Forthcoming Issue 1 2024 Bacterial aetiology and antimicrobial susceptibility of osteo-articular infections at a tertiary-level paediatric unit in South Africa.

Main Article Content

A Horn
C Centner
M Laubscher
H Tootlah

Abstract

Background


Osteoarticular infections (OAI) are very common in children living in low-and-middle income countries, yet the bacterial aetiology and antibiotic susceptibility of OAI in children is not well described for this population. This study was designed to address this deficit in the South African context.


Methods


All patients that underwent surgery for the treatment of OAI over a 3-year period were identified and those with organisms identified from tissue, pus, fluid, or blood were included. Duplicate cultures from the same patient were excluded if the organism and antibiotic susceptibility profile was the same. Patients were categorised according to age and class of infection (Septic arthritis, acute osteomyelitis, fracture related infection, post-operative sepsis, and chronic osteomyelitis) and organisms were stratified accordingly.


Results


We identified 132 organisms from 123 samples collected from 96 patients. Most cultured organisms were from children older than 3-years with acute haematogenous septic arthritis, osteomyelitis, or both. Methicillin sensitive Staphylococcus aureus accounted for 56% (74/132) of organisms cultured. The enterobacterales accounted for 17% (22/132) of organisms cultured, mostly in the fracture related and post-operative infection groups. Of these, 6 each were extended spectrum B-lactamase producers and AmpC producers respectively. There were no carbapenemase producing Enterobacterales.


Conclusion


Methicillin sensitive Staphylococcus aureus is the most common infecting organism in paediatric OAI, and an anti-staphylococcal penicillin is the most appropriate empiric treatment for haematogenous OAI in our environment. In fracture related or post-operative infections, Enterobacterales were more frequently cultured, and treatment should be guided by culture and susceptibility results.

Article Details

How to Cite
Forthcoming Issue 1 2024: Bacterial aetiology and antimicrobial susceptibility of osteo-articular infections at a tertiary-level paediatric unit in South Africa. (2023). South African Journal of Child Health, 17(3). https://doi.org/10.7196/
Section
Research

How to Cite

Forthcoming Issue 1 2024: Bacterial aetiology and antimicrobial susceptibility of osteo-articular infections at a tertiary-level paediatric unit in South Africa. (2023). South African Journal of Child Health, 17(3). https://doi.org/10.7196/

References

Horn A, Wever S, Hoffman E. Complications following acute severe haematogenous osteomyelitis of the long bones in children. SA Orthop J. 2019;18(3):23-9. https://doi.org/10.17159/2309-8309/2019/v18n3a1

Ferreira N, Reddy K, Venter R, Centner C, Laubscher M. Antibiogram profiles and efficacy of antibiotic regimens of bacterial isolates from chronic osteomyelitis of the appendicular skeleton: A developing-world perspective. S Afr Med J. 2021;111(7):642-8. https://doi.org/10.7196/samj.2021.v111i7.15516

Mthethwa PG, Marais L. The microbiology of chronic osteomyelitis in a developing world setting. SA Orthop J. 2017;16(2):39-45. https://doi.org/10.17159/2309-8309/2017/v16n2a4

Lavy C, Thyoka M, Pitani A. Clinical features and microbiology in 204 cases of septic arthritis in Malawian children. Bone Joint J. 2005;87(11):1545-8. https://doi.org/10.1302/0301-620x.87b11.16735

Ali AM, Maya E, Lakhoo K. Challenges in managing paediatric osteomyelitis in the developing world: analysis of cases presenting to a tertiary referral centre in Tanzania. Afr J Paediatr Surg. 2014;11(4):308. https://doi.org/10.4103/0189-6725.143136

Metsemakers W-J, Morgenstern M, McNally M, Moriarty T, McFadyen I, Scarborough M, et al. Fracture-related infection: a consensus on definition from an international expert group. Injury. 2018;49(3):505-10. https://doi.org/10.1016/j.injury.2017.08.040

Lorrot M, Gillet Y, Le Guen CG, Launay E, Cohen R, Grimprel E. Antibiotic therapy of bone and joint infections in children: proposals of the French Pediatric Infectious Disease Group. Arch Pediatr. 2017;24(12):S36-S41. https://doi.org/10.1016/s0929-693x(17)30517-1

Agarwal A, Aggarwal AN. Bone and joint infections in children: septic arthritis. The Indian Journal of Pediatrics. 2016;83(8):825-33. https://doi.org/10.1007/s12098-015-1816-1

Agarwal A, Aggarwal AN. Bone and joint infections in children: acute hematogenous osteomyelitis. Indian J Pediatr. 2016;83(8):817-24. https://doi.org/10.1007/s12098-015-1806-3

Lavy CB. Septic arthritis in Western and sub-Saharan African children-a review. Int Orthop. 2007;31(2):137-44. https://doi.org/10.1007/s00264-006-0169-9

Trifa M, Bouchoucha S, Smaoui H, Frikha M, Marzouk SB, Ghachem MB, et al. Microbiological profile of haematogenous osteoarticular infections in children. Orthop Traumatol Surg Res. 2011;97(2):186-90. https://doi.org/10.1016/j.otsr.2010.10.005

Gafur OA, Copley LA, Hollmig ST, Browne RH, Thornton LA, Crawford SE. The impact of the current epidemiology of pediatric musculoskeletal infection on evaluation and treatment guidelines. J Pediatr Orthop. 2008;28(7):777-85. https://doi.org/10.1097/bpo.0b013e318186eb4b

Saavedra-Lozano J, Mejías A, Ahmad N, Peromingo E, Ardura MI, Guillen S, et al. Changing Trends in Acute Osteomyelitis in Children: Impact of Methicillin-Resistant Staphylococcus Aureus Infections. J Pediatr Orthop. 2008;28(5):569-75. https://doi.org/10.1016/s0084-3954(09)79439-4

Brischetto A, Leung G, Marshall CS, Bowen AC. A retrospective case-series of children with bone and joint infection from Northern Australia. Medicine. 2016;95(8). https://doi.org/10.1097/md.0000000000002885

Hunter S, Chan H, Baker JF. Global epidemiology of childhood bone and joint infection: a systematic review. Infection. 2022:1-13. https://doi.org/10.1007/s15010-021-01741-3

Sodavarapu P, Sudesh P, Gopinathan NR, Jayashree M, Kumar P, Rangasamy K. Characteristics of Musculoskeletal Involvement in Pediatric Patients with Disseminated Sepsis in a Tertiary Care Center. Indian J Orthop. 2021:1-8. https://doi.org/10.1007/s43465-021-00488-1

Visser HF, Visser A, Goller K, Goller R, Nel J, Snyckers CH. Paediatric septic arthritis in a tertiary setting: A retrospective analysis. SA Orthop J. 2010;9(2):92-6.

Ilharreborde B, Bidet P, Lorrot M, Even J, Mariani-Kurkdjian P, Liguori S, et al. New real-time PCR-based method for Kingella kingae DNA detection: application to samples collected from 89 children with acute arthritis. J Clin Microbiol. 2009;47(6):1837-41. https://doi.org/10.1128/jcm.00144-09

Ceroni D, Cherkaoui A, Ferey S, Kaelin A, Schrenzel J. Kingella Kingae Osteoarticular Infections in Young Children: Clinical Features and Contribution of a New Specific Real-time PCR Assay to the Diagnosis. J Pediatr Orthop. 2010;30(3):301-4. https://doi.org/10.1097/bpo.0b013e3181d4732f

Most read articles by the same author(s)

1 2 3 4 5 6 7 8 9 10 > >>