Pathogens of acute hematogenous osteomyelitis in children

Background. The issues of timely diagnosis and treatment of acute hematogenous osteomyelitis (AHO) confirm the importance and relevance of the problem under study, and therefore it is necessary to conduct in-depth research to determine antibiotic resistance in order to improve the quality of treatment for children with AHO.

The aim of the study to study the features of the structure of pathogens of AHO in children and their sensitivity to antibacterial drugs.

Materials and methods. The results of a microbiological study were studied in 128 children aged 5 days to 15 years who were being treated in a tertiary hospital in the Kyrgyz Republic with AHO in the period from 2015 to 2022.

Results and discussion. Microflora growth was observed in 76.6 % of cases: gram-positive microorganisms were detected in 79.7 %, gram-negative microorganisms in 16.2 %, and fungal infection in 4.1 %. Among the pathogens of AHO in children, microorganisms from the ESCAPE group were detected in 74.6 % of cases, of which Staphylococcus aureus – in 63.3 %, Klebsiella pneumoniae – in 4.1 %, Pseudomonas aeruginosa – in 4.1 %, Escherichia coli – in 3.1 %, which explains the frequent development of septic complications. Determination of the sensitivity of Staphylococcus aureus showed the presence of MRSA strains in 16.1 %. The maximum sensitivity of Staphylococcus aureus was detected to amikacin (100.0 %), vancomycin (90.0 %), moxifloxacin (90.0 %), meropenem (80.0 %) and linezolid (80.0 %). Staphylococcus aureus is less sensitive to gentamicin (75.0 %), levofloxacin (74.0 %), clindamycin (70.0 %), ciprofloxacin (66.0 %), erythromycin (65.0 %). Low sensitivity of staphylococcus aureus was detected to cephalosporins (cefazolin – 40.0 %, cefotaxime – 38.0 %, ceftazidime – 41.0 %, cefepime – 41.0 %) and penicillins (oxacillin – 35.0 %, ampicillin – 30.0 %).

1. Woods CR, Bradley J S, Chatterjee A, et al. Clinical Practice Guideline by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America: Guideline on Diagnosis and Management of Acute Hematogenous Osteomyelitis in Pediatrics. J Pediatric Infect Dis Soc. 2021;10(8)801–844. https://doi.org/10.1093/jpids/piab027

2. Castellazzi L, Mantero M, Esposito S. Update on the management of pediatric acute osteomyelitis and septic arthritis. Intern J Molecular Sciences. 2016;17(6):855–864.219. https://doi.org/10.3390/ijms17060855

3. Akberov RF, Lyurov DA, Svarich VG. Acute hematogenous osteomyelitis in children // Pediatric Surgery. 2016;20(4):200–203. (In Russ.) https://doi.org/10.18821/1560-9510-2016-20-4-200-203

4. Akberov RF, Lyurov DA, Svarich VG. Multispiral computed tomography in the early diagnosis of acute hematogenous osteomyelitis in children. Children's Postgraduate doctor. 2015;70(3):28–32. (In Russ.)

5. Karimova ZK, Turgunova KhZ, Mirzaeva MA, et al. Dinamika osobennostey etiologii, klinicheskogo techeniya i struktury gnoyno-vospalitel'nykh zabolevaniy u detey [Dynamics of features of etiology, clinical course and structure of purulent-inflammatory diseases in children]. Aprobatsiya. 2015;2:78–80. (In Russ.)

6. Tsybin AA, Mashkov AE, Vays AV, et al. Gematogennyy osteomiyelit u novorozhdennykh. Vestnik novykh meditsinskikh tekhnologiy = Journal of New Medical Technologies. 2019;1:40–47. (In Russ.) https://doi.org/10.24411/2075-4094-2019-16305

7. Terekhova RP, Mitish VA, Paskhalova YuS, et al. Osteomyelitis agents of the long bones and their resistance. Wounds and wound infections. The prof. B.M. Kostyuchenok journal. 2016;3(2): 24–30. (In Russ.) https://doi.org/10.17650/2408-9613-2016-3-2-24-30

8. Gisak SN, Sklyarova EA, Shestakov AA, et al. Optimizatsiya ranney diagnostiki ostrogo gematogennogo osteomielita u detey i effektivnogo lecheniya bol'nykh [Optimization of early diagnosis of acute hematogenous osteomyelitis in children and effective treatment of patients]. Prikladnye informatsionnye aspekty meditsiny. 2016;19(4):167–174. (In Russ.)

9. Imankulova AS, Kozhomkulova KA, Kabaev BA, et al. Sovremennye podkhody uluchsheniya praktiki primeneniya antimikrobnykh preparatov v khirurgii [Modern approaches to improving the practice of using antimicrobial drugs in surgery]. Vestnik Kyrgyzskoy gosudarstvennoy meditsinskoy akademii imeni I.K. Akhunbaeva. 2021;5–6:43–50. (In Russ.)

10. Tsybin AA, Boyarintsev VS, Mashkov AE, et al. Osteomyelitis in children: a monograph. Tula: Aquarius, 2016. 384 p. (In Russ.)

11. Street M, Puna R, Huang M, et al. Pediatric Acute Hematogenous Osteomyelitis. J Pediatr Orthop. 2015;35 (6):634–639. https://doi.org/10.1097/BPO.0000000000000332

12. Barskaya MA, Kuzmin AI, Terekhina MI, et al. Ostryy gematogennyy osteomielit u detey [Acute hematogenous osteomyelitis in children]. Mezhdunarodnyy zhurnal prikladnykh i fundamental'nykh issledovaniy. 2015;12– 7:1217–1219. (In Russ.)

13. Lorrot M, Gillet Y, Le Guen CG, et al. Antibiotic therapy of bone and joint infections in children: proposals of the French Pediatric Infectious Disease Group. Arch Pediatr. 2017;24(12S):36–41. https://doi.org/10.1016/S0929-693X(17)30517-1

14. Keren R, Shah SS, Srivastava R, et al. Pediatric research in inpatient settings network comparative effectiveness of in trave-nous vs. oral antibiotics for postdischarge treatment of acute osteomyelitis children. JAMA Pediatr. 2015;169(2):120–128. doi:10.1001/jamapediatrics.2014.2822

15. Spyridis N, Syridou G, Goossens H, et al. Variation in paediatric hospital antibiotic guidelines in Europe. Arch Dis Childh. 2016;101(1):72–76. https://doi.org/10.1136/archdischild-2015-308255

16. Mingazova EN, Imankulova AS, Djumalieva GA, et al. The effect of application of monitoring and training programs on quality of antimicrobial drugs use in high-risk department.The problems of social hygiene, public health and history of medicine. 2023;31(1):5–10. https://doi.org/10.32687/0869-866X-2023-31-1-5