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

Abstract

<i>Background</i>: 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. <i>Methods</i>: Data from children with AHOM, hospitalized between 2010 and 2015, and aged > 1 month, were retrospectively collected and analyzed. <i>Results</i>: 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 (<i>n</i> = 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. <i>Staphylococcus aureus</i> was the most commonly identified pathogen (<i>n</i> = 20); no methicillin-resistant <i>Staphylococcus aureus</i> (MRSA) was isolated, 10.0% (<i>n</i> = 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, <i>S. aureus</i> infection. At multivariate analyses <i>S. aureus</i> infection remained the only risk factor for complicated AHOM (aOR = 3.388 (95%CI: 1.061-10.824); <i>p</i>-value = 0.039). <i>Conclusions</i>: In this study microbiological diagnosis was obtained in over one third of cases. Empiric treatment targeting methicillin-sensitive <i>Staphylococcus aureus</i> seems to be justified by available microbiological data.