Microbiological Evaluation of Paediatric Chronic Haematogenous Osteomyelitis in a Tertiary Care Hospital in Northern India and its Association with Radiological Appearance: A Retrospective Study

Abstract

Introduction: Chronic osteomyelitis in the paediatric age group is a frequent complication of improperly treated acute haematogenous osteomyelitis, leading to devastating complications such as pathological fractures and deformities in affected children. There is a growing need to comprehend the disease process and develop improved treatment strategies. Aim: To evaluate bacterial culture and antibiotic sensitivity patterns in children and adolescents with chronic haematogenous osteomyelitis in North India and to explore associations between radiological patterns and antibiotic sensitivity. Materials and Methods: The present retrospective study was conducted in the Department of Orthopaedics of tertiary care centre, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, North India, from July 2018 to June 2020. Total 100 children and young adolescents with chronic osteomyelitis who reported to OPD of hospital with pus discharge from an extremity persisting for more than six weeks, along with radiological features indicative of chronic osteomyelitis. Parameters such as site of infection, illness duration, blood parameters, bacteriological culture reports, etc., were examined. Radiological evaluation was performed using the Beit CURE (BC) classification. Data were analysed and represented in the form of frequencies and percentages. The Chi-square test was used to compare proportions, with significance set at p-value<0.05. Results: The median age of the study population was 13 years, there were 32 (32%) females and 68 (68%) males. The majority of cases (70%) belonged to the B1-B3 group. Staphylococcus aureus was responsible for 86 (86%) cases, followed by Pseudomonas aeruginosa in 7 (7%) cases. Out of the 86 Staphylococcus aureus (S. aureus) isolates, 58 (67.44%) were Methicillin-resistant Staphylococcus aureus (MRSA). Multidrug resistance was observed among gram-negative species, as well. Pseudomonas aeruginosa showed resistance to fluoroquinolones in 4 (57%) cases, aminoglycosides in 2 (28%) cases, and carbapenem in 1 (14%) case, which is considered highly effective in treating serious infections caused by multidrug resistant Gram-negative species. No significant association was found between drug sensitivity patterns and radiological features in the present study. Conclusion: Staphylococcus aureus remains the most predominant organism isolated from deep tissue cultures. Among S. aureus isolates, MRSA was the most frequently identified. Identifying the causative organism may be challenging in some cases. Among cases where the offending microbe was identified, drug resistance was widespread among both Gram-negative and Gram-positive specimens. No significant relationship was found between the radiological appearance of infected bone and the pattern of antibiotic resistance.