Acute osteomyelitis in children: a population-based retrospective study 1965 to 1994.

Abstract

To investigate changes in occurrence, clinical features, laboratory and other investigations, aetiology and use of antibiotics, and to calculate the incidence of acute hematogenous osteomyelitis (AHO) in children up to 12 y of age in the county of Troms in the northern part of Norway. Retrospective chart review of 86 children, newborn to 11 y old. with AHO between 1965 and 1994. A constant yearly incidence (95% CI) of 0.1 (0.08-0.12) per 1000 children could be calculated (X2 for trend 0.51;p = 0.48). The female proportion (95% CI) was 0.6 (0.48-0.72). The median duration of complaints prior to admission was 4 days. Erythrocyte sedimentation rate (ESR; mean (95% CI)= 59 mm/h (52-66)) and C-reactive protein concentration (CRP; mean (95% CI)= 63 mg/l (36-90)) were elevated in 96% and 89%, respectively. Local and/or blood cultures were taken in 97%. In 55% an agent was found. Staphylococcus aureus (S. aureus) was responsible in 76%. The proportion of betalactamase-producing strains tended to increase (49%; X2 for trend 3.72; p = 0.054). In 78% the long bones of the upper or lower extremities were affected. Penicillin or ampicillin combined with cloxacillin or dicloxacillin was the preferred therapy. The median duration of antibiotic treatment was 7 weeks. The use of penicillin declined (p = 0.008), whereas that of cloxacillin/dicloxacillin increased (p < 0.001). The use of ampicillin was unchanged (p = 0.79). The study confirms reports from various epochs and remote regions concerning the unchanged characteristics of AHO in children, except for the high proportion of females in the present study. An incidence for childhood AHO in a defined geographical region is given.