Acute Osteomyelitis in Children

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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 influenzaetype b, andPseudomonos aeruginosawere identified in 34 (25%), 16 (12%), and eight (6%) children, respectively.Staphylococcus aureusoccurred in all age groups,H influenzaetype b occurred only in children younger than 3 years and was the number one cause of disease in this group.Pseudomonas aeruginosaoccurred exclusively in children older than 9 years. Children withH influenzaetype 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 withH influenzaetype 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 toP aeruginosadid not represent the hematogenous route of infection; penetrating injury to the foot was present in every case. Children withP aeruginosainfections 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)