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Uruguayan Medical Journal

ISSN: 1688-0390

Vol.24 - Nº 4 - Dic. 2008

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Etiology and clinical features of osteoarticular infections in children hospitalized at the Pediatric Hospital of the Pereira Rossell Health Care Center from 2003 through 2005

Rev Med Urug 2008; 24: 230-237
Full text (spanish) |  Full text (spanish) (New windows, pdf) | Abstract


Introduction: in the year 2001 an increase in isolation frequencies of methicillin-resistant Staphylococcus aureus (CA-MRSA) was observed in children with communityacquired infections. We need to know the epidemiology and clinical presentation of osteoarticular infections in order to adapt therapeutic recommendations.

Objective: to describe etiology, clinical features and evolution of children hospitalized with osteoarticular infections at the Pediatric Hospital of the Pereira Rossell Health Care Center.

Method: the study included children hospitalized from January 1, 2003 through December 31, 2005, with a discharge diagnosis of osteomyelitis, osteoarthritis or septic arthritis. The following were considered for case definition: clinical features, bone centellogram findings, blood or bone culture isolated germ, or both cultures or articular isolated germ. Etiology, clinical features, evolution and treatment were analyzed.

Results: 106 children were included, average age was 7 years old. The germ was isolated in 56 (52%):41% methicillin- sensitive Staphylococcus aureus (n=23), community 27% acquired methicillin-resistant Staphylococcus aureus (n=15), S. pneumoniae 14% (n=8), S. pyogenes 5.5% (n=3), others 12.5% (n=7).

When compared with other etiologies, children with community acquired methicillin-resistant Staphylococcus aureus showed the most serious clinical presentation: pandiaphysis (n=7), multiple foci (n=1), deep venous thrombosis and pulmonarthromboembolism (n=2). 15 children required surgical drainage; and hospitalization time was longer ( average 31 versus 13 days) and more sequels (6 versus 1). Two deaths corresponded to children with this etiology.

Conclusions: community acquired methicillin-resistant Staphylococcus aureus constitutes a new agent in osteoarticular infections in children in our country. Upon clinical suspicion of this infection, it is necessary to insist on performing bone puncture as a diagnostic procedure, and to initiate empirical administration of antibiotics that are appropriate for this agent.