A Retrospective Case-Series of Children With Bone and Joint Infection From Northern Australia

Abstract

Our clinical workload as infectious diseases pediatricians in northern Australia is dominated by complicated bone and joint infections in indigenous children. We reviewed the clinical presentation, microbiology, management, and outcomes of children presenting to Royal Darwin Hospital with bone and joint infections between 2010 and 2013, and aimed to compare severity and incidence with other populations worldwide.A retrospective audit was performed on children aged 0 to 18 years who were admitted to Royal Darwin Hospital between 1 January 2010 and 31 December 2013 with a bone and joint infection.Seventy-nine patients were identified, of whom 57 (72%) had osteomyelitis ± associated septic arthritis and 22 (28%) had septic arthritis alone. Sixty (76%) were indigenous Australians. The incidence rate of osteomyelitis for indigenous children was 82 per 100,000 children. Staphylococcus aureus was the confirmed pathogen in 43/79 (54%), of which 17/43 (40%) were methicillin resistant. Median length of stay was 17 days (interquartile range: 10–31 days) and median length of IV antibiotics was 15 days (interquartile range: 6–24 days). Fifty-six (71%) required at least 1 surgical procedure. Relapse within 12 months was documented in 12 (15%) patients.We report 3 key findings: osteomyelitis incidence in indigenous children of northern Australia is amongst the highest reported in the world; methicillin-resistant S aureus accounts for 36% of osteomyelitis with a positive microbiological diagnosis; and the severity of disease requires extended antibiotic therapy. Despite this, 15% of the cohort relapsed within 12 months and required readmission.

Skin infections in Australian Aboriginal children: a narrative review

“…Osteomyelitis in children most commonly originates from haematogenous S. aureus and occasionally S. pyogenes seeding, and is often preceded by skin infection . The incidence of osteoarticular infection in children in northern Australia is among the highest in the world, with Aboriginal children (incidence, 90 per 100 000 per year) having rates tenfold higher than non‐Aboriginal children (incidence, 9 per 100 000 per year) of children living in high income countries, where the incidence is reported to be 3–13 per 100 000 per year …”

Complications of Sepsis in Infant. A Case Report

“…In one study, Staphylococcus aureus was the causative organism in 54% of the cases of osteomyelitis and septic arthritis [13]. Also, similarly with the case presented here, the most affected part of the body, was the lower limb [13]. The function assessment at the follow-up was normal in 91% of the studied cases.…”

“…Infectious arthritis and acute osteomyelitis in children are usually a result of haematogenous bacterial spread, and the most frequent the causative agent is Staphylococcus aureus (80%), though others such as Streptococcus pneumoniae and Haemophilus influenza can be involved [13][14][15]. In one study, Staphylococcus aureus was the causative organism in 54% of the cases of osteomyelitis and septic arthritis [13]. Also, similarly with the case presented here, the most affected part of the body, was the lower limb [13].…”

Enterobacter cloacae osteoarticular infection without risk factors: Case report and review of the literature

“…The incidence of paediatric osteomyelitis in high‐income countries has been estimated at between 3 and 13 per 100 000. Australia reported one of the highest incidences of osteoarticular infections world‐wide among the indigenous children (90 per 100 000) compared to non‐indigenous children (9 per 100 000) …”

“…Australia reported one of the highest incidences of osteoarticular infections world-wide among the indigenous children (90 per 100 000) compared to non-indigenous children (9 per 100 000). 1 Staphylococcus aureus is the most common cause of septic arthritis overall, accounting for up to 80% of culture-positive cases 2 followed by Streptococcus pyogenes and Kingella kingae. Other organisms are relatively uncommon causes of acute osteomyelitis.…”