Microbiological spectrum of osteomyelitis in children and adolescents from rural population of kashmir valley.

Abstract

Introduction: Osteomyelitis in children can prove detrimental in terms of morbidity if left untreated or undertreated. This study describes the microbiological spectrum of osteomyelitis and the antimicrobial susceptibility of its causative agents in children in a predominant rural population. Further it helps guide the choice of empirical antibiotics for this condition in children and adolescents, so as to reduce chances of osteomyelitis requiring drainage or it getting complicated by the timely institution of the treatment.

Aims: The aim of the study is to look into the microbiologic spectrum of osteomyelitis in children and adolescents in rural population of Kashmir, so that the pattern of their susceptibility to antibiotics is also known, thereby helping in the institution of empirical antibiotics.

 METHODS: This is a retrospective analysis of the children who had been treated for the acute osteomyelitis and whose records were available for the study. This study was carried in the Department of Orthopaedics and Microbiology, SKIMS Medical college Hospital Srinagar which caters to the most rural areas around Srinagar. Records of 102 patients with osteomyelitis who were treated in our hospital from October 2015 to October 2023 contributed to this study. Patients with known immunodeficiency syndromes were excluded.

RESULTS: Staphylococcus aureus was recovered in almost 80% of the cases of osteomyelitis in both infants and children and most of them were Methicillin Sensitive Staphylococcus aureus (MSSA) and thus were sensitive to Cefazolin, Amikacin and Clindamycin. About one third of these cases were Methicillin Resistant Staphylococcus aureus (MRSA) accounting for about 26%  of the total number of isolates and 33% of the staphylococcus group. This was followed by Escherichia coli which accounted for about 4.5% of the total isolates.  Distal end of femur and upper end tibia were the most common sites of infection. Boys were more infected than girls with male female ratio of 2.7:1 and the age group of 6-15 comprise 70% of the cases.

CONCLUSION: The pathogenesis of haematogenous osteomyelitis in children is a process that is influenced by characteristics of the growing skeleton.  Bacteria, principally Staphylococcus aureus causes the majority of cases of acute osteomyelitis in children. A single organism is responsible for most of the infections. Most of the patients were infected by MSSA . We suggest that any patient in the said age group with osteomyelitis in our set up be put empirically on a combination of Cefazolin and Amikacin till the culture sensitivity report comes, as the combination is synergistic and less likely to cause adverse reactions.