Abstract

HORN, A; CENTNER, C; LAUBSCHER, M  and  TOOTLA, H. Bacterial aetiology and antimicrobial susceptibility of osteoarticular infections at a tertiary-level paediatric unit in South Africa. S. Afr. j. child health [online]. 2024, vol.18, n.1, pp.59-62. ISSN 1999-7671.  http://dx.doi.org/10.7196/SAJCH.2024.v18i1.643.

BACKGROUND. Osteoarticular infections (OAI) are very common in children living in low- and middle-income countries, yet the bacterial aetiology and antibiotic susceptibility of OAI in children are not well described. OBJECTIVE. To determine bacterial aetiology and antibiotic susceptibility of OAI in paediatric patients in a regional hospital in Cape Town, South Africa. METHODS. The study included all patients who underwent surgery for OAI over a 3-year period, and those with organisms identified from tissue, pus, fluid or blood. Duplicate cultures from the same patient were excluded if the organism and antibiotic susceptibility profiles were the same. Patients were categorised by age and class of infection (septic arthritis, acute osteomyelitis, fracture-related infection, postoperative sepsis and chronic osteomyelitis) and organisms were stratified accordingly. RESULTS. We identified 132 organisms from 123 samples collected from 96 patients. Most cultured organisms were from children older than 3 years with acute haematogenous septic arthritis, osteomyelitis or both. Methicillin-sensitive Staphylococcus aureus (S. aureus) accounted for 56% (n=74/132) of organisms cultured. The Enterobacterales accounted for 17% (n=22/132) of organisms cultured, mostly in the fracture-related and postoperative infection groups. Of these, six each were extended-spectrum ß-lactamase producers and AmpC producers, respectively. There were no carbapenemase-producing Enterobacterales. CONCLUSION. Methicillin-sensitive S. aureus is the most common infecting organism in paediatric OAI and anti-staphylococcal penicillin is the most appropriate empiric treatment for haematogenous OAI in our environment. In fracture-related or postoperative infections, Enterobacterales were more frequently cultured, and treatment should be guided by culture and susceptibility results.

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