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An Update on Pediatric Acute Hematogenous Osteomyelitis in New Zealand - A Decade on
Anna C E McDonald1, Jack Julian, Lesley M Voss
1Starship Childrens Hospital, Auckland District Health Board; Department of Paediatrics, The University of Auckland Faculty of Medical and Health Sciences.
Insights
New Zealand has high rates of pediatric acute hematogenous osteomyelitis (AHO), but incidence has decreased. Males, Pasifika, and Māori children, and those from low socioeconomic areas bear a high disease burden.
Area of Science:
- Pediatric infectious diseases
- Orthopedic surgery
- Epidemiology
Background:
- New Zealand reports high incidence of pediatric acute hematogenous osteomyelitis (AHO).
- Males and children of Pasifika and Māori ethnicity are disproportionately affected.
- High disease burden exists in low socioeconomic populations.
Purpose of the Study:
- To update the incidence of pediatric AHO over a 10-year period (2008-2017).
- To identify trends in presentation, causative organisms, treatment strategies, and patient outcomes.
- To compare current data with previous decade's findings.
Main Methods:
- Retrospective review of 796 pediatric AHO cases (6 weeks to 15 years) across two centers.
- Data collection included demographics, clinical presentation, investigations, management, and complications.
- Incidence calculated using census data; comparison with historical data.
Main Results:
- Incidence of pediatric AHO was 18 per 100,000 annually.
- Staphylococcus aureus (MSSA) was the predominant pathogen (87%); MRSA rates were low (4.4%).
- Increased use of MRI, higher rates of surgery (41%), and a rise in chronic infection (1.7% to 5.7%) were observed.
Conclusions:
- Despite a decrease from the previous decade, pediatric AHO incidence remains high in New Zealand.
- Targeted interventions are needed for overrepresented demographic groups and socioeconomic strata.
- Further research focusing on prospective analysis and long-term morbidity is crucial for improving outcomes and reducing chronic infection rates.
Introduction:
New Zealand (NZ) has high rates of pediatric acute hematogenous osteomyelitis (AHO) with males and children of Pasifika and Māori ethnicity overrepresented.
Aims:
To update the incidence of Pediatric AHO over 10 years, identifying trends in presentation, organisms, treatment, and outcomes.
Methods:
A 10-year retrospective review of children aged 6 weeks to 15 years admitted with Pediatric AHO across two centers from 2008 to 2017. Demographic data, features of presentation, investigations, management, and complications were collected. Incidence was calculated from census data. Data were compared with our osteomyelitis database from the previous decade. (1).
Results:
796 cases were identified. The incidence was 18 per 100,000 per annum. The average age was 7.7 years. Pasifika and Māori children are overrepresented (57%). 370 children (51%) came from low socioeconomic areas. Methicillin-sensitive Staphylococcus aureus was the most common pathogen (87%). Methicillin-resistant Staphylococcus aureus (MRSA) rates are low (4.4%). Forty-four (5.5%) children were admitted to the Pediatric Intensive Care Unit (PICU) with 9% mortality. The mean duration of antibiotics was 40 days. 325 children (41%) had surgery. Chronic infection has increased from 1.7% to 5.7%.
Conclusions:
NZ has high rates of AHO, however, the incidence has decreased from the previous decade. Males, those in low socioeconomic areas, Pasifika and Māori have high disease burden. The use of MRI as a diagnostic modality has increased. Future studies should focus on improving treatment via prospective analysis and reporting long-term morbidity to improve outcomes for children with severe disease and reduce rates of chronic infection.
