A Retrospective Case-Series of Children With Bone and Joint Infection From Northern Australia

Abstract

Our clinical workload as infectious diseases pediatricians in northern Australia is dominated by complicated bone and joint infections in indigenous children. We reviewed the clinical presentation, microbiology, management, and outcomes of children presenting to Royal Darwin Hospital with bone and joint infections between 2010 and 2013, and aimed to compare severity and incidence with other populations worldwide.A retrospective audit was performed on children aged 0 to 18 years who were admitted to Royal Darwin Hospital between 1 January 2010 and 31 December 2013 with a bone and joint infection.Seventy-nine patients were identified, of whom 57 (72%) had osteomyelitis ± associated septic arthritis and 22 (28%) had septic arthritis alone. Sixty (76%) were indigenous Australians. The incidence rate of osteomyelitis for indigenous children was 82 per 100,000 children. Staphylococcus aureus was the confirmed pathogen in 43/79 (54%), of which 17/43 (40%) were methicillin resistant. Median length of stay was 17 days (interquartile range: 10-31 days) and median length of IV antibiotics was 15 days (interquartile range: 6-24 days). Fifty-six (71%) required at least 1 surgical procedure. Relapse within 12 months was documented in 12 (15%) patients.We report 3 key findings: osteomyelitis incidence in indigenous children of northern Australia is amongst the highest reported in the world; methicillin-resistant S aureus accounts for 36% of osteomyelitis with a positive microbiological diagnosis; and the severity of disease requires extended antibiotic therapy. Despite this, 15% of the cohort relapsed within 12 months and required readmission.

FIGURE 1

The age distribution of children admitted with bone and joint infections to Royal Darwin Hospital 2010 to 2013.

FIGURE 2

Crude incidence rate of osteomyelitis and septic arthritis per 100,000 population (0–17 year olds) between 2010 and 2013.

FIGURE 3

Microbiological causes of osteomyelitis and septic arthritis. #Methicillin-sensitive Staphylococcus aureus; additional organisms cultured in the osteomyelitis group were nonmultimethicillin-resistant S aureus (2), group A. Streptococcus (1), cutaneous flora (1). ∗Nonmultimethicillin-resistant S aureus; additional organisms cultured in the osteomyelitis group were methicillin-sensitive S aureus (1), group. A Streptococcus (1), group G Streptococcus (1), Klebsiella pneumoniae (1), and Candida albicans (1). +Group A Streptococcus. βPasteurella canis. ^Pseudomonas aeruginosa. ϕBurkholderia pseudomallei. θStaphylococcus capitis. αNeisseria gonorrhoeae.