Epidemiology and Management of Acute Haematogenous Osteomyelitis in a Tertiary Paediatric Center

Elena Chiappini, Caterina Camposampiero, Simone Lazzeri, Giuseppe Indolfi, Maurizio De Martino and Luisa Galli
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Elena Chiappini: Paediatric Infectious Disease Unit, Anna Meyer Children’s University Hospital, Florence 50100, Italy
Caterina Camposampiero: Paediatric Infectious Disease Unit, Anna Meyer Children’s University Hospital, Florence 50100, Italy
Simone Lazzeri: Orthopedics and Traumatology Department, Anna Meyer Children’s University Hospital, Florence 50100, Italy
Giuseppe Indolfi: Department of Pediatrics, Anna Meyer Children’s University Hospital, Florence 50100, Italy
Maurizio De Martino: Meyer Health Campus, Anna Meyer Children’s University Hospital, Florence 50100, Italy
Luisa Galli: Paediatric Infectious Disease Unit, Anna Meyer Children’s University Hospital, Florence 50100, Italy

IJERPH, 2017, vol. 14, issue 5, 1-11

Abstract: Background : Paediatric acute hematogenous osteomyelitis (AHOM) is a serious disease requiring early diagnosis and treatment. To review the clinical presentation, management and organisms responsible for AHOM, and to explore risk factors for complicated AHOM, a large cohort referring to a single center over a 6-year period was evaluated. Methods : Data from children with AHOM, hospitalized between 2010 and 2015, and aged > 1 month, were retrospectively collected and analyzed. Results : 121 children (median age 4.8 years; 55.4% males) were included. Fever at onset was present in 55/121 children (45.5%); the lower limb was most frequently affected ( n = 68/121; 56.2%). Microbiological diagnosis (by culture and/or polymerase chain reaction (PCR)) was reached in 33.3% cases. Blood and pus/biopsy culture sensitivities were 32.4% and 46.4%, respectively. PCR sensitivity was 3.6% (2/55) on blood, and 66.6% (16/24) on pus/biopsy sample. Staphylococcus aureus was the most commonly identified pathogen ( n = 20); no methicillin-resistant Staphylococcus aureus (MRSA) was isolated, 10.0% ( n = 2) strains were Panton-Valentine-Leukocidin (PVL) producer; 48.8% (59/121) cases were complicated. At univariate analysis, factors associated with complicated AHOM were: recent fever episode, fever at onset, upper limb involvement, white blood count (WBC) ? 12,000/µL, C reactive protein (CRP) ? 10 mg/L, S. aureus infection. At multivariate analyses S. aureus infection remained the only risk factor for complicated AHOM (aOR = 3.388 (95%CI: 1.061–10.824); p -value = 0.039). Conclusions : In this study microbiological diagnosis was obtained in over one third of cases. Empiric treatment targeting methicillin-sensitive Staphylococcus aureus seems to be justified by available microbiological data.

Keywords: acute haematogenous osteomyelitis; children; antibiotic therapy; outcome (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2017
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (1)

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