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Pelvic osteomyelitis in children: a comparison of decades from 1980-1989 with 1990-2001
Darin Davidson1, Merv Letts, Khalid Khoshhal
1Children's Hospital of Eastern Ontario, University of Ottawa, Canada.
Insights
Pelvic osteomyelitis in children is often caused by Staphylococcus aureus. Early treatment with antibiotics and surgical intervention leads to favorable outcomes, though complications can occur.
Area of Science:
- Pediatric Orthopedics
- Infectious Diseases
- Pediatric Infectious Diseases
Background:
- Pelvic osteomyelitis is a serious bone infection affecting children.
- It presents with symptoms like pain, fever, and altered weight-bearing.
Purpose of the Study:
- To analyze the clinical characteristics, treatment, and outcomes of pediatric pelvic osteomyelitis.
- To identify trends and potential factors influencing disease severity.
Main Methods:
- Retrospective review of 64 pediatric cases of pelvic osteomyelitis treated from 1980 to present.
- Analysis of presenting symptoms, laboratory findings, causative organisms, treatment modalities, and complications.
Main Results:
- Staphylococcus aureus was the most common pathogen (26/64).
- Commonly affected sites included the ilium and acetabulum.
- Most children (62/64) were successfully treated with intravenous antibiotics; five underwent irrigation and debridement.
- Complications occurred in three children, including joint fusion, acetabular deformity, and thromboembolism.
Conclusions:
- Pelvic osteomyelitis in children can be effectively treated with antibiotics and, in select cases, surgical intervention.
- Recent cases suggest an increase in severity, possibly due to enhanced organism virulence.
- Prompt diagnosis and management are crucial for favorable outcomes and minimizing long-term sequelae.
Abstract:
Since 1980, 64 children with pelvic osteomyelitis (40 boys) were treated at a major pediatric referral center. The average age was 11 years and 6 months. The presenting complaints included pain in 61 children, fever in 30, and altered weight-bearing in 31. The erythrocyte sedimentation rate was elevated in 56 and there was leukocytosis in 19. The most commonly affected sites were the ilium in 21 and the acetabulum in 20, followed by the pubis in 11 and the ischium in 10. Culture results were negative in 32 and positive for Staphylococcus aureus in 26. Treatment consisted of intravenous antibiotics in 62 and irrigation and debridement in five children, all of whom presented since 1990. The infection resolved in 62 children and persisted in two. Three developed complications, including fusion of the sacroiliac joint in one, deformity of the acetabulum in one, and one child with an underlying protein C deficiency developed thromboembolism. Recent patients have demonstrated increased severity, likely due to increased virulence of the organism.