Current Data on Acute Hematogenous Osteomyelitis in Children in Southern Israel: Epidemiology, Microbiology and Influence on Clinical Decisions

Cohen Eugen 1 Vodonos Alina 2 Lipshitz Karin 3 Leibowitz Eugene 3
1Orthopaedics, Soroka Medical Center,Ben Gurion University, Israel, Israel
2Center for Medical Research, Soroka Medical Center,Ben Gurion University, Beer Sheva, Israel
3Pediatrics, Soroka Medical Center,Ben Gurion University, Beer Sheva, Israel

Background: The prevalence, etiology and outcome of AHO may vary from region to region and period to period. The study objectives were to define the haracteristics and treatment consequences of AHO in children in southern Israel.

Methods: a retrospective cohort study, enrolling all children

Results: Ninety -one patients were diagnosed with AHO during 2005-2012. The incidence was 5.6:100,000 with differences between Jewish and Bedouin Populations The most involved bone was tibia (39.6%), followed by femur (19.8%), humerus (8.8%) . The most common pathogen was methicillin-susceptible Staphylococcus aureus (MSSA, 18 patients, 19.8%). There was only one case of methicillin- resistant Staphylococcus aureus (MRSA). More positive cultures were recorded among children requiring surgery compared to children treated conservatively (P<0.01). MSSA representation in cases requiring surgical intervention was higher than in cases treated conservatively (P=0.01).. Humeral AHO required most frequently surgical intervention and longer hospitalization.

Conclusions: The presentation of AHO is often atypical .57.8% of our patients were afebrile on admission. . There is a high variability in AHO microbiology . The most frequent pathogen was MSSA but in absolute number , in less than fifth of cases . The rarity of MRSA and Kingella Kingae was a surprise. Thus emphasizes the need to obtain bone cultures . In our series we found that radiological signs of osteomyelitis and positive blood cultures were associated with higher requirement for surgical intervention . During the study period magnetic resonance imaging (MRI) was not available to use on an emergency basis .It is possible that regular use of MRI may allow faster diagnosis and therefore may influence the outcomes of AHO, a hypothesis that should be confirmed in the future .