Bacteriological Profile of Osteomyelitis in Drepanocytic Children at the David Bernardino Pediatric Hospital from May to August 2017

Abstract

Introduction: Osteomyelitis is defined as the infection of the entire bone structure caused by a pyogenic infectious agent. Depending on the evolution time, clinical and radiological findings can be classified as acute or chronic. The present study aimed to describe the bacteriological profile of osteomyelitis in patients with sickle cell disease, admitted to the Pediatric Hospital David Bernardino, in Luanda/Angola, from June 1 to October 31, 2017. Methodology: We carried out a descriptive, longitudinal and prospective study in a universe consisting of 33 children with sickle cell anemia admitted to the Surgery Service of this Hospital. Sample collection was performed during the surgical procedure. Results: We identified a higher percentage of cases in male children with 58% and in the age group from 5 to 10 years with 63.6%. The most affected bone segment was the tibia with 33.4%, followed by the humerus and femur with 30.3% each. Most patients, 66.7% of cases, were admitted to the Surgery Service before the surgical procedure. Of the samples collected for bacteriological study, only 31.3% were positive, with the most identified germs being Citrobacter spp, Enterobacter species and Proteus species, with 6.1% each. The sensitivity profile of Gram positive cocci was 100% for Ofloxacin and Cloxacillin and gram negative cocci had 100% sensitivity for Ofloxacin, Amikacin and Minocycline. There was total resistance in Gram positives to Ampicillin and 80% in Gram negatives. Most children had severe anemia (hemoglobin below 9 g), in 17 cases (69.69%), Erythrocyte Sedimentation Velocity levels between 60 to 83 mm, in 16 cases (48.5%), and levels of C-Reactive Protein (CRP) between 40 to 50 mg/L in 8 cases (24.3%). Cloxacillin was used in 60.7% of cases, followed by Cloxacillin + Gentamicin in 7 children (21.1%). Twenty-seven children (82%) underwent surgical treatment, with fenestration being the most used procedure. Conclusion: The characteristics of the patients and the disease regarding sex, age and the most affected bone are in accordance with those described in the literature. Of the 10 patients without previous antibiotic therapy had samples with bacterial growth, with identification of Citrobacter spp (2), Enterobacter sp (2) Proteus spp (2), E.Coli (1), S.Aureus (1), Proteus Vulgaris (1) and Proteus Mirabilis (1). Patients were hospitalized for more than seven (7) days, due to other pathologies during hospitalization. About 60.7% of the children were treated with Cloxacillin and 21.1% with an association of Cloxacillin with Gentamicin, with surgical debridement and fenestration being the surgical procedure performed in 82% of patients. Patients operated on and undergoing targeted antibiotic therapy had good results in 87.87% of cases; One case (3.03%) required readmission and underwent a new surgical approach.