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Reassessment of Etiologic Agents and Their Clinical Characteristics

Howard Faden, MD; Mauro Grossi, MD

Am J Dis Child. 1991;145(1):65-69.

Abstract
• One hundred thirty-five children with acute osteomyelitis were identified by chart review during a 7-year period, January 1, 1980, through December 31, 1986. Bacteriologic causes were detected in 75 (55%) of the patients. Staphylococcus aureus, Haemophilus influenzae type b, and Pseudomonos aeruginosa were identified in 34 (25%), 16 (12%), and eight (6%) children, respectively. Staphylococcus aureus occurred in all age groups, H influenzae type b occurred only in children younger than 3 years and was the number one cause of disease in this group. Pseudomonas aeruginosa occurred exclusively in children older than 9 years. Children with H influenzae type b had clinical and laboratory findings that were almost indistinguishable from a matched group of children with osteomyelitis due to other known bacteria, although children with H influenzae type b tended to have more joint effusions (63% vs 27%), less lower extremity disease (22% vs 70%), and fewer positive cultures from bone or joint aspirates (41% vs 89%). Unlike most pediatric cases of osteomyelitis, the ones due to P aeruginosa did not represent the hematogenous route of infection; penetrating injury to the foot was present in every case. Children with P aeruginosa infections were older than 9 years (100%), predominantly male (88%), often afebrile (83%), and never bacteremic. These data provide guidelines for the initial work-up and management of osteomyelitis in children.

(AJDC. 1991;145:65-69)

Author Affiliations
From the Divisions of Infectious Diseases and Hematology/Oncology, Department of Pediatrics, State University of New York, School of Medicine at Buffalo, and Children's Hospital of Buffalo (NY).

Footnotes
Accepted for publication June 4,1990.

Reprint requests to Division of Infectious Diseases, Children's Hospital of Buffalo, 219 Bryant St, Buffalo, NY 14222 (Dr Faden).

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