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[Bacterial osteomyelitis and arthritis in Icelandic children 1996-2005]
Asgeir Thor Masson1, Thorolfur Gudnason, Gudmyndur K Jonmundsson
1Barnaspitali Hringsins, Lanspitali, Reykajavik.
Insights
Pediatric osteomyelitis and septic arthritis incidence rose in Iceland, particularly in young children. Staphylococcus aureus was the most common pathogen, but culture-negative cases increased, suggesting a need for better diagnostic methods.
Area of Science:
- Pediatric infectious diseases
- Musculoskeletal infections
Background:
- Osteomyelitis and septic arthritis are significant pediatric infections.
- Understanding causative pathogens and incidence trends is crucial for effective treatment.
Purpose of the Study:
- To determine the incidence and causative pathogens of osteomyelitis and septic arthritis in Icelandic children.
- To analyze presenting symptoms and diagnostic patterns.
Main Methods:
- Nationwide retrospective review of pediatric cases (<18 years) from 1996-2005.
- Cases divided into three age groups: 0-5, 6-11, and 12-17 years.
- Comparison of culture-positive and culture-negative cases.
Main Results:
- 220 cases identified (161 osteomyelitis, 59 septic arthritis).
- Overall incidence increased significantly, driven by the youngest age group (osteomyelitis).
- Staphylococcus aureus was the most frequent pathogen; Kingella kingae was second. Culture-negative cases rose significantly.
Conclusions:
- Increased incidence of pediatric osteomyelitis, especially culture-negative cases in the youngest children.
- Staphylococcus aureus and Kingella kingae are key pathogens.
- Enhanced pathogen detection methods may be beneficial for culture-negative cases.
Objective:
The main objective was to determine the incidence and causative pathogens of osteomyelitis and septic arthritis in Icelandic children, as well as presenting symptoms and diagnosis.
Methods:
A nationwide retrospective review was done of all children <18 year old, 1996-2005. Subjects were divided into three equal age groups, 0-5, 6-11 and 12-17 years old. Cultures were reviewed and postive and negative cases compared.
Results:
Over the study period 220 cases were identified, 161 osteomyelitis and 59 septic arthritis cases. The incidence increased significantly over the period (p=0.019), mostly in the youngest age group (p<0.001) with osteomyelitis. Incidence of cases with a pathogen identified was unchanged over the period while culture negative cases increased significantly (p<0.001). Median age for osteomyelitis (6,1 years) was higher than in cases of septic arthitis (1,8 years) (p=0.003). A pathogen was identified in 59% of cases with osteomyelitis and 44% with septic arthritis. S. aureus was most common (65% and 27%, respectively) and K. kingae was second most common pathogen (7% and 11%, respectively). Methicillin resistant S. aureus was not identified. The tibia and knee were the predominant sites for osteomyelitis and septic arthritis respectively.
Conclusions:
An increased incidence was found in the youngest age group with osteomyelitis, especially in cases without a pathogen identified. The most commonly cultured pathogen was S. aureus, followed by K. kingae. A more sensitive technique to identify pathogens might be indicated in culture negative cases.
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