[Current bacterial causes of osteomyelitis in children with sickle cell disease].
BACKGROUND
Osteomyelitis in children with sickle cell disease has been caused mainly by salmonella species, but in recent years, greater variation has resulted in other bacteria sometimes heading this list. We conducted this survey to determine the present distribution of causative bacteria, to improve initial probabilistic antibiotic therapy.


METHODS
This retrospective survey reviewed files of children hospitalised during the 8-year period from 1998 to 2005 for osteomyelitis who had haemoglobinopathy SS or SC. In all, we identified 32 patients (mean age: 6.5 years) - 22 boys and 10 girls, 18 with SS and 14 SC. Eleven children with haemoglobinopathy AS were not included. Thirteen children had acute osteomyelitis and 19 chronic osteomyelitis. Bacteriological research included blood cultures, needle aspiration or biopsy, and cytobacteriological examination of pus.


RESULTS
Of 4 blood cultures, one was positive. Only one needle aspiration was performed, and it was positive. Pus was examined in 19 cases and positive in 16 (84%). No bacteriological research was performed in 8 of the cases (25%) of acute osteomyelitis. Staphylococcus accounted for 22% of the bacteria identified, salmonella for 19% and Pseudomonas aeruginosa for 6%.


CONCLUSIONS
Initial probabilistic antibiotic therapy for osteomyelitis in children with sickle cell disease must target staphylococcus and salmonella, preferably by combining a third-generation cephalosporin and aminoglycoside. Systematic bacteriological testing will provide a more reliable selection and improve initial treatment.
Akakpo-Numado
Gamedzi Komlatsè
GK
Service de chirurgie pédiatrique CHU de Tokoin, Lomé Togo.
Gnassingbe
Komla
K
Boume
Missoki Azanledji
MA
Songne
Badjona
B
Tekou
Hubert
H
D000293:Adolescent; D000367:Age Factors; D000617:Aminoglycosides / Q000008:administration & dosage / Q000627:therapeutic use; D000755:Anemia, Sickle Cell / Q000150:complications*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001419:Bacteria / Q000302:isolation & purification; D001431:Bacteriological Techniques; D001769:Blood / Q000382:microbiology; D002511:Cephalosporins / Q000008:administration & dosage / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D016971:Citrobacter freundii / Q000302:isolation & purification; D004359:Drug Therapy, Combination; D005260:Female; D006450:Hemoglobin SC Disease / Q000150:complications; D006451:Hemoglobin, Sickle; D006785:Hospitals, University; D006801:Humans; D007223:Infant; D007711:Klebsiella pneumoniae / Q000302:isolation & purification; D008297:Male; D010019:Osteomyelitis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification; D012189:Retrospective Studies; D012475:Salmonella / Q000302:isolation & purification; D012737:Sex Factors; D013210:Staphylococcus / Q000302:isolation & purification; D014037:Togo
D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D006451:Hemoglobin, Sickle