Acute Hematogenous Osteomyelitis

Abstract

A review of all the patients with acute hematogenous osteomyelitis admitted to Charity Hospital during the period. January 1, 1956, to May 1, 1959, was undertaken to verify the clinical impression that this disease is increasing in frequency and changing in character. Sixty-six patients were seen during this time and are included in this study. A significant increase in the incidence of acute hematogenous osteomyelitis has occurred in southern Louisiana over the past four years. This increase in incidence has been ascribed to the increasing number of bacteria resistant to the usual antibiotics and particularly to the resistance of Staphylococcus aureus to penicillin. In contrast to previous reports the sex distribution in the series was almost equal. Twenty-three per cent of the patients were one year of age or less. Staphylococcus aureus was identified in 90 per cent of the patients in whom positive cultures were obtained. Streptococcus hemolyticus , contrary to many early reports, was not identified as the etiological organism in any of the infants. One-third of our patients were admitted with a very mild form of this disease and had no significant fever or other systemic manifestations. Treatment consisted in antibiotics, immobilization, and surgery when indicated. Despite what was considered adequate treatment in almost every instance, chronic osteomyelitis developed in 29 per cent of the patients in this study who were adequately followed. It is our impression that early but inadequate antibiotic treatment caused an increased tendency to the development of chronic osteomyelitis. Additional emphasis should be placed upon the basic orthopaedic principle of immobilization. In this survey complications developed in the majority of the patients who were not treated initially by immobilization. Antibiotics have unquestionably decreased both the mortality and morbidity associated with acute hematogenous osteomyelitis. Nevertheless, as more bacteria become resistant to our common antibotics, the incidence of chronic osteomyelitis will continue to increase. Perhaps more liberal utilization of early incision and drainage in those cases which are prone to become chronic, as evidenced by slow indolent progression of the local lesion, may improve the present results.