Epidemiology of acute osteoarticular sepsis in a setting with a high prevalence of pediatric HIV infection.
BACKGROUND
There is limited information on osteoarticular infections in human immunodeficiency virus (HIV)-infected children. The purpose of this study was to determine the effect of HIV on the epidemiology of osteoarticular infections in a setting with a high prevalence of pediatric HIV infection.


METHODS
A retrospective evaluation of children presenting with acute septic arthritis or osteomyelitis from June 2005 to July 2009 was undertaken. Standard departmental protocols for the management of osteoarticular infections, including testing for HIV, were practised.


RESULTS
A total of 102 cases of acute septic arthritis or osteomyelitis were identified during the study period. These included 22 (21.6%) episodes in HIV-infected children, 66 (64.7%) in HIV-non-infected children, and 14 (13.7%) cases in whom the HIV status was unknown. The median age of children was 30.6 months (range, 9.2 to 82.9 mo) and did not differ by HIV status. Streptococcus pneumoniae was identified in 8 of 12 (66.7%) HIV-infected children compared with 3 (9.7%) of 31 HIV-non-infected children (P<0.001). Conversely, fewer episodes in HIV-infected children (4.8%) were associated with Staphylococcus aureus compared with HIV-non-infected children (24.6%; P=0.06). No patients died. Twelve cases required repeated surgical procedures.


CONCLUSIONS
Empirical management of osteoarticular infections in settings with a high prevalence of HIV-infected children or children known to be HIV infected needs to be tailored based on a higher proportion of episodes being due to S. pneumoniae in HIV-infected children.


CONCLUSIONS
Our results suggest that HIV-infected children with osteoarticular infections should be started on broader spectrum antibiotics before culture results are available.


METHODS
Level IV, diagnostic study.
Division of Orthopaedic Surgery, University of the Witwatersrand, Johannesburg, South Africa.
Anthony J F
AJ
Robertson
Gregory B
GB
Firth
Candice
C
Truda
Dustin A
DA
Ramdass
Michelle
M
Groome
Shabir
S
Madhi
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001170:Arthritis, Infectious / Q000150:complications* / Q000188:drug therapy; D002648:Child; D002675:Child, Preschool; D006678:HIV; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D007223:Infant; D010019:Osteomyelitis / Q000150:complications* / Q000188:drug therapy; D011008:Pneumococcal Infections / Q000150:complications* / Q000188:drug therapy; D015995:Prevalence; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000150:complications* / Q000188:drug therapy; D013211:Staphylococcus aureus / Q000302:isolation & purification; D013296:Streptococcus pneumoniae / Q000302:isolation & purification
D000900:Anti-Bacterial Agents