Epidemiology and Antibacterial Treatment of Acute Hematogenous Osteomyelitis in Patients Hospitalized at Children’s Clinical University Hospital in Riga, Latvia

Abstract

Abstract Introduction.Acute hematogenous osteomyelitis (AHO) is one of the most serious bacterial infections in children that may result in severe complications, such as sepsis, septic shock, bone and joint destruction, disruption of longitudinal bone growth, and even death. Early recognition and evaluation of severity of AHO, awareness of the local prevalence of different microorganisms, as well as timely initiated adequate treatment are crucial for prevention of serious complications. Aim of the Study. To identify the main causative agents of AHO and their antibacterial susceptibility, and to evaluate the applied treatment strategies of AHO in pediatric patients in Clinical Children’s University Hospital (CCUH) in Riga, Latvia. Material and methods. All patients diagnosed with AHO and treated at CCUH were included in retrospective, descriptive study conducted between 1st of January 2014 and 31st of December 2017. Results. The main causative agent for AHO in the study patients was methicillin-sensitive Staphylococcus aureus (MSSA), which was isolated from blood cultures of 40% (n=24) of patients and from 79% (n=57) of intraoperative cultures. The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) was low (found only in one patient, or 1.4%). Thirteen different antibiotics were applied for treatment of AHO, of which Oxacillin was the most common (received by 89.4% of patients). In 57% of cases (n=54) the patients received monotherapy, and 43% of patients (n=40) received a combination of two or more antimicrobials. The most commonly used combination of antibiotics was Oxacillin plus Clindamycin, which was applied in 25.5% of cases (n=24). In 77% of cases (n=72). a transition from one antibiotic to another was observed. On discharge, oral treatment with Cefuroxime or Clindamycin was most commonly prescribed (in 52.5% and 36% of cases, respectively). The total duration of treatment varied between 5 and 20 days, with a median of 25 days. Conclusions. The main causative agent of acute hematogenous osteomyelitis in children treated at Children’s Clinical University Hospital was Methicillin-sensitive Staphylococcus aureus (MSSA). The prevalence of MRSA at CCUH was very low, which must be considered when prescribing empirical antibacterial treatment, giving preference to narrow spectrum antibiotics. Establishment of local guidelines for management of AHO in children at CCUH, including necessary investigations, treatment algorithm for inpatient and outpatient use with defined duration of treatment and time of conversion to oral antibiotics, follow-up and clinical endpoint criteria, and information for parents or carers.