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Int. J. Environ. Res. Public Health 2017, 14(5), 477; doi:10.3390/ijerph14050477

Epidemiology and Management of Acute Haematogenous Osteomyelitis in a Tertiary Paediatric Center

1
Paediatric Infectious Disease Unit, Anna Meyer Children’s University Hospital, Florence 50100, Italy
2
Orthopedics and Traumatology Department, Anna Meyer Children’s University Hospital, Florence 50100, Italy
3
Department of Pediatrics, Anna Meyer Children’s University Hospital, Florence 50100, Italy
4
Meyer Health Campus, Anna Meyer Children’s University Hospital, Florence 50100, Italy
*
Author to whom correspondence should be addressed.
Academic Editor: Paul B. Tchounwou
Received: 12 December 2016 / Revised: 11 April 2017 / Accepted: 20 April 2017 / Published: 4 May 2017
(This article belongs to the Section Global Health)
View Full-Text   |   Download PDF [310 KB, uploaded 4 May 2017]

Abstract

Background: Paediatric acute hematogenous osteomyelitis (AHOM) is a serious disease requiring early diagnosis and treatment. To review the clinical presentation, management and organisms responsible for AHOM, and to explore risk factors for complicated AHOM, a large cohort referring to a single center over a 6-year period was evaluated. Methods: Data from children with AHOM, hospitalized between 2010 and 2015, and aged > 1 month, were retrospectively collected and analyzed. Results: 121 children (median age 4.8 years; 55.4% males) were included. Fever at onset was present in 55/121 children (45.5%); the lower limb was most frequently affected (n = 68/121; 56.2%). Microbiological diagnosis (by culture and/or polymerase chain reaction (PCR)) was reached in 33.3% cases. Blood and pus/biopsy culture sensitivities were 32.4% and 46.4%, respectively. PCR sensitivity was 3.6% (2/55) on blood, and 66.6% (16/24) on pus/biopsy sample. Staphylococcus aureus was the most commonly identified pathogen (n = 20); no methicillin-resistant Staphylococcus aureus (MRSA) was isolated, 10.0% (n = 2) strains were Panton-Valentine-Leukocidin (PVL) producer; 48.8% (59/121) cases were complicated. At univariate analysis, factors associated with complicated AHOM were: recent fever episode, fever at onset, upper limb involvement, white blood count (WBC) ≥ 12,000/µL, C reactive protein (CRP) ≥ 10 mg/L, S. aureus infection. At multivariate analyses S. aureus infection remained the only risk factor for complicated AHOM (aOR = 3.388 (95%CI: 1.061–10.824); p-value = 0.039). Conclusions: In this study microbiological diagnosis was obtained in over one third of cases. Empiric treatment targeting methicillin-sensitive Staphylococcus aureus seems to be justified by available microbiological data. View Full-Text
Keywords: acute haematogenous osteomyelitis; children; antibiotic therapy; outcome acute haematogenous osteomyelitis; children; antibiotic therapy; outcome
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).

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MDPI and ACS Style

Chiappini, E.; Camposampiero, C.; Lazzeri, S.; Indolfi, G.; De Martino, M.; Galli, L. Epidemiology and Management of Acute Haematogenous Osteomyelitis in a Tertiary Paediatric Center. Int. J. Environ. Res. Public Health 2017, 14, 477.

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