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[Course and treatment of osteomyelitis in childhood (author's transl)]
Insights
High-dose bactericidal antibiotics, like penicillin and gentamicin, are superior for treating pediatric osteomyelitis. Early diagnosis and surgical intervention improve outcomes in children with bone infections.
Area of Science:
- Pediatric Orthopedics
- Infectious Diseases
- Bacteriology
Context:
- Osteomyelitis in children presents diagnostic and therapeutic challenges.
- This study analyzes a significant cohort of pediatric osteomyelitis cases treated over 17 years.
Purpose:
- To review the incidence, causative agents, diagnostic methods, and treatment outcomes of pediatric osteomyelitis.
- To provide evidence-based recommendations for antibiotic therapy in osteomyelitis.
Summary:
- A retrospective analysis of 132 children with osteomyelitis (1955-1972) revealed Staphylococcus as the primary pathogen (90%).
- Acute hematogenous osteomyelitis was most common (111 cases); 107 were cured with bactericidal antibiotics and surgical intervention when necessary.
- Diagnostic tools like blood/pus cultures and antistaphylolysin tests were crucial, especially when radiological signs were absent.
Impact:
- Highlights the efficacy of bactericidal antibiotics and surgical management in pediatric osteomyelitis.
- Informs clinical practice regarding optimal antibiotic selection and adjunctive treatments for bone infections in children.
Abstract:
In the years 1955-1972 132 children with osteomyelitis were treated in the Pediatric, Surgical and Orthopedic Department of the university of Kiel. There was no increase in the incidence of osteomyelitis during this period. Acute hematogenous osteomyelitis was diagnosed in 111 children, chronic hematogenous osteomyelitis in 11 children, traumatic and postoperative osteomyelitis in 10 children. Secondary chronic osteomyelitis occurred in 1 patient. Mainly staphylococci (in 90%) were the pathogenic bacteria, whereas haemophilus, pseudomonas, streptococci group A, E. coli and mixed infections occurred less frequently. In 17 of 111 patients with acute hematogenous osteomyelitis there were no roentgenological changes. Bacteriological investigations of blood and pus, and the antistaphylolysin reaction (repeated in the course of the disease) were helpful to establish the diagnosis in many cases. 107 of 111 patients with acute hematogenous osteomyelitis were cured (8 patients with defects). 4 children died in septic shock or because of complications (meningitis, pleural empyema, pneumonia). Bactericidal antibiotics in high dosage (penicillins, gentamicin) were superior to bacteriostatic antibiotics. Additional surgical treatment was necessary in 49 of 111 patients with acute hematogenous osteomyelitis. Recommendations for antibiotic therapy of osteomyelitis are given.