Two decades of acute hematogenous osteomyelitis in children: are there any changes?

Abstract

Our purpose was to compare the clinical course of acute hematogenous osteomyelitis (AHO) 20 years ago and today in the Department of Paediatric Surgery, Kaunas Medical University Hospital, Lithuania. Retrospective data analysis from patients aged 1-16 years with confirmed diagnosis of AHO was performed. The data were collected from 1982 to 2003. The incidence of AHO per year for 1,00,000 children (0-16 years) was analyzed for that period. The patients were divided into two groups-group A, treated in 1982-1983, and group B, treated in 2002-2003. The number of patients, patient age, duration of illness, complications, and length of hospital stay were compared using statistical methods for nonparametric data analysis (Mann-Whitney U test, chi-square criterion). Linear regression was used for incidence analysis. Population data were obtained from the Lithuanian Statistics Department. From 1982-2003, 758 patients were treated. The incidence of AHO increased from 1982. There was no statistically significant difference between the periods 1982-1983 and 2002-2003 in median patient age (10.36 and 10.72 years, respectively), in gender proportion (20.4% and 29.8% of the cases were girls), or in median duration of symptoms until admission (4 days and 3 days, respectively, p=0.058). Median hospital stay and duration of antibiotic therapy were longer in the period 1982-1983 (50 days and 43 days) than during 2002-2003 (29 days and 29 days). The differences in frequency of positive blood cultures (36.4% in group A and 64.9% in group B, p=0.046) and frequency of periosteal abscess (40.8% in group A and 19.3% in group B, p=0.015) were statistically significant. An increase in AHO incidence is seen when comparing contemporary data and the data from two decades ago, but nowadays the clinical course is less complicated and is marked by shorter hospital stays and shorter duration of antibiotic therapy.

Trends in the Epidemiology of Osteomyelitis

“…The most common etiology in children is hematogenous infections. Previous studies from Norway 32,33 and Lithuania 34 have noted an annual incidence of approximately ten to fourteen cases of hematogenous osteomyelitis per 100,000 children. On the other hand, a lower incidence of acute hematogenous osteomyelitis has been reported in Scotland in two separate studies of the Glasgow population between 1970 and 1997, with an annual incidence of 2.9 new cases per 100,000 population 35,36 .…”

Antibiotic treatment for acute haematogenous osteomyelitis of childhood: Moving towards shorter courses and oral administration

“…During the past 10 years or so, evidence has been accumulating that AHOM could be treated with shorter courses [71,72], at least in industrialised countries where patients present early (usually within 1-4 days). Few prospective trials have been performed (Table 2).…”

Some aspects of long-term results of treatment of acute hematogenous osteomyelitis

“…Our treatment strategy for AHO differs from the United States and Western Europe due to different clinical course (3). Almost all our patients (18 of the 19) were operated on.…”

“…However, the prevalence of AHO in some of Eastern Europe countries is still high (3), and there is a large number of former patients who might have complaints and sequelae after AHO. This number might be even higher than after surgery due to congenital anomalies or after other serious pediatric conditions.…”