Neonatal Osteomyelitis

Abstract

Bone and joint infections in neonates differ significantly from what is seen in older children, adolescents, and adults. They are more common in preterm neonates but occasionally are seen in term babies. A high index of suspicion, coupled with careful daily physical examination, is important for early identification and treatment. Multiple foci should be sought. Underlying bone or joint involvement should be suspected in patients who have cutaneous abscesses. Surgical debridement or drainage, as required, and long-term appropriate antibiotic therapy are the pillars of therapy. Long-term outcome must be monitored closely, even in babies whose disease is rapidly identified and appropriately treated.

Neonatal sepsis: Highlighting the principles of diagnosis and management

“…[21,22] Osteomyelitis, although uncommon, is another consideration in a neonate suspected of sepsis, and may be accompanied by positive blood cultures in severe disease. [24] Pathogenic organisms and contaminants…”

“…[1,[3][4][5] The majority of LOS (70%) in the developed world is due to Gram-positive infections, [1,3,25] with CoNS, [6] Staphylococcus aureus, Enterococcus spp., and GBS being most common in VLBW infants. [3] Approximately 18 -20% of LOS is due to Gram-negative infections (mostly Enterobacteriaceae spp.…”

“…[3] LOS is mainly caused by Grampositive organisms, such as CoNS, [6] S. aureus, S. pneumoniae and S. pyogenes, [3] although the proportion of LOS caused by Gram-negative organisms is rising. [25] An SA study published in 2005 reported that Gram-negative organisms (E. coli) are responsible for the majority of EOS, and Gram-positive organisms (CoNS, Enterococcus faecalis, viridans streptococci) are the major contributors to LOS (57.9%). [8] This contrasts with two more recent SA studies, which reported that LOS and healthcare-associated infections are predominantly due to Gram-negative organisms, such as Acinetobacter spp., Klebsiella spp., Enterobacter spp., and E. coli (46.1 -48.2%).…”

“…If a unit has a high incidence of methicillinresistant S. aureus (MRSA), oxacillin may be substituted with vancomycin. [24] …”

“…[22] Osteomyelitis must be treated for a total duration of 4 -6 weeks with intravenous antimicrobials; however, a longer duration of therapy is recommended if the causative organism is S. aureus (methicillin-sensitive or resistant). [24] …”