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A comparative study of osteomyelitis and purulent arthritis with special reference to aetiology and recovery
Insights
Pediatric acute hematogenous osteomyelitis and purulent arthritis, primarily caused by Staphylococcus aureus, show good prognoses with prompt treatment. Most children recover with minimal long-term effects, regardless of specific antibiotic choices.
Area of Science:
- Pediatric Infectious Diseases
- Orthopedic Surgery
- Microbiology
Background:
- Acute hematogenous osteomyelitis and purulent arthritis are significant pediatric bone and joint infections.
- Understanding their epidemiology, causative agents, and treatment outcomes is crucial for effective management.
Purpose of the Study:
- To analyze the clinical characteristics, causative pathogens, treatment modalities, and outcomes of pediatric acute hematogenous osteomyelitis and purulent arthritis.
- To determine the incidence and identify risk factors for long-term sequelae in affected children.
Main Methods:
- Retrospective analysis of 44 pediatric cases of acute hematogenous osteomyelitis (ages 0-14) and 25 cases of purulent arthritis (ages 0-13).
- Data collected on incidence, bacteriology, localization, surgical interventions, antimicrobial therapy, and clinical outcomes.
- Statistical analysis to compare outcomes between different treatment groups and identify prognostic factors.
Main Results:
- Annual incidences were 4.5 and <2 per 100,000 children for osteomyelitis and arthritis, respectively.
- Staphylococcus aureus was the predominant pathogen (70%), followed by streptococci (20%) and Haemophilus influenzae (7%).
- Osteomyelitis commonly affected the femur (41%), while arthritis primarily involved the knee (76%). Surgical intervention was frequent (82% for osteomyelitis, 32% for arthritis).
- Overall, 14% experienced minor permanent damage; no sequelae were observed in the purulent arthritis group.
- Average antimicrobial therapy durations were 44 days (osteomyelitis) and 29 days (arthritis).
Conclusions:
- Pediatric osteomyelitis and purulent arthritis have distinct epidemiological patterns and common causative agents.
- Prompt diagnosis and appropriate antimicrobial therapy, often combined with surgical intervention, lead to favorable outcomes.
- The choice of specific antibiotics did not significantly impact the overall positive prognosis in this cohort.
Abstract:
We analysed the records of 44 paediatric cases of acute haematogenous osteomyelitis (age 0-14 years) and 25 cases of purulent arthritis (age 0-13 years). The annual incidences were 4.5 and less than two per 100,000 children, respectively. Bacteriologic diagnosis was achieved in 82% of the acute haematogenous osteomyelitis cases and in 40% of the acute purulent arthritis cases. Staphylococcus aureus was responsible for 70% of the proven acute haematogenous osteomyelitis and acute purulent arthritis cases combined, followed by streptococci (20%) and Haemophilus influenzae (7%), which caused only acute purulent arthritis. Acute haematogenous osteomyelitis was localized in the femur in 41% of the cases and acute purulent arthritis in the knee joint in 76%. Surgery (in most cases drilling, fenestration or arthrotomy) was performed on 82% of the acute haematogenous osteomyelitis and on 32% of the acute purulent arthritis patients. Although six of the acute haematogenous osteomyelitis patients (but none of the acute purulent arthritis patients) underwent surgery for a second time, permanent damage, which was functionally non-significant, developed in only 14%. No sequelae were found in the acute purulent arthritis group. The average duration of antimicrobial therapy was 44 days in the acute haematogenous osteomyelitis group and 29 days in the acute purulent arthritis group. The prognosis for the children was similar, irrespective of whether the drugs used were staphylococcal penicillins, ampicillin, lincomycin or clindamycin.
