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. 2023 May 3:11:1067206.
doi: 10.3389/fped.2023.1067206. eCollection 2023.

Nonbacterial and bacterial osteomyelitis in children: a case-control retrospective study

Mikhail M Kostik  1 , Alexey S Maletin  2 , Veronika V Petukhova  1   2 , Alexander Yu Mushkin  2   3
Affiliations

Nonbacterial and bacterial osteomyelitis in children: a case-control retrospective study

Mikhail M Kostik et al. Front Pediatr. .

Abstract

Purpose: Osteomyelitis is a group of bone infectious (bacterial osteomyeilitis-BO) and noninfectious inflammatory diseases (nonbacterial osteomyelitis-NBO) with similar clinical, radiology, and laboratory features. Many patients with NBO are misdiagnosed as BO and receive unnecessary antibiotics and surgery. Our study aimed to compare clinical and laboratory features of NBO and BO in children, to define key discriminative criteria, and to create an NBO diagnostic score (NBODS).

Methods: The retrospective multicenter cohort study included clinical, laboratory, and instrumental information about histologically confirmed NBO (n = 91) and BO (n = 31). The variables allowed us to differentiate both conditions used to construct and validate the NBO DS.

Results: The main differences between NBO and BO are as follows: onset age-7.3 (2.5; 10.6) vs. 10.5 (6.5; 12.7) years (p = 0.03), frequency of fever (34.1% vs. 90.6%, p = 0.0000001), symptomatic arthritis (67% vs. 28.1%, p = 0.0001), monofocal involvement (28.6% vs. 100%, p = 0.0000001), spine (32% vs. 6%, p = 0.004), femur (41% vs. 13%, p = 0.004), foot bones (40% vs. 13%, p = 0.005), clavicula (11% vs. 0%, p = 0.05), and sternum (11% vs. 0%, p = 0.039) involvement. The following four criteria are included in the NBO DS: CRP ≤ 55 mg/l (56 points), multifocal involvement (27 points), femur involvement (17 points), and neutrophil bands ≤ 220 cell/μl (15 points). The sum > 17 points allowed to differentiate NBO from BO with a sensitivity of 89.0% and a specificity of 96.9%.

Conclusion: The diagnostic criteria may help discriminate NBO and BO and avoid excessive antibacterial treatment and surgery.

Keywords: bacterial osteomyelitis; chronic recurrent multifocal osteomyelitis; diagnostic criteria; hematogenous osteomyelitis; nonbacterial osteomyelitis.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Distribution of foci in bones in nonbacterial (left) and bacterial (right) osteomyelitis.
Figure 2
Figure 2
Receiver operating characteristic (ROC) curve analysis for diagnosis NBO in children with diagnostic scores computed with the developmental data set. The optimal cutoff was selected as the threshold giving the highest value for the sum of sensitivity and specificity. Area under the curve (AUC) = 0.948 (0.893; 0.980), NBO DS >17 points with 89.0% sensitivity and 96.9% specificity.
See this image and copyright information in PMC

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