Bactériologie des ostéomyélites de l’enfant drépanocytaire au CHU de Tokoin (Togo) : tentative d’évaluation et thérapeutiques

Abstract

Osteomyelitis in children with sickle cell disease has been caused mainly by salmonella species, but in recent years, greater variation has resulted in other bacteria sometimes heading this list. We conducted this survey to determine the present distribution of causative bacteria, to improve initial probabilistic antibiotic therapy. This retrospective survey reviewed files of children hospitalised during the 8-year period from 1998 to 2005 for osteomyelitis who had haemoglobinopathy SS or SC. In all, we identified 32 patients (mean age: 6.5 years) - 22 boys and 10 girls, 18 with SS and 14 SC. Eleven children with haemoglobinopathy AS were not included. Thirteen children had acute osteomyelitis and 19 chronic osteomyelitis. Bacteriological research included blood cultures, needle aspiration or biopsy, and cytobacteriological examination of pus. Of 4 blood cultures, one was positive. Only one needle aspiration was performed, and it was positive. Pus was examined in 19 cases and positive in 16 (84%). No bacteriological research was performed in 8 of the cases (25%) of acute osteomyelitis. Staphylococcus accounted for 22% of the bacteria identified, salmonella for 19% and Pseudomonas aeruginosa for 6%. Initial probabilistic antibiotic therapy for osteomyelitis in children with sickle cell disease must target staphylococcus and salmonella, preferably by combining a third-generation cephalosporin and aminoglycoside. Systematic bacteriological testing will provide a more reliable selection and improve initial treatment.