Retrospective Assessment of Subacute or Chronic Osteomyelitis in Children and Young Adults

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To identify factors associated with and to describe treatment outcomes of pediatric subacute or chronic osteomyelitis (S/CO), we retrospectively identified 52 patients with S/CO from January 1994 to November 1999 seen at a large pediatric hospital infectious disease clinic. S/CO was defined by the following: >10 days of clinical symptoms; radiographic, surgical, or pathologic changes consistent with S/CO; or relapse of prior osteomyelitis. Of these patients 63% were male, median age 9 years. Bones involved included vertebra (19% of subjects), femur (17%), finger (12%), humerus (10%), and tibia (8%). Sixty-five percent had at least 1 risk factor (most commonly hardware, neurologic disease or preceding trauma, sepsis, or surgery). Blood, bone, or wound aspirate cultures were positive in 67%, most commonly for Staphylococcus aureus. Erythrocyte sedimentation rate (ESR) was elevated in 88% of 41 patients at the time of diagnosis. Intravenous antibiotics were given for a median of 6 weeks and oral antibiotics for a median of 4.5 months. One child had a complication. In conclusion, consideration of S/CO should be high when predisposing factors are present. ESR may be useful for determining effectiveness and duration of therapy. With prolonged antibiotic therapy nearly all patients demonstrated resolution of disease. Clin Pediatr. 2004;43:549-555

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