The clinical profile of childhood osteomyelitis: A Saudi experience

Article type: Research Article

Authors: Al Zamil, Fahad A. | Al Saadi, Muslim M. | Bokhary, Nada A. | Al Shamsa, Laila | Al Alola and, Sulaiman | Al Eissa, Yousef

Affiliations: Department of Pediatric, College of Medicine, King Khalid University Hospital, Riyadh, Saudi Arabia | Department of Pediatric, College of Medicine, King Fahad National Guard Hospital, Riyadh, Saudi Arabia

Note: [] Correspondence: Dr. Fahad A. Al Zamil, Department of Pediatrics, College of Medicine, King Khalid University Hospital, P. O. Box 2925, Riyadh 11461, Saudi Arabia. Tel.: +9661 4670547; Fax: + 9661 4672650; E-mail: [email protected]

Abstract: Our aim is to study the demographic features, clinical presentations, laboratory and radiographic findings, management, and outcome of children with acute osteomyelitis in Kingdom of Saudi Arabia. A retrospective chart review study of children 14 years of age and younger, with acute osteomyelitis hospitalized in King Fahad National Guard Hospital, Riyadh during the 10-years period, and January 1997 through December 2006. Seventy-five patients (67% males), aged 9 days to 12 years of age, were studied. The peak incidence rate of osteomyelitis was during the first year of life. Pain, fever and localized signs were the most frequent symptoms and signs. The white blood cell count and erythrocyte sedimentation rate were elevated in 27% and 87% of cases respectively. Cultures of blood and tissue were positive in 27% and 73% of patients respectively. Staphylococcus aureus was the commonest causative agent, isolated from 55% of patients. No methicillin-resistant S. aureus was recovered from these patients. Abnormal plain radiographs were seen in 54%, positive skeletal scintigraphy in 93%, and diagnostic magnetic resonance imaging in 100% of cases in whom these investigations were performed. The most commonly involved bones were those of the lower extremities (76%). The majority of patients (38%) were initially treated with either intravenous cloxacillin or cefuroxime. In all patients infected with S. aureus the intravenous therapy was followed by oral first generation cephalosporin's until the 3 weeks course was completed. In patients infected with other organisms appropriate antibiotic therapy directed by susceptibility testing was initiated. The infection resolved in 73 (97%) of children and persisted in two (3%). Our data indicate that acute osteomyelitis is as common in young infants of this series from Kingdom of Saudi Arabia as it is from other parts of the world. The early diagnosis and administration of appropriate antimicrobial therapy results in good outcome.

Keywords: Acute osteomyelitis, children, S. aureus, skeletal scintigraphy, MRI

Journal: Journal of Pediatric Infectious Diseases, vol. 3, no. 4, pp. 235-240, 2008