RESUMO
To determine the demographic, clinical, biological and bacteriological profile of acute community acquired hematogenous osteomyelitis [AHO] in children. Prospective study including children admitted for AHO. We noted the demographic parameters of patients and the clinical, biological and radiological characteristics of the infection. Blood cultures and local specimen in operated children were systematically performed. 70 patients were included. The mean age was 7.7 years. The mean time between onset of symptoms and admission was 3.2 days. Distal tibia was the most frequent localization [18.66%]. Fever higher than 38[degree sign] on admission was found in 92.8% of patients. Creactive protein [CRP] was superior to 20 mg / L in 95.8% and ESR superior to 20 mm in the first hour in 92% of cases. A deep venous thrombosis was found in 7 patients and a pleuropulmonary Staphylococcus infection in 4 patients. Amicroorganism was isolated in 64.7% of cases. Staphylococcus aureus methicillin susceptible [SAMS] was the predominant germ. Staphylococcus aureus methicillin resistant [SAMR] accounted for 15.7% of staphylococcus aureus infections. The importance of CRP on admission and time to resolution of fever after the start of treatment were significantly higher in SAMR infections. The existence of deep venous thrombosis and a pleuropulmonary Staphylococcus infection and the need for surgical drainage were significantly more frequent in SAMR infections. The existence of a severe form of AHO should lead to a high suspicion of SAMR infection and prompt the prescription of an appropriate antibiotiotherapy
RESUMO
The subacute osteomyelitis of the hip is rare and remains a difficult diagnostic. We report a case of right pain hip in a 9-year-old girl, associated with a slight fever, rebel to the antibiotic treatment. Biology showed moderated raised inflammatory markers. The plain radiographs of the pelvic showed a little bone demineralization of the acetabular roof. The ultrasonography of the right hip was normal. The pelvic magnetic resonance imaging [MRI] showed a medullary edema in the acetabular roof. The bone scintigraphy showed an intense uptake on the right acetabulum. The computed tomography [CT] of the hip revealed the presence in the right acetabular roof of two bone defects enclosing bony sequestra thus evoking the diagnosis of subacute osteomyelitis. The evolution was favourable under antibiotic treatment managed by the intravenous way during 15 days [Bristopen, Gentamycin] then relayed by the oral way for one month