A comparison of the epidemiology, clinical features, and treatment of acute osteomyelitis in hospitalized children in Latvia and Norway

Publisher Copyright: © 2020 by the authors. Licensee MDPI, Basel, Switzerland.Background and objectives: Paediatric acute osteomyelitis (AO) may result in major lifethreatening and limb-threatening complications if not recognized and treated early. The management of AO may depend on local microbial prevalence and virulence factors. This study compares the approach to paediatric AO in hospitals in two countries-Latvia and Norway. Materials and Methods: The study includes patients with AO hospitalized in the paediatric department in the Norwegian hospital Sørlandet Sykehus Kristiansand (SSK), in the period between the 1st of January 2012 and the 31st of December 2019. The results from SSK are compared to the results of a published study of AO in patients hospitalized at the Children’s Clinical University Hospital (CCUH) in Riga, Latvia. Results: The most isolated pathogen from cultures in both hospitals was S. aureus (methicillinsensitive). The lower extremity was the most affected body part (75% in CCUH, 95% in SSK), the main clinical symptom was pain (CCUH 92%, SSK 96.6%). Deep culture aspiration was most often taken intraoperatively in CCUH (76.6%) and percutaneously in SSK (44.8%). Oxacillin was the most applied antibiotic in CCUH (89.4%), and Cloxacillin in SSK (84.6%). Combined treatment with anti-Staphylococcal penicillins and Clindamycin was administered in 25.5% and 33.8% of CCUH and SSK patients, respectively. The median duration of the intravenous antibacterial treatment in CCUH and SSK was 15 and 10 days, respectively, and a switch to oral therapy was mainly made at discharge in both hospitals. The median total duration of antibiotic treatment was 25 days in CCUH and 35 days in SSK. 75% of CCUH and 10.3% of SSK patients were treated surgically. Complications were seen in 47% of patients in CCUH and in 38% in SSK. Conclusions: The transition to oral antibacterial treatment in both hospitals was delayed, which suggests a lack of criteria for discontinuation of intravenous therapy and could potentially contribute to longer hospitalization, higher cost of treatment and risk of complications. The use of more invasive techniques for deep culturing and significantly more common surgical interventions could possibly be linked to a higher complication rate in AO patients treated at the Latvian hospital.publishersversionPeer reviewe

Akūta osteomielīta epidemioloģisko, klīnisko pazīmju un ārstēšanas salīdzinošs raksturojums Latvijā un Norvēģijā hospitalizētiem bērniem

MedicīnaVeselības aprūpeMedicineHealth CarePētījuma mērķis: Noskaidrot un salīdzināt akūta osteomielīta galvenos izraisītājus un to antibakteriālo jutību, klīniskās pazīmes, diagnostiku un terapijas principus, kā arī komplikācijas bērniem, kuri ārstēti stacionārā divās dažadās valstīs – Latvijā un Norvēģijā. Hipotēze: Akūta osteomielīta izraisītāji un to antibakteriālā jutība, klīniskās pazīmes un diagnostikas principi bērniem Latvijā un Norvēģijā ir līdzīgi. Taču dažādu veselības aprūpes sistēmu dēļ atšķiras abu valstu pelietotā ārstēšanas taktika. Metodes: Retrospektīvā novērojošā pētījumā iekļauti pacienti, kuri stacionēti Norvēģijas dienvidos esošās reģionālās slimnīcas “Sørlandet Sykehus Kristiansand” (SSK) pediatrijas nodaļā ar diagnozi: akūts osteomoelīts, laika periodā starp 2012. gada 1. janvāri un 2019. gada 31. decembri. Rezultāti tika salīdzināti ar Latvijas datiem, kas izklāstīti publikācijā ar nosaukumu “Epidemiology and Antibacterial Treatment of Acute Hematogenous Osteomyelitis in Patients Hospitalized at Children’s Clinical University Hospital in Riga, Latvia” (tulk. Akūta hematogēna osteomielīta epidemioloģijas un antibakteriālās terapijas īpatnības pacientiem Bērnu Klīniskajā universitātes slimnīcā (BKUS)) [20]. Rezultāti: Akūta osteomielīta biežākais asins un audu kultūrās identificētais izraisītājs abās slimnīcās bija Staphylococcus aureus (meticilīnjutīgs). S. aureus tika noteikts 40% BKUS kultūru and 71.4% SSK kultūru. Abu slimnīcu pacientiem lielākajā daļā gadījumu iekaisums lokalizējās apakšējā ekstremitātē (BKUS aptuveni 75%, SSK aptuveni 95% gadījumu), un visbiežāk novērotais klīniskais simptoms bija sāpes (sastopamas 92% BKUS un 96.6% SSK pacientu). Abu slmnīcu pacientiem bieži tika noteiktas negatīvas asins kultūras (73.2% SSK un 55.0% BKUS ņemtās asins kultūras bija negatīvas). Dziļo audu kultūras BKUS visbiežāk tika ņemtas intraoperatīvi (76.6% gadījumu), taču SSK biežāk izmantotā metode bija perkutāna biopsija ar aspirācijas metodi (44.8%). Abās pētījuma populācijās antibiotikas visbiežāk tika uzsāktas pirmajā hospitalizācijas dienā (BKUS 70%, SSK 49.4%). 38.0% SSK pacientiem un 47.0% BKUS pacientiem ar akūtu osteomielītu tika novērotas komplikācijas. Secinājumi: Pacientiem ar akūtu osteomielītu tā izraisošie mikrooorganismi un klīniskās izpausmes abās slimnīcās bija līdzīgi. Dziļo kultūru iegūšanas veidi Latvijas un Norvēģijas slimnīcā atšķīrās. Terapijas principos galvenā loma lielākaja daļā gadījumu bija agrīni uzsāktai antibakteriālajai terapijai, kas abās slimnīcas tika uzsākta intravenozi, pāreja uz perorālu antibakteriālo terapiju notika tikai izrakstīšanās brīdī. Empīriskajai antibakteriālai terapijai abās slimnīcās visbiežāk tika lietoti pret stafilokokiem efektīvie penicilīnu grupas medikamenti. Tika novērotas nozīmīgas atšķirības pacientu skaitā, kuriem tika pielietota ķirurģiskā terapija, kā arī bija nelielas atšķirības komplikāciju un to veidu sastopamībā starp abām slimnīcām.Aim of the research: To clarify and compare the main causative agents of AO and their antibacterial susceptibility, to evaluate the clinical signs, diagnostic and treatment strategies and complications of AO in pediatric patients in hospitals in two countries – Latvia and Norway. Hypotheses: The causative agents, bacterial resistance, clinical features and diagnostics of AO in children are similar in the Latvian and Norwegian hospital. Management (including treatment) strategies varies between countries due to differences of health care systems. Methods of research: this is a retrospective, observational study that includes patients hospitalized in the pediatric department in the Norwegian hospital Sørlandet Sykehus Kristiansand – Hospital of Southern Norway (SSK), in the period between 1st of January 2012 and 31st of December 2019. The results from SSK are compared to results in “ Epidemiology and Antibacterial Treatment of Acute Hematogenous Osteomyelitis in Patients Hospitalized at Children’s Clinical University Hospital in Riga, Latvia” [20]. Results: The most common causative agent of AO detected in blood cultures and local tissue cultures in both hospitals was S. aureus (methicillin-sensitive). S. aureus were present in 40% in CCUH and 71.4% in SSK cultures. The lower extremity was the most commonly affected body part (CCUH around 75%, SSK around 95% of infections), and the most common presenting clinical symptom was pain (CCUH 92%, SSK 96,6%). Negative blood cultures were frequently encountered, 73.2% in SSK and 55.0% of blood cultures in CCUH were negative. Deep cultures were most frequently taken intraoperatively in CCUH (76.6%) and percutaneous with aspiration biopsy in SSK (44.8%). Antibiotics were started in the first day of admission in most patients in both study populations (CCUH 70%, SSK 49.4%). Complications were seen in 38.0% of SSK patients, and 47.0% of CCUH patients. Conclusions: Causative agents and clinical picture in the patients admitted with AO was similar in the Latvian and the Norwegian hospital. Diagnostic methods in radiology and for obtaining deep tissue cultures differed between the two hospitals. Early antibiotic treatment was the main focus of management in most cases, both hospitals applied intravenous therapy, and a change to per oral therapy at discharge. Similarly, both in CCUH and SSK anti-Staphylococcal antibiotics were one of the antibiotics initiated in the initial phase. A significant difference was seen in number of patients treated surgically, and a slight difference was seen in frequency and range of complications