), mode of administration and duration of therapy requires individualization depending upon the severity of infection, causative organism, regional sensitivity patterns, time elapsed between onset of symptoms and the child's presentation, age, risk factors and the clinical and laboratory response to treatment. There is paucity of appropriate guidelines regarding the diagnosis and management of BJIs in children in Indian context. Hence, the need for this expert consensus guidelines in Indian settings.
骨关节感染在儿童中相当常见，但这些感染常常存在诊断不足、诊断延迟和处理不当的情况。这导致并发症的发生率增加和治疗效果不佳。鉴于印度在儿童骨关节感染管理方面缺乏标准方案，印度儿科学会（IAP）已主动制定了早期诊断和合理管理骨与关节感染（BJI）的指南。
批判性评估现有证据，并制定儿童 BJI 的诊断和管理共识指南。
成立了一个由来自印度各地的著名儿科传染病、小儿骨科和肌肉骨骼放射学领域的专家组成的委员会，并得到了 IAP 的正式批准。2021 年 1 月 16 日，举行了一次虚拟会议，详细讨论了制定这些指南的必要性。随后，专家组在第一阶段确定了关键问题，随后收集和审查了科学证据，包括现有的国家和国际建议或指南。接着，小组成员进行了详细的讨论并提出了建议。这些建议在 2021 年 8 月 1 日的在线会议上进行了最终确定，并制定了一份共识声明，由小组通过。
骨关节感染是需要早期诊断和适当治疗的医疗急症，以预防肢体畸形等长期后遗症。金黄色葡萄球菌等细菌感染是最常见的病因。非特异性和微妙的临床表现使得儿童 BJI 的诊断更具挑战性。BJI 的诊断主要基于临床，辅以实验室和影像学检查。抗生素的选择、给药方式和治疗持续时间需要根据感染的严重程度、病原体、区域敏感性模式、症状发作和就诊时间、年龄、危险因素以及治疗的临床和实验室反应进行个体化。印度在儿童骨关节感染的诊断和管理方面缺乏适当的指南，因此需要在印度制定这一专家共识指南。
