Possible causes of failure in the management of acute osteomyelitis in Saudi Arabia

ABSTRACT

Twenty-four cases of acute osteomyelitis in which primary treatment of the patients was unsuccessful were reviewed. The aim was to analyse the possible causes of failure and to identify means of minimizing their occurence. There were 83.3% males, 16.7% females, with an average age of 6 years. All patients were initially treated by a combination of erythromycin and fucidin. Surgical intervention was carried out in 75% of the cases. The causal organisms were Staphylococcus aureus [the commonest] Streptococcus haemolyticus, Escherichia coli, Brucella and Pseudomonas. Late presentation and diagnosis, ineffective immobilization, surgical intervention and treatment due to an unusual causal organism [brucella] were the principal causes of failure. It was concluded that the following steps are necessary to minimize the risks of complications [1] a public health education Programme to stress the value of early medical consultation; [2] continuation of effective immobilization until clinical cure and a fall of sedmentation rate has occurred; [3] radiological localization of site infection by isotope scan in clinically difficult cases; and [4] generation of a high index of suspicion of brucellosis as a causal organism in endemic areas