Acute community-acquired osteoarticular infections in children: high incidence of concomitant bone and joint involvement.

Background/purpose: Pediatric acute osteoarticular infections remain a challenging clinical issue for physicians. This paper provides recent clinical experiences on acute community-acquired osteoarticular infections in children in Taiwan.

Methods: Children with acute community-acquired osteoarticular infections admitted to hospital were retrospectively reviewed and the findings compared with related infections in Taiwan published during the past 10 years.

Results: We enrolled 27 children in our study, and reviewed 692 patients reported from six major studies in Taiwan. Of the 27 patients, 15 (55.6%) had concomitant bone and joint involvement. Blood cultures were positive in 44.4% of the children in this study and 48-52% in the other studies. Pathogens could be identified in 66.7% of our children and 63-76% in the other studies, when surgical specimens were available for culture. Staphylococcus aureus was consistently the most common pathogen found in all studies. Of the S. aureus isolates, methicillin-resistant S. aureus accounted for 13.3% in our study and 22-24% in the others.

Conclusion: Concomitant osteomyelitis and septic arthritis occurred in over half of our patients. The long-term effect of combined bone and joint infection on bone growth remains to be determined. Surgical intervention remains an important component of management of osteoarticular infections. Our findings are consistent with current recommendations of aggressive microbiology diagnosis and initiation of empirical monotherapy with oxacillin or oxacillin plus an agent effective against Gram-negative bacteria in most cases of community-acquired osteoarticular infections.