Abstract
Background and objectives: Paediatric acute osteomyelitis (AO) may result in major life-threatening and limb-threatening complications if not recognized and treated early. The management of AO may depend on local microbial prevalence and virulence factors. This study compares the approach to paediatric AO in hospitals in two countries—Latvia and Norway. Materials and Methods: The study includes patients with AO hospitalized in the paediatric department in the Norwegian hospital Sørlandet Sykehus Kristiansand (SSK), in the period between the 1st of January 2012 and the 31st of December 2019. The results from SSK are compared to the results of a published study of AO in patients hospitalized at the Children’s Clinical University Hospital (CCUH) in Riga, Latvia. Results: The most isolated pathogen from cultures in both hospitals was S. aureus (methicillin-sensitive). The lower extremity was the most affected body part (75% in CCUH, 95% in SSK), the main clinical symptom was pain (CCUH 92%, SSK 96.6%). Deep culture aspiration was most often taken intraoperatively in CCUH (76.6%) and percutaneously in SSK (44.8%). Oxacillin was the most applied antibiotic in CCUH (89.4%), and Cloxacillin in SSK (84.6%). Combined treatment with anti-Staphylococcal penicillins and Clindamycin was administered in 25.5% and 33.8% of CCUH and SSK patients, respectively. The median duration of the intravenous antibacterial treatment in CCUH and SSK was 15 and 10 days, respectively, and a switch to oral therapy was mainly made at discharge in both hospitals. The median total duration of antibiotic treatment was 25 days in CCUH and 35 days in SSK. 75% of CCUH and 10.3% of SSK patients were treated surgically. Complications were seen in 47% of patients in CCUH and in 38% in SSK. Conclusions: The transition to oral antibacterial treatment in both hospitals was delayed, which suggests a lack of criteria for discontinuation of intravenous therapy and could potentially contribute to longer hospitalization, higher cost of treatment and risk of complications. The use of more invasive techniques for deep culturing and significantly more common surgical interventions could possibly be linked to a higher complication rate in AO patients treated at the Latvian hospital.
Highlights
Paediatric musculoskeletal infections are a wide spectrum of disorders that may result in major life-threatening and limb-threatening complications if they are not recognized and treated early [1,2,3]
The data were compared with the published results of a similar study conducted in the Children’s Clinical University Hospital (CCUH) in Riga, Latvia: “Epidemiology and Antibacterial Treatment of Acute Hematogenous Osteomyelitis in Patients Hospitalized at Children’s Clinical University Hospital in Riga, Latvia” [35], including paediatric patients with acute osteomyelitis admitted to CCUH between the 1st of January 2014 and the 31st of December 2017
Though great efforts have been made to reach a consensus regarding the development of evidence-based guidelines for the diagnosis and management of musculoskeletal infections in children [1,3], little evidence was obtained from randomized control studies with large patient populations [3], as acute osteomyelitis in children living in developed countries is rare [6,7,8]
Summary
Paediatric musculoskeletal infections are a wide spectrum of disorders that may result in major life-threatening and limb-threatening complications if they are not recognized and treated early [1,2,3]. Acute haematogenous osteomyelitis (AHO), an inflammation and destruction of a bone caused by bacterial seeding through bacteraemia, is the most common among paediatric musculoskeletal infections [4,5]. The causative microorganisms can vary in different populations, where they depend on vaccination programmes and regional antibacterial susceptibility, and techniques used for microbial culturing and identification can affect the prevalence of isolated bacteria [17]. Kingella kingae is a major cause of paediatric AHO in children younger than 4 years, in whom this pathogen can be isolated more frequently than S. aureus if molecular diagnostic methods are applied [18,20]. The use of more invasive techniques for deep culturing and significantly more common surgical interventions could possibly be linked to a higher complication rate in AO patients treated at the Latvian hospital
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