Epidemiology of paediatric pyogenic musculoskeletal infections in a developing country

Background: Epidemiological data regarding paediatric pyogenic musculoskeletal infections from developing countries of Asia and Africa are sparse and is further complicated by presence of factors like malnutrition, delay in initiating treatment, belief in alternative form of treatment and under vaccination. The aim of this study is to retrospectively analyse the cases of paediatric pyogenic musculoskeletal infections in a tertiary care centre in India.
Methods: It is a retrospective study including patients below 18 years of age who had been diagnosed with any pyogenic musculoskeletal infection. Demographic, clinical, laboratory and radiological details were collected.
Results: A total of 216 children with mean age of 12.8±4.9 years (10 days – 18 years) were included in the study. The causative organism could be isolated in 98 cases (45.3%). Escherichia coli and methicillin sensitive Staphylococcus aureus were the most common pathogens isolated in infants and children, respectively. Imipenem and linezolid were the commonest sensitive antibiotics for children up to 10 years and after 10 years, respectively. Linezolid was the antibiotic of choice in culture negative cases. The majority (78.3%, n = 169) of the children underwent a surgical procedure during the stay at the hospital. Higher relapse rate (61%) was noted in negative culture patients.
Conclusion: Improved methods of pathogen detection should be explored to improve the rate of positive cultures. Additional prospective studies with longer patient follow-up and the creation of care protocols are necessary to improve therapeutic decision-making and the prognosis for children with suspected musculoskeletal infection.