Characteristics and outcomes of osteomyelitis in children with sickle cell disease: A 10‐year single‐center experience

Abstract

Background Patients with sickle cell disease (SCD) are at increased risk for osteomyelitis (OM). Diagnosis of OM in SCD is challenging as the clinical presentation is similar to a vasoocclusive crisis (VOC) with no diagnostic gold standard. We report characteristics and outcomes of OM in SCD patients treated at our center over 10‐year period. Design/Method We conducted a retrospective analysis of patients with SCD who were treated for OM at our center over a 10‐year period (2006‐2016). Cases were identified utilizing radiology data mining software. Radiology reports and medical charts of potential OM cases were reviewed. Results Twenty‐eight children with SCD were treated for OM at our institution. Patients treated for OM were largely similar to patients treated for a VOC. However, patients treated for OM had significantly higher C‐reactive protein (10 mg/dL vs 5.58 mg/dL, P = 0.03) and erythrocyte sedimentation rate (60 mm/h vs 47 mm/h, P = 0.02). Magnetic resonance imaging (MRI) findings were consistent with OM in 18 (64%) patients and indeterminate in the remaining. Based on clinical, laboratory, and radiological findings, the diagnosis of OM was considered confirmed in 3 patients, probable in 6 patients, and presumed in 19 patients. Nontyphoidal Salmonella was isolated from cultures in 9 (32%) patients, while no organism was identified in 19 (67%) patients. All patients were treated with antibiotics. Six patients (21%) required surgical interventions. Conclusions OM continues to pose diagnostic challenges. Most patients are treated for OM without definitive confirmation. Nontyphoidal Salmonella was the only organism identified in our cohort.

Osteomyelitis in sickle cell disease: You know it when you see it?

“…Furthermore, patients not treated for osteomyelitis, presumed VOC, were more likely to have an indeterminate MRI. 3 Both of these studies highlight the difficulty in making a diagnosis of osteomyelitis in SCD and how the decision to treat is influenced by many factors. If the gold standard for diagnosing osteomyelitis is both positive bone culture and histopathologic confirmation of bone tissue, 4 only a combined nine of the 66 patients (13%) treated for osteomyeli- While we often urge our orthopedic consultants to obtain a tissue diagnosis, there can be reluctance to go to the operating room.…”

“…In addition, a recently published study by Weisman et al 3 approached the identification of osteomyelitis cases in the reverse direction. The authors presented data from a large, single‐institution, retrospective cohort of patients with SCD treated for osteomyelitis over a 10‐year period.…”

“…They found that patients who were treated for osteomyelitis were more likely to have an elevated CRP and ESR than patients not treated for osteomyelitis. Furthermore, patients not treated for osteomyelitis, presumed VOC, were more likely to have an indeterminate MRI 3 …”

Microbiology and radiographic features of osteomyelitis in children and adolescents with sickle cell disease

“…While there are no standard diagnostic criteria for OM, isolation of a bacterial pathogen from the suspected site of infection or from blood in a patient with clinical and radiographic findings consistent with OM is highly suggestive 8 . Staphylococcus aureus is the most common cause of OM in children, while Salmonella species are a unique cause in children with SCD 9‐12 . Less commonly, other enteric pathogens have been described as the cause of osteoarticular infections in children with SCD, including Serratia, Enterobacter cloacae, Enterococcus faecium , and Pseudomonas aeruginosa 5 …”

“…8 Staphylococcus aureus is the most common cause of OM in children, while Salmonella species are a unique cause in children with SCD. [9][10][11][12] Less commonly, other enteric pathogens have been described as the cause of osteoarticular infections in children with SCD, including Serratia, Enterobacter cloacae, Enterococcus faecium, and Pseudomonas aeruginosa. 5 The epidemiology of invasive bacterial infections and the treatment of OM in general pediatrics have evolved over the past few decades.…”