Clinical Research Directory

Evaluation of the Efficacy of Corticosteroids in Septic Arthritis in Adults

Septic arthritis is a severe infection associated with significant morbidity and mortality. Despite eradication of the microorganisms, persistent inflammation may lead to substantial long-term functional joint sequelae. The use of corticosteroids could reduce this inflammation, thereby improving functional joint outcomes and facilitating first-line medical treatment. The hypothesis of this study is that corticosteroid administration, in addition to antibiotic therapy, reduces persistent inflammation and improves functional joint prognosis in adult patients with acute septic arthritis.

Infrared Thermography for Diagnosis of Musculoskeletal Infections

This is a pilot proof of feasibility study to explore the efficacy of High Resolution Infrared Thermographic Imaging (HRTI) to assist with the detection of musculoskeletal infections in children. In HRTI, a sensitive thermal camera is used to capture the temperature profile of the suspected infected body region in the form of images. In this study, a 10-second video will be recorded to allow dynamic monitoring. The resulting video will be processed and interpreted to determine whether there is a musculoskeletal infection. Bone, joint and soft tissue infections can be caused by bacteria which can enter the body through accidental injuries, or because of surgery or implants. Once in the body, they circulate through the bloodstream until they reach a bone, joint, or muscle, multiply and cause infection. These conditions can cause significant complications in children and adults and can even result in death if untreated. Infections of the bone, called osteomyelitis can inhibit bone growth in children. As a result, children who have suffered from osteomyelitis may require extensive treatment later in childhood. While osteomyelitis accounts for only 1% of childhood hospital admissions, its incidence in children has increased in recent decades. This is associated with an increase in the prevalence of antibiotic resistant bacteria such as MRSA. Infections of the joint, called septic arthritis, is an emergency condition that requires prompt diagnosis and treatment. Long delays in diagnosis and surgical drainage of the joint may lead to irreversible damage to the cartilage and bone destruction. There is currently a need for improved technologies to screen for and monitor bone, joint, and soft tissue infections. Plain radiographs appear normal in the first 7 to 10 days of osteomyelitis. Magnetic resonance imaging (MRI) is the most sensitive modality for diagnosing osteomyelitis. However, MRI scans are costly their accessibility is limited, plus the scan can take 30 minutes to perform. As the child needs to be still during the scan, sedation is required. Infrared thermal imaging is a harmless, cost effective and rapid scanning method that has proven industrial applications such as condition monitoring of machineries and fault findings. There has also been extensive interest in utilising and this technology for medical diagnosis and monitoring. This study builds on our earlier work that used HRTI to detect inflammation in the abdomen in infants. This technology may allow timelier and more cost-effective diagnosis of the condition. Sheffield Children's Hospital and Sheffield Hallam University collaborate in conducting the study. The study will involve recruiting 30 patients at Sheffield Children's Hospital with suspected infection of either bone, joint or soft tissue. They will have their HRTI recorded and processed to follow up the study's research questions. The findings from the study will not alter the routine medical treatments of the patients and participation is voluntary.

BonE and Joint Infections - Simplifying Treatment in Children Trial

This is a multi- centre trial of children with bone and joint infections (BJIs) at eight major paediatric hospitals in Australia and New Zealand. The primary objective is to establish if in children with acute, uncomplicated BJIs, entirely oral antibiotic treatment is not inferior to initial intravenous (IV) treatment for 1 to 7 days followed by an oral antibiotic course in achieving full recovery 3 months after presentation. Children will be randomly allocated to the 'entirely oral antibiotic' group or the 'standard treatment' group.

Alpha-Defensin and Synovial Proteins to Improve Detection of Pediatric Septic Arthritis

Differentiating between septic arthritis and other causes of joint inflammation in pediatric patients is challenging and of the utmost importance because septic arthritis requires surgical debridement as part of the treatment regimen. The current gold standard to diagnose septic arthritis in children is a positive synovial fluid culture; however, joint cultures may take several days to return. If a bacterial infection is present, it requires immediate surgical intervention in order to prevent lasting articular cartilage damage. Frequently surgeons must decide whether to surgically debride a joint before culture results are available. There is no single lab test or clinical feature that reliably indicates bacterial infection over other causes of joint inflammation. The alpha-defensin assay has shown high sensitivity and specificity for joint infection in other studies.The purpose of this study is to determine the sensitivity and specificity of several synovial biomarkers for diagnosing pediatric septic arthritis.

Trimethoprim-sulfamethoxazole vs. Clindamycin for the Treatment of Children With Invasive MRSA Infections

The goal of this clinical trial is to learn if trimethoprim-sulfamethoxazole (TMP-SMX) works to treat invasive infections due to methicillin-resistant Staphylococcus aureus (MRSA) in children. It will also learn about the safety of TMP-SMX in the treatment of children with invasive MRSA infections. The main questions it aims to answer are: -Is TMP-SMX effective at successfully treating children with invasive infections due to MRSA? What are the side effects of TMP-SMX in children taking it for invasive infections due to MRSA? Researchers will compare TMP-SMX to a clindamycin (a commonly prescribed antibiotic for the treatment of MRSA in children) to see if TMP-SMX works better, worse or the same as clindamycin for children with invasive infections due to MRSA. Participants will: Take TMP-SMX or clindamycin for the treatment of their invasive infection due to MRSA. Will follow up with the provider treating their invasive infection at the discretion of the treating provider. Keep a diary of their symptoms and any side effects of the medicine

Retention and Re-Engagement in Treatment for Addiction Following Serious Injection Related Infections (RETAIN)

This project is a pilot study of an adapted intervention of an existing Opioid Use Disorder (OUD) treatment retention intervention called Recovery Management Checkups (RMC). This intervention has been adapted to better fit the experiences and unique issues of those that have been hospitalized with serious injection related infections (SIRI) based on the findings from a prior qualitative study from the principal investigator. This project plans to test the adapted intervention within a smaller group of participants to assess feasibility, acceptability, and calculate early findings of intervention efficacy. Hospitalizations for SIRIs are a unique entry point for patients to start their recovery journey with medications for OUD (MOUD), but many people do not remain on long-term treatment, despite evidence that indicates MOUDs reduce death and re-hospitalization after SIRIs. The study objectives are to: * Assess the implementation feasibility of the adapted RMC model for patients with SIRI and OUD. * Establish preliminary estimates of intervention efficacy. * Make further adaptions to the intervention that will reduce both known and unknown barriers to care and increase effectiveness in future larger scale trials. Findings from this pilot study will result in further intervention refinement to better fit the target population, and serve as the basis for a larger randomized control trial that will have aims focused on more in-depth analysis of the efficacy of this program

Initial Oral Antibiotics for Bone and Joint Infections in Children

Initial oral antibiotic treatment for children and adolescents with uncomplicated bone and joint infections (BJI) has been found non-inferior to initial IV antibiotics in one randomized controlled trial (RCT). The real-world effectiveness of initial oral antibiotics for children and adolescents with BJI is unclear. This nationwide, prospective, multicenter, real-world cohort study aims to compare the effectiveness and safety of initial oral antibiotic treatment for children and adolescents with uncomplicated BJI in a real-world setting with those who received initial oral antibiotics in our RCT.

Diagnostic and Management of Hand Infection.

Primary or secondary (post-traumatic infections, notably related to bites, wounds, etc.) infections of the hand are very common situations, even if the epidemiology is poorly understood. For example, hand bite injuries represent 1.2 million referrals to the healthcare system per year in the United States. Their nosological framework extends from simple infections of the skin and soft tissues such as whitlows, to potentially severe deep damage such as arthritis and osteitis, or phlegmons of the tendon sheaths. The diagnostic approach is not consensual, and the contribution of additional biological parameters (inflammatory syndrome) and morphological investigations (x-rays, ultrasound, CT-scan or MRI) is not codified. Microbiology seems dominated by Staphylococcus aureus, but few studies have precisely described the microbial etiology. Consequently, probabilistic antibiotic therapy and the need to take bacteriological samples for secondary adaptation are not standardized. Likewise, surgical strategies (abstention, systematic washing or depending on evolution) remain operator dependent. We consequently aim to described diagnostic, management and related outcomes or hand infections in a specialized tertiary care center.