Clinical features | |
Gram-positive bacteria | |
Staphylococcus aureus | All ages; possible associated skin or soft tissue infection; MRSA may be associated with venous thromboembolism and pulmonary disease |
Coagulase-negative staphylococci | Neonates in intensive care unit; children with indwelling vascular catheters (eg, for chronic hemodialysis) |
Group A Streptococcus | More common in children younger than 4 years; may occur as a complication of concurrent varicella-zoster virus infection |
Group B Streptococcus | Infants younger than 3 months (usually 2 to 4 weeks) |
Streptococcus pneumoniae | Children younger than 2 years who are incompletely immunized; children older than 2 years with underlying medical conditions (eg, sickle cell disease, asplenia, splenic dysfunction, immunodeficiency, chronic heart disease, chronic lung disease, diabetes mellitus) |
Actinomyces | May affect the facial bones, the pelvis, or vertebral bodies |
Gram-negative bacteria | |
Kingella kingae | Children 6 to 36 months; indolent onset; oral ulcers preceding musculoskeletal findings; may affect nontubular bones |
Nonsalmonella gram-negative bacilli (eg, Escherichia coli, Serratia) | Birth to 3 months; children with sickle cell disease; instrumentation of the gastrointestinal or urinary tract; immunocompromised host (eg, CGD) |
Haemophilus influenzae type b | Incompletely immunized children in areas with low Hib immunization rates |
Bartonella henselae | Children with cat exposure; may affect the vertebral column and pelvic girdle; may cause multifocal infection |
Pseudomonas aeruginosa | Injectable drug use |
Brucella | Travel to or living in an endemic area; ingestion of unpasteurized dairy products |
Mycobacterium tuberculosis | Birth in, travel to, or contact with a visitor from, a region endemic for M. tuberculosis |
Nontuberculous mycobacteria | Surgery or penetrating injury; CGD; other underlying immunodeficiency; HIV infection |
Salmonella species | Children with sickle cell disease or related hemoglobinopathies; exposure to reptiles or amphibians; children with gastrointestinal symptoms; children in resource-limited countries |
Polymicrobial infection | |
More likely with direct inoculation (eg, penetrating trauma) or contiguous spread (eg, from skull, face, hands, feet) |
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