The Epidemiology of Osteomyelitis in Children.

Nike Walter,Volker Alt,Susanne Bärtl,Markus Rupp

doi:10.3390/children8111000

Abstract

Pediatric osteomyelitis remains challenging to treat. Detailed epidemiological data are required to estimate future developments. Therefore, we aimed to analyze how the incidence has changed over the last decade depending on age, gender, osteomyelitis subtype, and anatomical localization. Cases were quantified for patients aged 20 years or younger, using yearly reported ICD-10 diagnosis codes from German medical institutions for the time period 2009 to 2019. Incidence rates of osteomyelitis increased by 11.7% from 8.2 cases per 100,000 children in 2009 to 9.2 cases per 100,000 children in 2019. The age-specific incidence rate revealed the highest occurrence of osteomyelitis in patients aged 10–15 years (15.3/100,000 children), which increased by 23% over the observation period, followed by the age group 5–10 years (9.7/100,000 children). In 2019, out of all diagnoses, 39.2% were classified as acute, 38.4% as chronic, and 22.4% were unspecified, whereby chronic cases increased by 38.7%. The lower extremity was mainly affected, with 58.9% of osteomyelitis diagnoses in 2019. In conclusion, pediatric osteomyelitis is a serious issue, even in a developed and industrialized country such as Germany. Considering the recent incidence increase, the permanent need for appropriate treatment should let pediatricians and orthopedic surgeons deal with diagnosis and treatment protocols.

Highlights

Osteomyelitis is one of the most prevalent musculoskeletal infections in children
The age-specific incidence rate per 100,000 children revealed the highest occurrence of osteomyelitis in patients aged 10–15 years (15.3/100,000 children), which increased by 23% over the observation period
This was followed by an incidence of 8.1/100,000 children aged younger than 1 year; whereby, less children were diagnosed with osteomyelitis in comparison to 2009 (−25.9%)

Summary

Introduction

Osteomyelitis is one of the most prevalent musculoskeletal infections in children. Bone infection is most commonly caused by Staphylococcus aureus and can occur as a hematogenous infection or after a direct inoculation of bacteria, for instance, due to surgery or open fractures [1,2]. Antibiotic treatment without surgical intervention is a feasible option in cases of acute osteomyelitis, which is regarded within 2 weeks after onset of symptoms. In chronic osteomyelitis, which is defined after more than 2 weeks after onset of symptoms, surgical treatments (including debridement and dead space management) are necessary to achieve eradication of infection [1]. Reliable data on the incidence of pediatric osteomyelitis is of great importance for the evaluation of advances in treatment approaches, prevention strategies, and future developments

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Discussion

Conclusion