M. Trifa

Microbiological profile of haematogenous osteoarticular infections in children.

INTRODUCTION Staphylococcus aureus, Kingella kingae and β-hemolytic streptococcus are presently the most frequently identified bacteria in child haematogenous osteoarticular infection. OBJECTIVE To determine the microbiological profile (bacteria and antibiotic susceptibility) of osteoarticular infections in a paediatric hospital, so as to adapt treatment protocols to the ecology of the bacteria isolated. PATIENTS AND METHODS Prospective descriptive study, including children admitted for acute osteomyelitis or septic arthritis. A series of blood cultures was performed systematically on admission. In case of surgery, local samples were taken for bacteriology. Antibiotherapy was initiated and subsequently adapted to the bacteriological findings. RESULTS One hundred and six children were included. Thirty-five were under (Group 1) and 71 over 3 years of age (Group 2). Ninety-five underwent surgery. Peroperative samples were positive in 61 cases and blood culture in 23. Bacteria were isolated in 22 patients in G1. Extended-spectrum β-lactamase-producing Klebsiella pneumoniae was isolated in five neonates who had passed through intensive care. Staphylococcus aureus was the most frequently isolated bacterium in G2 (n=40), and was methicillin-resistant (MRSA) in six children. DISCUSSION Methicillin-susceptible Staphylococcus aureus was the most frequently isolated microorganism. Other than neonates who had passed through intensive care and the six patients with community-acquired MRSA infection, all isolated bacteria were susceptible to second-generation cephalosporins. LEVEL OF EVIDENCE II, prospective descriptive prognostic study.

Antibiothérapie intraveineuse des ostéomyélites aiguës : traitement long versus court

The aim of this study was to evaluate the results of two antibiotic therapy protocols for osteomyelitis with different durations of intravenous treatment. This was a prospective randomized study of children treated for acute hematogenous osteomyelitis. Patients in group 1 (G1) received 7 days of intravenous antibiotics, whereas patients in group 2 (G2) received 14 days. Treatment was deemed effective if there were no signs of chronic osteomyelitis at the last follow-up. Fifty-three patients were included in the study (G1=27, G2=26). After a mean follow-up of 11.5 months, none of the patients in either group showed signs of chronic osteomyelitis. In conclusion, a shortened treatment of 7 days of intravenous antibiotic therapy is as effective as a longer treatment.

Bactéries aérobies associées aux appendicites aiguës de l’enfant

OBJECTIVE The aim of the study was to determine the microbiological profile of acute appendicitis in children. STUDY DESIGN Prospective descriptive study including children hospitalized for acute appendicitis. METHODS A specimen of the appendice and the peritoneal exudates (if exists) was performed intraoperatively for aerobe bacteriological examination. Anaerobic incubation was not possible in our study. RESULTS Eighty children were included. The specimen culture isolated aerobic bacteria in 56 patients (70%). Polymicrobial infection was found in 14 children. Gram-negative bacilli were the most frequently isolated microorganisms (64/70). Escherichia coli was found in 48 children. The resistance rate to amoxicilline-clavulanic acid and to cefazolin was 35%. Pseudomonas aeruginosa susceptible to ticarcillin was detected in seven patients. CONCLUSION In our study, the specimen culture found aerobic bacteria in 70% of cases, especially Gram-negative bacilli. Empiric antibiotherapy in acute complicated appendicitis in children should be efficient against these microorganisms.