Haematogenous acute and subacute paediatric osteomyelitis

Abstract

A delay in the diagnosis of paediatric acute and subacute haematogenous osteomyelitis can lead to potentially devastating morbidity. There are no definitive guidelines for diagnosis, and recommendations in the literature are generally based on expert opinions, case series and cohort studies. All articles in the English literature on paediatric osteomyelitis were searched using MEDLINE, CINAHL, EMBASE, Google Scholar, the Cochrane Library and reference lists. A total of 1854 papers were identified, 132 of which were examined in detail. All aspects of osteomyelitis were investigated in order to formulate recommendations. On admission 40% of children are afebrile. The tibia and femur are the most commonly affected long bones. Clinical examination, blood and radiological tests are only reliable for diagnosis in combination. Staphylococcus aureus is the most common organism detected, but isolation of Kingella kingae is increasing. Antibiotic treatment is usually sufficient to eradicate the infection, with a short course intravenously and early conversion to oral treatment. Surgery is indicated only in specific situations. Most studies were retrospective and there is a need for large, multicentre, randomised, controlled trials to define protocols for diagnosis and treatment. Meanwhile, evidence-based algorithms are suggested for accurate and early diagnosis and effective treatment.

Akute hämatogene Osteomyelitis im Wachstumsalter

“…Die SA gilt daher als orthopädischer Notfall und bedarf einer sofortigen chirurgischen Intervention [3]. [2,6,14,15].…”

“…Einige Studien propagieren eine frühe Untersuchung 3 Wochen vor Ende der antibiotischen Therapie, anschließend Kontrollen nach 6 und 12 Wochen und 6 und 12 Monaten. Eine Nachsorge über 1 Jahr ist auf jeden Fall indiziert, da Folgeschäden wie Wachstumsstörungen durch Defektheilung erst im Verlauf und mit dem Längenwachstum auftreten [2,5,28]. …”

Osteomielitis pélvica en una paciente de 15 años. Presentación de un caso

“…Case report y de 1 cada 500 a 2300 niños en los países en vías de desarrollo. 1 En los niños, la osteomielitis hematógena aguda suele afectar los huesos tubulares largos. 2 Es más frecuente en los varones que en las niñas, y la mayoría de los niños con osteomielitis son menores de 5 años.…”

Misconceptions about childhood acute osteomyelitis

“…It is logical, therefore, to advise 3-5 days of intravenous administration followed by 3 weeks of oral administration, monitoring the response on clinical and simple laboratory grounds. Dartnell et al's [6] recent review of paediatric osteomyelitis suggested that ''the duration and route of antibiotic treatment are debatable'' and commented that there was only one prospective randomised study on this subject.…”