Bacterial causes of acute osteomyelitis in sickle cell anaemia: changing infection profile

The bacterial causes of osteomyelitis were reviewed on 25 patients with sickle cell anaemia using blood culture and direct wound swab. Age range was 2 to 45 years with a median of 23 years. Klebsiella species were cultured in 45% of the blood samples. Staphylococcus aureus was responsible in 20%, Salmonella species in 8% and Streptococcus pyogenes was cultured in 4% of the samples. From direct wound swab culture, Klebsiella was responsible for 36%, Staphylococcus aureus 28% and coagulase Negative Staphylococcus 24%. Proteus species were responsible for 8% and Salmonella was cultured in 4%. The highest number of patients presenting with osteomyelitis occurred in the second decade. From (culture) sensitivity tests, ceftazidine and Ofloxacine were found to be the most effective antibacterial drugs. The preponderance of Klebsiella indicates a change in the previously accepted pattern of infection in which Salmonella species were considered to be the main causative organism.