A Study of 29 Pediatric Patients With Osteomyelitis Resulting From Neuropathy and Pressure Effects

Pediatric osteomyelitis secondary to underlying neuropathies is a rare, complex, but clinically severe entity. Loss of protective pain sensation and proprioception predisposes children to repetitive unperceived microtrauma and chronic pressure ulceration, facilitating insidious progression to deep bone infection. Comprehensive pediatric studies documenting the presentation, diagnostic characteristics, microbiological spectrum, and long-term outcomes of this vulnerable cohort remain exceptionally scarce.

To characterize the clinical presentation, inflammatory biomarker utility, microbiological profile, surgical intervention rates, and disease recurrence patterns in pediatric patients with neuropathy-associated osteomyelitis managed at a tertiary referral center.

This single-center descriptive case series analyzed 29 pediatric patients (< 18 years) with confirmed underlying neuropathies and MRI/pathologically proven chronic osteomyelitis between 10.10.2012 and 20.09.2022. Clinical features, laboratory markers, microbiological isolates, operative procedures, hospitalizations, and long-term recurrence rates were extracted and evaluated.

The cohort comprised 15 males (51.7%) and 14 females (48.3%) with a median age at presentation of 122 months (range: 31-211 months). Underlying neuropathies included myelomeningocele (69.0%), hereditary sensory and autonomic neuropathies (27.6%), and cerebral palsy (3.4%). Overlying cutaneous ulcers were present in 89.7% of cases, with a marked mean diagnostic delay of 22.8 ± 17.8 months (median: 24 months). ESR (65.5%) and CRP (75.9%) demonstrated high diagnostic sensitivity, whereas procalcitonin was elevated in only 10.3%. Microbiological analysis revealed a complex polymicrobial profile yielding 42 distinct isolates across 89.7% of cultured patients. Surgical intervention was required in 86.2% of patients, with 37.9% undergoing lower extremity amputation. The median hospital stay was 36.0 days (range: 1-333 days). Among patients completing regular outpatient follow-up, 100% experienced chronic relapses requiring multiple re-admissions (up to 14 admissions).

Factors such as resistant microorganisms, multiple antibiotic use, prolonged hospitalizations, the financial burden on the healthcare sector, and deterioration in patients' quality of life show the importance of preventive measures for this disease group that progresses with chronic and recurrent osteomyelitis.