Acute hematogenous osteomyelitis in pediatric patients: epidemiology and risk factors of a poor outcome

Abstract

Objective: Acute hematogenous osteomyelitis (AHO) has declining incidence in developed countries. AHO can cause rapid destruction of bone that can lead to functional impairment or even death if misdiagnosed and not treated urgently. In this study, we aimed to identify the main factors that may lead to a poor outcome and to establish a profile of patients with AHO who might have a negative outcome. Methods: We conducted a retrospective single-center study including 94 patients with AHO, over a 10-year interval. Complete medical history including age at diagnosis, sex, socioeconomic status, symptoms, entry portal, pathogenic agent, location of infection, radiological features, treatment, and outcome were recorded. Results: Male predominance was observed, with boys from rural areas more prone to a poor outcome. This is likely because they are more exposed to trauma and do not have proper access to emergency medical care. Staphylococcus aureus was the most common etiologic agent, with 84 patients testing positive. Disease evolution was toward chronicity in patients diagnosed late. The most frequent complications were sepsis and pathological fractures. Conclusions: In our study, patients with negative outcomes were characterized by young age, repeated negative cultures, delayed surgery, rural residence, and male sex.

Contemporary clinical isolates ofStaphylococcus aureusfrom pediatric osteomyelitis patients display unique characteristics in a mouse model of hematogenous osteomyelitis

“…Additionally, our HOM model mimics many of the hallmarks of juvenile HOM. Clinically, the most frequent site of infection is the metaphysis of the femur or tibia (12), a trend recapitulated in our studies. We also found several examples of abscesses located within the diaphysis of the femur and tibia, although this was not in the majority of samples.…”

“…The recurrence rate may be as high as 9% (7)(8)(9)(10), and this problematic event can extend into adulthood (11). Typically, HOM involves the metaphysis of long bones, predominantly the distal femur or proximal tibia (12). A main concern with pediatric HOM is the development of chronic infection.…”

“…A main concern with pediatric HOM is the development of chronic infection. This can cause pathological bone changes leading to fractures, dislocations, and devitalized bone segments known as sequestra (12). HOM infections can also spread to an adjacent joint, causing septic arthritis (SA), or systemically, leading to potentially lethal sepsis (12, 13).…”

“…This can cause pathological bone changes leading to fractures, dislocations, and devitalized bone segments known as sequestra (12). HOM infections can also spread to an adjacent joint, causing septic arthritis (SA), or systemically, leading to potentially lethal sepsis (12, 13). Additionally, antimicrobial resistant strains, particularly methicillin-resistant (MRSA), are highly prevalent in both healthcare and community settings (14).…”

Multifocal subacute osteomyelitis in adjacent bones in the ankle without septic joint

“…Multifocal osteomyelitis occurs rarely, with studies showing only 10% of children who present with osteomyelitis have multiple foci of infection [12 , 15] . Patients with multifocal osteomyelitis usually present in the acute setting with a hematogenous spread [12 , 16] , as opposed to the subacute setting seen in this case.…”