Objective: To analyze the clinical characteristics, pathogenic bacteria, complications and risk factors of prognosis of acute hematogenous osteomyelitis in children. Methods: The clinical manifestations, laboratorg tests, etiological charateristics and clinical data of 107 patients with acute hematogenous osteomyelitis admitted to Beijing Children's Hospital from January 2017 to December 2020 were retrospectively analyzed. According to the drug sensitivity results of Staphylococcus aureus, the group was divided into methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-susceptible Staphylococcus aureus (MSSA) group; according to the presence or absence of complications, the group was divided into the group with and without complications; according to the prognosis of the follow-up children, the group was divided into good prognosis and poor prognosis. The χ² test or Mann-Whitney U test used for comparison between groups, and Logistic regression was used to analyze the risk factors for complications and prognosis. Results: Of the 107 patients, 62 were males and 45 were females. The age of presentation was 5.6 (1.7, 10.0) years, including 5 patients (4.7%) age from >28 days to 3 months, 46 patients (43.0%) age from >3 months to 5 years, 43 patients (40.2%)>5-12 years of age, and 13 patients (12.1%)>12-18 years of age. The first symptoms were acute fever in 35 patients (32.7%), limb pain in 24 patients (22.4%), and fever with limb pain in 23 patients (21.5%). Pathogen culture was positive in 75 patients (70.1%), Streptococcus pyogenes, Salmonella enterica and Escherichia coli in 1 case (1.4%) each, and Staphylococcus aureus in 72 cases (96.0%), among them, 47 cases were MSSA, 22 cases were MRSA, and 3 cases had positive reports of Staphylococcus aureus from other hospitals without drug-sensitive tests. The proportion of infected children living in rural areas and receiving surgical treatment was higher in the MRSA group than in the MSSA group (14 cases (63.6%) vs. 18 cases (38.3%) and 21 cases (95.5%) vs. 33 cases (70.2%), χ²=3.87, 4.23, both P<0.05). Sixty-five children had no complications while 42 children (39.3%) suffered from complications. Common complications consisted of 19 cases (17.8%) of sepsis, 17 cases (15.9%) of septic arthritis, and 12 cases (11.2%) of venous thrombosis. The group with complications showed higher mental changes, decreased appetite and (or) weakness, positive pathogenic cultures, and time from admission to surgery than the group without complications (18 cases (42.9%) vs. 9 cases (13.8%), 20 cases (47.6%) vs. 12 cases (18.5%), 34 cases (81.0%) vs. 41 cases (63.1%), 3.5 (2.0, 6.0) vs. 2.0 (1.0, 4.0) d,χ²=11.38, 10.35, 3.89, Z=2.21, all P<0.05). The poor prognosis group had more comorbidities, combined local complications, and positive aureus than the good prognosis group (10/15 vs. 34.9% (30/86), 7/15 vs. 17.4% (15/86), 14/15 vs. 61.6% (53/86), χ²=5.39, 6.40, 4.42, all P<0.05). Multifactorial Logistic regression analysis showed that acute phase C-reactive protein (CRP) was both an independent risk factor for complications (OR=1.01, 95%CI 1.01-1.02) and an independent risk factor for poor prognosis (OR=1.01, 95%CI 1.00-1.02). Conclusions: The first symptoms of acute hematogenous osteomyelitis are acute fever, limb pain, and fever with limb pain are most common. Staphylococcus aureus is the most common pathogenic organism. Those with loss of appetite and (or) weakness, mental changes, positive pathogenic cultures, and longer time between admission and surgery are prone to complications. Those with complications, combined local complications, and positive for Staphylococcus aureus had a poor prognosis. Elevated CRP is an independent risk factor not only for complications but for poor prognosis as well.
Acute Disease ; Adolescent ; Anti-Bacterial Agents/therapeutic use* ; Child ; Female ; Fever/etiology* ; Humans ; Male ; Methicillin-Resistant Staphylococcus aureus ; Osteomyelitis/microbiology* ; Pain/drug therapy* ; Prognosis ; Retrospective Studies ; Staphylococcal Infections/diagnosis* ; Staphylococcus aureus

OBJECTIVETo explore the distribution and antibiotic resistance of pathogens in lesions of diabetic foot osteomyelitis (DFO) and analyze the risk factors causing osteomyelitis.

METHODSA total of 372 patients with diabetic foot infections hospitalized between January 2011 and December 2014, including 203 with osteomyelitis (OM group) and 169 without osteomyelitis (non-OM group), were examined for the distribution and antibiotic resistance profile of the pathogens in the wounds. Logistic regression analysis was used to analyze the risk factors causing osteomyelitis.

RESULTSGram-negative bacteria were the predominant pathogens (53.7%) in the infected wounds in OM group, whereas Gram-positive bacteria were the most frequently found (56.7%) in non-OM group (P=0.001). Among the Gram-positive bacteria, Staphylococcus was the dominating flora (35.1%). The resistance rate to oxacillin and cefoxitin of the isolated bacteria in OM group (64.9% and 68.5%, respectively) was significantly higher than that in non-OM group (29.2% and 32.6%, respectively; P<0.05). Among the gram-negative bacteria, Enterobacteriaceae was the dominating flora (62.4%), with a higher resistance rate to Cefepime and Aztreonam in OM group (30.1% and 38.6%, respectively) than in non-OM group (15.1% and 22.2%, respectively; P<0.05). Logistic regression analysis indicated that the infection by multi-drug resistant bacteria and an wounds area >4 cm(2) were the risk factors for osteomyelitis in patients with diabetic foot infections (P<0.05).

CONCLUSIONIn addition to an empirical anti-infection therapy, clinicians should choose specific antibiotics against Gram-negative bacteria according to the microbial spectrum and antibiotic resistance of pathogens in patients with DFO; patients with diabetic foot infections by multi-drug resistant bacteria and those with a wound area exceeding 4 cm(2) are exposed to an increased risk of osteomyelitis.

Anti-Bacterial Agents ; Cephalosporins ; Diabetic Foot ; microbiology ; Drug Resistance, Multiple, Bacterial ; Gram-Negative Bacteria ; classification ; isolation & purification ; Gram-Positive Bacteria ; classification ; isolation & purification ; Humans ; Osteomyelitis ; microbiology ; Risk Factors ; Wound Infection ; microbiology

Any medical diagnosis should take a multimodal approach, especially those involving tumour-like conditions, as entities that mimic neoplasms have overlapping features and may present detrimental outcomes if they are underdiagnosed. These case reports present diagnostic pitfalls resulting from overdependence on a single diagnostic parameter for three musculoskeletal neoplasm mimics: brown tumour (BT) that was mistaken for giant cell tumour (GCT), methicillin-resistant Staphylococcus aureus osteomyelitis mistaken for osteosarcoma and a pseudoaneurysm mistaken for a soft tissue sarcoma. Literature reviews revealed five reports of BT simulating GCT, four reports of osteomyelitis mimicking osteosarcoma and five reports of a pseudoaneurysm imitating a soft tissue sarcoma. Our findings highlight the therapeutic dilemmas that arise with musculoskeletal mimics, as well as the importance of thorough investigation to distinguish mimickers from true neoplasms.
Adult ; Aneurysm, False ; diagnosis ; Biopsy ; Bone Diseases ; diagnosis ; Bone Diseases, Metabolic ; diagnosis ; Bone Neoplasms ; diagnosis ; Cell Proliferation ; Diagnosis, Differential ; Diagnostic Errors ; prevention & control ; Female ; Giant Cell Tumors ; diagnosis ; Humans ; Hyperparathyroidism ; complications ; Leukocytosis ; diagnosis ; Male ; Methicillin-Resistant Staphylococcus aureus ; Middle Aged ; Neoplasms ; diagnosis ; microbiology ; Osteomyelitis ; diagnosis ; microbiology ; Osteosarcoma ; diagnosis ; Sarcoma ; diagnosis ; Soft Tissue Neoplasms ; diagnosis ; Tibia ; pathology

BACKGROUND: To analyze the incidence and clinical-microbiological characteristics of osteomyelitis (OM) in a tertiary Spanish hospital. METHODS: All cases diagnosed with OM between January 2007 and December 2010 were retrospectively reviewed. The variables examined include epidemiological characteristics, risk factors, affected bone, radiographic changes, histology, microbiological culture results, antibiotic treatment, and the need for surgery. RESULTS: Sixty-three cases of OM were diagnosed. Twenty-six patients (41.3%) had acute OM whereas 37 patients (58.7%) were classified as chronic OM. OM may result from haematogenous or contiguous microbial seeding. In this group, 49 patients (77.8%) presented with OM secondary to a contiguous source of infection and 14 patients had hematogenous OM (22.2%). Staphylococcus aureus was the most commonly found microorganism. CONCLUSIONS: OM mainly affected patients with risk factors related to the presence of vascular diseases. Antibiotic treatment must be guided by susceptibility patterns of individual microorganisms, although it must be performed together with surgery in most of the cases.
Acute Disease ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents/therapeutic use ; Child ; Child, Preschool ; Chronic Disease ; Female ; Humans ; Infant ; Male ; Middle Aged ; *Osteomyelitis/drug therapy/epidemiology/microbiology ; Retrospective Studies ; Risk Factors ; Spain/epidemiology ; Staphylococcal Infections ; Staphylococcus aureus/isolation & purification ; Tertiary Care Centers ; Young Adult

Mycobacterium longobardum is a slow-growing, nontuberculous mycobacterium that was first characterized from the M. terrae complex in 2012. We report a case of M. longobardum induced chronic osteomyelitis. A 71-yr-old man presented with inflammation in the left elbow and he underwent a surgery under the suspicion of tuberculous osteomyelitis. The pathologic tissue culture grew M. longobardum which was identified by analysis of the 65-kDa heat shock protein and full-length 16S rRNA genes. The patient was cured with the medication of clarithromycin and ethambutol without further complications. To the best of our knowledge, this is the first report of a M. longobardum infection worldwide.
Aged ; Anti-Bacterial Agents/therapeutic use ; Bacterial Proteins/genetics ; Chaperonin 60/genetics ; Clarithromycin/therapeutic use ; Elbow/pathology ; Ethambutol/therapeutic use ; Humans ; Male ; Mycobacterium Infections, Nontuberculous/*microbiology ; Nontuberculous Mycobacteria/classification/genetics/*isolation & purification ; Osteomyelitis/diagnosis/drug therapy/*microbiology/pathology ; RNA, Ribosomal, 16S/genetics ; Treatment Outcome

No abstract available.
Acute Disease ; Adolescent ; Alkaline Phosphatase/*blood ; Anti-Bacterial Agents/*therapeutic use ; Arthritis, Infectious/*drug therapy/*enzymology/microbiology ; *Bacterial Infections/drug therapy/enzymology/microbiology ; Child ; Child, Preschool ; Haemophilus influenzae type b/isolation & purification ; Humans ; Infant ; Osteomyelitis/*drug therapy/*enzymology/microbiology ; Staphylococcus aureus/isolation & purification ; Streptococcus pneumoniae/isolation & purification ; Streptococcus pyogenes/isolation & purification

The bacilli Calmette-Guerin (BCG) Tokyo-172 strain was considered to exhibit good protective efficacy with a low rate of unfavorable side effects. However, we describe a rare case of BCG osteomyelitis developed in an immunocompetent host who was given with BCG Tokyo-172 vaccine on the left upper arm by multipuncture method. A 9-month-old girl presented with progressive inability to move her right elbow and had radiographic evidence of septic elbow combined with osteomyelitis of right distal humerus. A biopsy from the site revealed chronic caseating granulomatous inflammation, positive for BCG Tokyo-172 strain on the multiplex polymerase chain reaction. The child had to undergo second surgical debridements and oral antituberculosis chemotherapy. There were no sequelae after 2 yr of follow-up. This complication, although uncommon, should be considered in the appropriate clinical setting.
Antitubercular Agents/therapeutic use ; BCG Vaccine/*adverse effects ; DNA, Bacterial/genetics ; Female ; Humans ; Infant ; Magnetic Resonance Imaging ; Multiplex Polymerase Chain Reaction ; Mycobacterium bovis/genetics/*isolation & purification ; Osteomyelitis/drug therapy/*etiology/*microbiology/surgery

INTRODUCTIONInfection following grade IIIB open tibial fracture is common. The primary aim of managing this condition is to achieve control of infection before the bone reconstruction procedure is performed. The outcomes for such patients have not been evaluated in the literature. This study was conducted to examine the outcome of a multi-stage procedure for the treatment of infected grade IIIB open tibial fractures.

METHODSBetween 2004 and 2008, we treated 11 patients with infected grade IIIB open tibial fractures in our unit. The management of infected grade IIIB open tibial fracture comprised three stages, which included serial debridement, wound closure by local flap surgery and bone reconstruction. The margin of resection and the type of bone reconstruction depended on the anatomical location of the disease, the extent of osteomyelitis and patient preference regarding treatment options. Bone reconstruction procedures included bone grafting, plating, interlocking nail, hybrid and monolateral external fixator, and Ilizarov bone transport.

RESULTSGram-negative organisms were isolated from all patients. Pseudomonas aeruginosa (P. aeruginosa) (44%) was the most common organism cultured. Infection was resolved in all patients. Nine fractures achieved union, with a mean union time of 15 months. Two patients with P. aeruginosa infection developed non-union of the fracture and refused additional surgery after three years of treatment.

CONCLUSIONThe multi-stage management approach is well-accepted and effective in controlling infection in infected grade IIIB open tibial fractures.

Adult ; Aged ; Aged, 80 and over ; Debridement ; methods ; Female ; Fracture Fixation ; methods ; Fractures, Open ; complications ; surgery ; Fractures, Ununited ; surgery ; Humans ; Ilizarov Technique ; Malaysia ; Male ; Middle Aged ; Osteomyelitis ; etiology ; microbiology ; surgery ; therapy ; Prospective Studies ; Surgical Flaps ; Tibial Fractures ; complications ; surgery ; Treatment Outcome ; Wound Infection ; etiology ; microbiology ; surgery ; therapy

Bone Diseases ; complications ; pathology ; Bone Diseases, Infectious ; complications ; Humans ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; complications ; microbiology ; Male ; Middle Aged ; Necrosis ; Osteomyelitis ; complications

Skull base osteomyelitis (SBO) is difficult to diagnose when a patient presents with multiple cranial nerve palsies but no obvious infectious focus. There is no report about SBO with septic pulmonary embolism. A 51-yr-old man presented to our hospital with headache, hoarseness, dysphagia, frequent choking, fever, cough, and sputum production. He was diagnosed of having masked mastoiditis complicated by SBO with multiple cranial nerve palsies, sigmoid sinus thrombosis, and septic pulmonary embolism. We successfully treated him with antibiotics and anticoagulants alone, with no surgical intervention. His neurologic deficits were completely recovered. Decrease of pulmonary nodules and thrombus in the sinus was evident on the follow-up imaging one month later. In selected cases of intracranial complications of SBO and septic pulmonary embolism, secondary to mastoiditis with early response to antibiotic therapy, conservative treatment may be considered and surgical intervention may be withheld.
Anti-Bacterial Agents/therapeutic use ; Anticoagulants/therapeutic use ; C-Reactive Protein/analysis ; Cranial Nerve Diseases/complications/diagnosis ; Diagnosis, Differential ; Enterobacter aerogenes/isolation & purification ; Enterobacteriaceae Infections/diagnosis/drug therapy ; Humans ; Lung/pathology/radiography ; Magnetic Resonance Imaging ; Male ; Mastoiditis/complications/diagnosis ; Middle Aged ; Osteomyelitis/complications/*diagnosis/drug therapy ; Pulmonary Embolism/complications/*diagnosis/microbiology ; Sinus Thrombosis, Intracranial/complications/diagnosis ; Skull Base ; Sputum/microbiology ; Tomography, X-Ray Computed