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Clinical and diagnostic features of osteomyelitis occurring in the first three months of life
M Wong1, D Isaacs, R Howman-Giles
1Department of Immunology and Infectious Diseases, Royal Alexandra Hospital for Children, Westmead, NSW, Australia.
Insights
Osteomyelitis in infants is often linked to Staphylococcus aureus, particularly methicillin-resistant S. aureus (MRSA) in preterm, ventilated infants. Diagnostic imaging like bone and gallium scans are crucial for accurate detection.
Area of Science:
- Pediatric Infectious Diseases
- Musculoskeletal Infections
- Diagnostic Imaging in Pediatrics
Background:
- Osteomyelitis is a serious bone infection in infants, posing diagnostic challenges.
- Preterm infants, especially those requiring artificial ventilation, are at higher risk.
- Identifying causative organisms is critical for effective treatment and management.
Purpose of the Study:
- To retrospectively analyze the characteristics and outcomes of infant osteomyelitis.
- To identify common etiologic agents and risk factors, including prematurity and ventilation.
- To evaluate the diagnostic accuracy of bone scintigraphy and gallium scanning.
Main Methods:
- Retrospective review of 94 infants (< 4 months) investigated for osteomyelitis over 9 years.
- Analysis of clinical data, microbiological cultures, and imaging findings (99mTc bone scan, gallium scan).
- Correlation of diagnostic test results with confirmed osteomyelitis cases.
Main Results:
- 30 infants had proven osteomyelitis; 17 were preterm and artificially ventilated.
- Staphylococcus aureus (methicillin-susceptible and MRSA) was the most common pathogen.
- Bone scans showed 84% sensitivity and 89% specificity; adding gallium scans improved accuracy to 90% and 97% respectively.
Conclusions:
- Infant osteomyelitis, especially in preterm ventilated infants, is frequently caused by S. aureus.
- Focal clinical signs are common, but diagnosis requires high clinical suspicion, especially with positive blood cultures.
- Combined bone and gallium scintigraphy offers high diagnostic accuracy for infant osteomyelitis.
Abstract:
We report a retrospective study of 94 infants, ages < 4 months, who underwent investigation for possible osteomyelitis during a 9-year period. Of the 30 babies with proven osteomyelitis (radiographic changes or positive bone cultures or positive blood cultures plus a compatible clinical picture), 17 were preterm artificially ventilated babies and 4 were full term infants receiving intensive care. An etiologic organism was isolated from 28: methicillin-susceptible Staphylococcus aureus, 16; methicillin-resistant S. aureus (MRSA), 7; Escherichia coli, 3; and group B Streptococcus, 2. MRSA occurred exclusively in the preterm group. Osteomyelitis was multifocal in 40% and associated with septic arthritis in 47%. The long bones were frequently affected (80%) whereas the flat bones were often sites of clinically silent disease. Twenty-five (83.3%) of the 30 babies with proven osteomyelitis had focal clinical signs or evidence of disseminated staphylococcal disease. Only 10 were febrile. Four of 27 babies investigated because of positive blood cultures for S. aureus but no focal signs had osteomyelitis, as did only 1 of 27 babies with suspected sepsis but no focal signs. The sensitivity of 99mTc bone scanning was 84%, specificity 89%, positive predictive value 79% and negative predictive value 92%. The addition of gallium scanning (in 39 of the 94 infants) improved the respective figures to 90, 97, 93 and 95% and was useful in interpreting equivocal bone scans.