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Osteomyelitis in Paediatric Patients: Epidemiology, Pathogenesis and Management of 94 Cases

Background: Acute hematogenous osteomyelitis (AHO) has a currently declining incidence in developed countries. It can cause rapid destruction that can lead to functional impairment or even death if misdiagnosed and not treated urgently. The objective of this study is to identify the main factors that may lead to a poor outcome and to establish a profile of the patient suffering from AHO that might have a negative outcome. Methods: A retrospective single centre study was conducted, evaluating data from the medical records of 94 patients that suffered from AHO, in a 10 years interval. Complete medical history including age at diagnosis, sex, socioeconomic status, symptoms, entry site, pathogen agent, location of infection, radiological features, treatment and outcome were recorded. A male predominance was observed and boys from rural area are more prone to have a bad outcome, because of the fact that boys are more exposed to trauma, and, in rural areas, they do not benefit from a proper access to emergency medical care. Staphylococcus aureus was the most common bacteria, testing positive in 84 cases. The treatment of AHO is long lasting and complex. It consists of appropriate antimicrobial therapy and may require surgical incision and drainage, debridement for removal of all infective and necrotic material. Results: Disease evolution was towards chronicity in the cases that were diagnosed late. The most frequent complications were sepsis and pathological fractures. Patients that had a negative outcome were characterized by young age, repeated negative cultures, delayed surgery, rural provenience and masculine sex.