Evaluation of osteomyelitis cases followed in ITF Pediatric Infectious Disease Department

Introduction and Aim: Osteomyelitis is an infection localized to the bone. With this study, it was aimed to investigate and examine the patients' complaints at admission, clinical features, type of bone involved, disease agents, acute phase responses, and other laboratory and radiological features, followed up with the diagnosis of osteomyelitis by the Department of Pediatric Infectious Diseases, Department of Pediatrics, Istanbul University, Istanbul Medical Faculty. Materials and Methods: This research was carried out by retrospectively evaluating the data of 68 pediatric patients diagnosed with osteomyelitis between January 2002 and March 2021 by Istanbul University, Istanbul Faculty of Medicine, Department of Pediatric Infectious Diseases. The data were obtained by examining the hospital information record system and patient files. Data were analyzed using the SPSS 20.0 program. Results: The most common complaints of the patients were pain (45.58%) and swelling (45.58%). These complaints were followed by hyperemia with 23.52% and discharge with 19.11%. It was found that the foot bones were most involved with 29.4% (n=20), followed by the femur (n=19) with 27.9% and the tibia (n=17) with 25%. Humerus was found to be the most common site of involvement with 4 patients in the upper extremity. Osteomyelitis was detected in the hand bones of 2 patients, in the mandible in 2 patients, in the iliac bone in 1 patient, in the frontal bone in 1 patient, in the Radius in 1 patient, and in the sternum in 1 patient. In the laboratory values of the patients at the time of admission, WBC median value was 12786, CRP median value was 46 (17.25-79.5), ESR median value was 58.25 (25.5-83). When the radiological imagings were examined, it was determined that 95.6% of the patients underwent MRI and 100% of these patients had positive findings. Although direct X-rays were taken in all of the patients, positive findings were found in 20.6% of these patients. While positive findings were found in 11 of 13 patients who underwent scintigraphy, in 5 of 6 patients who underwent CT, a positive finding in favor of osteomyelitis was found in 3 of 15 patients who underwent USG. When the reproducing microorganisms were examined, it was determined that MSSA was the highest with 37.5% (n=21). It was determined that Pseudomonas followed it with 12.5%. While MRSA was found in 5.4% (n=3) of the patients, MRCNS was produced as a causative agent in 5.4% of the patients. Combined therapy was administered to the patients, most commonly with the addition of glycopeptide and beta lactam with a rate of 38.6%, intravenously. The second frequency (22.8%) was a single beta-lactam group antibiotic and then 10.5% alone glycopeptide antibiotic therapy. The patients were followed up most frequently with ciprofloxacin treatment (33.8%) and clindamycin treatment (32.3%) in their outpatient follow-up. When the complication status of the patients was examined, no complication developed in 52.9% (n:36) of the patients. It was found that 19.1% (n:13) of the patients developed chronic osteomyelitis. Abscess was detected in 11.8% (n:8) of the patients. Conclusion: Osteomyelitis should be considered in patients presenting with localized pain, even if there is no fever. The most common cause of osteomyelitis is S. aureus. ESR and CRP values are guides for the diagnosis of osteomyelitis. MRI has a great role in the diagnosis of osteomyelitis. In acute osteomyelitis, it would be wise to empirically give S. aureus inclusive treatment.