Treatment and Clinical Outcomes of Osteoarticular Infections Among Pediatrics Admitted to Jimma University Medical Center, Ethiopia: A Prospective Observational Study

Abstract

Background: Despite the high burden of osteoarticular infections in sub-Saharan Africa, there is a paucity of data regarding the osteoarticular infections management approach and clinical outcomes in the region. Hence, this study aimed to evaluate a management protocol, clinical outcomes, and its determinants among pediatric patients with osteoarticular infections. Methods: A pediatric patient admitted to Jimma University Medical Center (JUMC), Ethiopia, with a diagnosis of osteoarticular infections was enrolled prospectively from April 30 to October 30, 2019. Clinical characteristics, management modality, and inhospital complications were recorded from admission to discharge. Data were analyzed by using SPSS v.23 and the p-value <0.05 was considered statistically significant. Results: Among a total of 150 pediatric patients enrolled in this study, osteomyelitis was diagnosed in 111 (74%), while the rest 39 (26%) had septic arthritis. The majority 105 (70%) of the study participants were male with a mean age of 8.79 ± 4.2 years. The culture was performed for only 3.6% of the patients. Almost all (98.7%) of the patients received intravenous (IV) antibiotics, and ceftriaxone was the most common IV antibiotic used as a monotherapy 66 (44.6%) or in combination with metronidazole 47 (31.8%) or gentamicin (12.8%). Almost half (45.3%) of the patients had poor treatment outcomes. Factors associated with poor treatment outcome were comorbidity [AOR=3.3, 95% CI (1.08-10.16)] and use of combination antibiotics [AOR=2.9, 95% CI (1.16-7.3)]. Rural residence [AOR=0.39, 95% CI (0.168-0.92)] and surgical interventions [AOR=0.29, 95% CI (0.006-0.144)] were associated with good treatment outcomes. Conclusion: Almost half of pediatric patients with osteoarticular infections had poor treatment outcome. Health providers should increase the accessibility of microbiological tests and diagnostic imaging, which can guide treatment decisions and improve outcomes of patients with osteoarticular infections.

Magnitude of chronic osteomyelitis and its associated factors in children as diagnosed on X-ray visiting at Felege Hiwot Comprehensive Specialized Hospital, Northwest Ethiopia: A cross-sectional study

“… 10 – 12 COM is also a problem and a challenge to the orthopedic surgeons and the health facilities, as it is never truly cured. 13 …”

“…[10][11][12] COM is also a problem and a challenge to the orthopedic surgeons and the health facilities, as it is never truly cured. 13 In Ethiopia, COM accounted for 30% of admissions to Tikur Anbessa Specialized Hospital (TASH), Addis Ababa, Ethiopia. 9 Despite the significant burden imposed by COM, little research has been conducted in Ethiopia.…”

Factors associated with dissemination and complications of acute bone and joint infections in children

“…6,7 In sub-Saharan Africa, a study by Mamo et al in Ethiopia found that poor outcomes were associated with the presence of a comorbidity and the use of combination antibiotics (ceftriaxone and metronidazole). 8 Mue et al in Nigeria suggested that complications in their cohort of patients may be due to a long duration of symptoms and delay in treatment, underlying systemic and immunosuppressive illnesses, joint site (especially hip and shoulder), and the virulence of the organisms (e.g., Staphylococcus aureus and Gram-negative bacilli). 9 Unfortunately, no univariate analyses were performed on these proposed associations.…”