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[Epidemiology of acute hematogenous osteomyelitis in children: a prospective study over a 32 months period]
Sami Bouchoucha1, Ghassen Drissi, Mehdi Trifa
1Unversite Tunis, El Manar, Tunisie.
Insights
This study on childhood acute hematogenous osteomyelitis (AHO) found that methicillin-resistant Staphylococcus aureus (MRSA) infections present with more severe symptoms and complications. Early suspicion of MRSA is crucial for effective antibiotic treatment in severe AHO cases.
Area of Science:
- Pediatric Infectious Diseases
- Bacteriology
- Clinical Microbiology
Context:
- Acute hematogenous osteomyelitis (AHO) is a significant pediatric infection.
- Understanding the specific profiles of AHO is essential for targeted treatment.
- This study focuses on the demographic, clinical, biological, and bacteriological aspects of AHO in children.
Purpose:
- To delineate the comprehensive profile of pediatric acute hematogenous osteomyelitis (AHO).
- To identify clinical and microbiological characteristics differentiating AHO cases.
- To investigate the prevalence and impact of Staphylococcus aureus, including methicillin-resistant strains (MRSA).
Summary:
- A prospective study analyzed 70 children with AHO, revealing distal tibia as the most common site.
- Staphylococcus aureus was the predominant pathogen, with methicillin-resistant strains (MRSA) accounting for 15.7%.
- MRSA infections were associated with higher C-reactive protein (CRP) levels, prolonged fever resolution, deep venous thrombosis, pleuropulmonary infections, and increased need for surgical drainage.
Impact:
- Highlights the distinct clinical presentation and severity of MRSA-related AHO in children.
- Emphasizes the importance of early suspicion and appropriate antibiotic therapy for MRSA in severe AHO.
- Informs clinical practice regarding diagnostic workup and management strategies for pediatric osteomyelitis.
Aim:
To determine the demographic, clinical, biological and bacteriological profile of acute community acquired hematogenous osteomyelitis (AHO) in children.
Methods:
Prospective study including children admitted for AHO. We noted the demographic parameters of patients and the clinical, biological and radiological characteristics of the infection. Blood cultures and local specimen in operated children were systematically performed.
Results:
70 patients were included. The mean age was 7.7 years. The mean time between onset of symptoms and admission was 3.2 days. Distal tibia was the most frequent localization (18.66%). Fever higher than 38° on admission was found in 92.8% of patients. Creactive protein (CRP) was superior to 20 mg / L in 95.8% and ESR superior to 20 mm in the first hour in 92% of cases. A deep venous thrombosis was found in 7 patients and a pleuropulmonary Staphylococcus infection in 4 patients. A micro organism was isolated in 64.7% of cases. Staphylococcus aureus methicillin susceptible (SAMS) was the predominant germ. Staphylococcus aureus methicillin resistant (SAMR) accounted for 15.7% of staphylococcus aureus infections. The importance of CRP on admission and time to resolution of fever after the start of treatment were significantly higher in SAMR infections. The existence of deep venous thrombosis and a pleuropulmonary Staphylococcus infection and the need for surgical drainage were significantly more frequent in SAMR infections.
Conclusion:
The existence of a severe form of AHO should lead to a high suspicion of SAMR infection and prompt the prescription of an appropriate antibiotiotherapy.
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