Factors associated with dissemination and complications of acute bone and joint infections in children

Abstract

BACKGROUND: Paediatric bone and joint infections remain common in low- and middle-income countries (LMICs) and may have devastating long-term sequelae. There is a paucity of data from LMICs where the true incidence might be underreported, and delayed presentation is common. Our study aimed to determine the complication rate and incidence of disseminated infection in paediatric bone and joint infections in an LMIC setting. Secondly, we aimed to elucidate factors associated with complications and disseminated disease METHODS: We retrospectively reviewed our paediatric orthopaedic database for children that presented with bone and joint infections between September 2015 and March 2019. Data were extracted from medical records, laboratory results and radiological investigations to identify factors that were associated with the development of complications and disseminated infection at a median follow-up of four months RESULTS: We analysed 49 children. The median age at presentation was 6 years (range 1 month to 12 years). Locally advanced disease, with combined acute haematogenous osteomyelitis (AHOM) and septic arthritis (SA), was present in 13 children (27%). The remaining 36 children were evenly divided (18/49 each, 37%) between isolated AHOM and SA, respectively. Disseminated disease was present in 16 children (33%) and was associated with locally advanced disease, an increase in the number of surgeries and an increased length of stay. Twenty-six complications were documented in 22 (45%) children. Chronic osteomyelitis developed in 15/49 (31%) cases, growth arrest in 5/49 (10%), and pathological fracture, DVT and septic shock in 2/49 (4%) each. Complicated disease was associated with locally advanced disease, a higher number of surgeries, disseminated disease and an increased length of stay. Staphylococcus aureus was the infecting pathogen in 65% of cases (31 MSSA, 1 MRSA), while 25% (12/49) were culture-negative infections. While the median time from admission to surgery was one day, the median time from onset of symptoms to surgery was seven days CONCLUSION: We found a high complication rate despite a short follow-up period. More than a quarter of patients had locally advanced disease, and this was associated with the development of complications and disseminated disease. Further studies are needed to be able to predict which children will have poor outcomes Level of evidence: Level 4