In acute haematogenous multifocal osteomyelitis, infectious foci occur in several bones simultaneously due to haematogenous bacterial spread. Acute haematogenous multifocal osteomyelitis should be distinguished from chronic recurrent multifocal osteomyelitis (CRMO). We reviewed the medical records of three male adolescents of 15 years (range 13–16 years) with acute multifocal haematogenous osteomyelitis. All patients were athletes (soccer player, water polo player, practicing rowing). The mean duration of painful symptoms before seeking medical attention was 3 days. Osteomyelitis was confirmed by magnetic resonance imaging (MRI) and bone three phase scintigraphy. The lesions were at level of spine plus left femur in the first case, bilateral tibia and lumbosacral column in the second one, right foot plus left femur were interested in the third case. Two of the patients exhibited a spinal osteomyelitis, which is described as a common spinal affection in athletes. Blood cultures (in all patients) and culture of abscess drainage (in one case) were positive for Staphylococcus aureus (MSSA). Inflammatory indices were increased in all patients (mean values: WBC 15.130/mmc, CRP 19 mg/dl, and ESR 63,6 mm/h). Intravenous antibiotic therapy was prescribed for 19 days (range 13–33 days), followed by oral antibiotic therapy for a median of 18 days. After a median of 11 days, all patients clinically improved with resolution of fever and reduction of pain. Patients were discharged with oral antibiotic therapy after a median of 22 days hospitalization, and underwent a 16 months follow up. No patient reported sequelae. Differential diagnosis among multifocal acute osteomyelitis, septic arthritis, CRMO, juvenile idiopathic arthritis and/or reactive arthritis may be difficult. Previous studies reported that athletes are more at risk for osteomyelitis, but, to our knowledge, no case series of acute haematogenous multifocal infectious have been reported in competitive athletes. Staphylococcal outbreaks have been reported in sport players, as position, artificial grass abrasion, and body shaving are the main portal of bacterial entry. In conclusion, a diagnosis of acute multifocal osteomyelitis must be considered in a patient with fever and pain of several bones. A prompt hospitalization and an appropriate therapy reduce the morbidities and can help to avoid surgery

Acute haematogenous osteomyelitis remains a significant cause of morbidity in the paediatric population. The clinical presentation has changed, however, over the last number of decades. The typical picture of established osteomyelitis is less commonly seen. Children more often present with a less fulminant picture. The treatment of acute haematogenous osteomyelitis remains controversial. Antibiotic therapy, initially intravenous, then orally, is the gold standard. Hover, the role of surgery is unclear. Some centres, particularly in North America treat 25–40% of patients surgically. We present our experience with acute haematogenous osteomyelitis in children over a three year period. The total number of patients was forty-five. The mean age was 6.1 (range 6 months to thirteen years). The most common isolated organism was Staphylococcus Aureus. The mode of treatment was intravenous antibiotics for two weeks, or until clinical, and laboratory evidence of improvement, and the oral antibiotics for six weeks. No patients required surgical interventioin. All patients made a satisfactory recovery. We conclude that the treatment of acute haematogenous osteomyelitis in the paediatric population should consist of antibiotic therapy only, and that there is no place for surgery

Acute Haematogenous Osteomyelitis (AHO) remains a cause of severe illness among children with the possibility of long-term consequences for growth and development. Previous research on sequelae from AHO rarely considers outcomes more than two years following treatment. This study aims to establish the quality of life of patients diagnosed with AHO in childhood up to 13 years after diagnosis, evaluating the impact on social, emotional, physical, and school function. Children treated for AHO between 2008–2018 at a tertiary referral centre in New Zealand were identified. PedsQL™ questionnaires were conducted via phone with either the child or primary caregiver and responses analysed. 40 patients met inclusion criteria, were contactable by phone, and consented to participate. The mean age was 7 years (range 0–15) and most were female (60%). Health related quality of life (HRQOL) was scored as a percentage with most participants scoring >80% (n=27). Those who do experience reduced quality of life following treatment for AHO were likely to complain of pain, stiffness, or anxiety. The impact of significant childhood illness on mental health was not adequately captured by the PedsQL™ but was highlighted in qualitative feedback. We conclude that the majority of children treated for AHO reported excellent health-related quality of life up to 13 years following treatment although an negative impact on mental health was reported using qualitative analysis. A refined scoring system is needed to assess the long-term impact of musculoskeletal infection

Aims: to present a new classification of haematogenous chronic osteomyelitis based on the clinical and radiographic presentation so that a reliable post-surgery prognosis can be done. Methods: between January 2002 and December 2008, 864 children underwent 1632 surgeries for haematogenous osteomyelitis. The clinical and surgical notes were reviewed. Three groups were identified based on clinical and radiographic findings: the first consisting of 565 patients with “ordinary” osteomyelitis requiring treatment of the infection through a sequestrectomy. The second group, classified as “difficult” osteomyelitis, included 134 patients who needed more than one surgery to cure the bone infection. The third group consisted of 165 patients with “complex” osteomyelitis in need of treatment of the infection and its complications, such as pathological fractures, bone loss, and septic arthritis. In the latter group techniques of bone transport, bone graft and radio-ulna/fibula-tibia fusion were used. Results: all the cases of haematogenous osteomyelitis in our series could be classified in one of the following categories and the prognosis and the length of treatment needed to cure this condition appear to be closely related to these. The first group in the CoRSU classification is “Ordinary Osteomyelitis”. The sequestrum is clearly defined and there is a good involucrum on X-ray film. Surgery under tourniquet is possible. In most cases the surgical treatment achieves the healing of the bone and recurrence is uncommon. The second group is classified as “Difficul osteomyelitis”. The bone involved presents with multiple erosions-cavities and there is no clear sequestrum on X-ray film. This category also includes those cases where surgery under tourniquet is impossible. Blood for transfusion must be available. Despite treatment, this type of osteomyelitis often recurs and further surgeries are often needed. All the cases of multiple osteomyelitis are included in this group as well. The third category covers “Complex Osteomyelitis”, whereby chronic osteomyelitis is associated with a pathological fracture or septic arthritis. There is axial deformity, bone loss and non-union. Some sort of reconstruction is always required. Conclusions: Haematogenous chronic osteomyelitis in African children accounts for about 30% of the total number of orthopaedic surgeries performed in our Unit. The classification that is presented here facilitates the planning of the surgery, predicting the prognosis and the length of treatment needed to cure this condition

Acute osteomyelitis and septic arthritis are uncommon diseases in childhood that affect previously healthy children. A high index of suspicion, early diagnosis, initiation of appropriate antibiotic treatment and surgical intervention are essential for a good outcome. The aim of our study was to evaluate our approach, clinical signs and the outcome of the diseases. We retrospectively analyzed clinical, laboratory and microbiologic data in children hospitalized for acute haematogenous osteomyelitis or septic arthritis at the Department of Orthopaedic surgery in a 10-year period (from 2003 to 2013). Follow-up of outpatients was continued for at least 1 year or until the full recovery. Acute haematogenous osteomyelitis or septic arthritis were confirmed in 22 patients, 14/22 (64%) had osteomyelitis and 8/22 (36%) arthritis, 16/22 (73%) were boys. The mean patient age was 9,3 years (SD:3,5), the median of the hospitalization was 32 days (IQR:13 – 60 days). In children with osteomyelitis 10/14 (72%) had affected lower limb and in 4/14 (28%) the spine was affected. Six (80%) children had septic arthritis of the knee, hip joint was affected in one child and sacroiliac joint in one as well. We obtained blood cultures in 19/22 (86%) patients, bone biopsy was performed in 14/22 (64%). All infections were monomycrobial, Staphylococcus aureus was the most common pathogen, as expected. In one patient the cause of the osteomyelitis was Panton-Valentine leucocidin (PVL) producing S. aureus. The characterics are presented in Table 1. All affected children recovered completely. We observed 22 cases of pediatric bone and joint infections in a 10-year period. The most common pathogen was Staphylococcus aureus, as expected, althogh in more than half of cases no pathogens were found. One child suffered from osteomielitis caused by S. aureus strain producing PVL. We observed higher proportion of spine invovelment than previously reported in the literature

Acute haematogenous osteomyelitis in children occurs in metaphysis of a long bone, and the diagnosis is usually made within 48 hours of the onset of symptoms. From 1985 to 2001 we identified 682 cases with admission diagnosis of acute haematogenous osteomyelitis, which were treated in our hospital. Early diagnosis is essential to successful treatment. We excluded all patients without either radiological or bacteriological confirmation of the diagnosis those with a history of penetrating wound. Of 682 cases included in the full series, 320 or 47% fulfilled the diagnostic criteria. Of 320 cases, 173 (54%) the infection were on the right and 147 (46%) on the left. Five cases were multifocal, 47 cases were aged one year or less, in percent 14.6%. The principle of treatment were: identification of the organism, selection of the correct antibiotic, delivery of the antibiotic in sufficient concentration and for sufficient duration and arrest of destruction. In about 80% of cases Staphylococcus aureus was isolated. The reason for a fall in the incidence of Staphyloccocus aureus are not clear. Improvements in living standards, personal hygiene, and in the general health of population may well be responsible for decreased prevalence of Staphylococcus aureus. Oral administration of antibiotics is instituted after an initial good clinical response is seen during intravenous administration, and generally we use parenteral antibiotics for the first 21 days. Long-term follow-up of all patients is necessary, including the patient with an apparantly good early result

Acute haematogenous osteomyelitis in children is relatively uncommon but delay in diagnosis and inadequate treatment can result in significant morbidity. Most recently evidence has suggested conservative treatment with adequate antibiotic therapy should be the mainstay, with provision for surgical intervention in those who fail to respond to conservative management. The outcome of primary management has been evaluated in this review. Retrospective analysis of an osteomyelitis database was conducted on individuals presenting to Auckland’s Starship and Middlemore Hospital with an ICD-10 diagnosis of Osteomyelitis between January the 1st 1999 and December the 31st 2008. 813 children fulfilled the criteria for inclusion into this review. The annual incidence of acute haematogenous osteomyelitis in the paediatric population in Auckland over this period was approximately 1:4,000. 64% were male and 36% were female. The majority were New Zealand European (35%), with the other significant ethnic groups represented being New Zealand Maori (22%), and Pacific Island (30%). 23% of patients were aged less than three. 51% of patients were between three and ten, and 26% older than ten. Only 32% had an elevated white cell count on admission. A responsible pathogen was isolated in 50% with the most common being Staphylococcus aureus, which was isolated in 77% of this group. Diagnosis was made radiologically in 66%, clinically in 27%, and surgically after exploration in 7%. The most common site of osteomyelitis was the femur in 254 individuals, followed by the tibia in 198 individuals. 49 had multi-focal involvement. Flucloxacillin was the most common antibiotic used, with 510 individuals being administered flucloxacillin at one point in time during their management. The average length of treatment was 43.7 days, which included intravenous therapy of 22.3 days, and oral therapy of 21.4 days. 60% had a range of duration of therapy from greater than three weeks through to six weeks. 44% required surgical intervention. The relapse rate was 6.8%. The average duration till relapse was 5.8 months. Only 1.7% of the total population went on to develop chronic osteomyelitis. The incidence of paediatric acute haematogenous osteomyelitis in this population appears to be relatively high. The average length of treatment was longer than that now reported to be successful for eradication. This could possibly be a factor in the relatively low rate of relapse and low subsequent rate of chronic osteomyelitis

Introduction and Aims: This disease has an insidious onset and develops as a result of increased host resistance and decreased bacterial virulence. The aim of this paper is to describe the spectrum of primary subacute forms of haematogenous osteomyelitis and highlight the difficulties in diagnosis and the importance of histology. Method: Twenty-five children aged two to 12 years were reviewed between 1990 and 2002. Symptoms and signs were mild. Complaints were present for two to eight weeks; laboratory tests were non-contributory. Bone scans were done in all patients. All patients had biopsy with curettage of cavitating lesions. Microscopy, culture and histology were done in all patients. Four patients had MRI scans. Results: There were 28 osseous lesions in 24 children. The anatomical sites were: the tibia, 24 lesions, femur three and ulna one. One child had multifocal involvement involving both tibiae and the ulna. The lesions were classified using the system of Roberts et al. Two lesions were in the epiphysis, six in the metaphysis and 20 in the diaphysis. Radiologically, the lesions resembled several benign and malignant conditions such as tuberculosis and fungal infections, Ewing’s sarcoma, leukaemia, osteosarcoma, chondroblastoma and osteoid osteoma. Bone scan was positive in all cases. Histology of bone showed features of subacute osteomyelitis – inflammatory cells, plasma cells and polymorphonuclear leukocytes. Staphylococcus aureus was cultured in eight patients. All children were treated with Cloxacillin for six weeks. Follow-up ranged from six months to five years. All diaphyseal and epiphyseal lesions healed completely. Residual sclerosis was seen in metaphyseal lesions. No growth disturbance or articular changes were seen in this study. Conclusion: Primary subacute haematogenous osteomyelitis is uncommon. Metaphyseal and epiphyseal forms are more commonly reported in the literature. The diaphyseal form was the predominant type in this study. Bone lesions mimic benign and malignant conditions. Biopsy is mandatory. The diagnosis is made on histology. Staphylococus aureus is the usual causative organism, but difficult to culture

Purpose of study. The aim of this study was to identify the incidence of Gram negative bacterial vertebral osteomyelitis (VO) within our unit during a 3-year study period and evaluate if this corresponds to published evidence that the occurrence is increasing. Methods. Between May 2007 and May 2010, all patients, over the age of 18 years, suffering from Gram-negative VO were identified and their microbiological diagnoses were evaluated. All patients were treated within a large tertiary spinal surgery unit in Leeds. Results. This study identified 79 patients with haematogenous VO. Of these 79 patients, 10 patients (12.66%) had Gram-negative organisms isolated. These organisms included E. Coli (4), Pseudomonal aeruginosa (3), Klebsiella pneumonia (1), Haemophilus influenza (1) and Enterobacter cloacae (1). Four patients had the causative organism isolated on =2 positive blood cultures, three from biopsy and =2 positive blood culture, one from biopsy alone and two were diagnosed from 1 positive blood culture. Conclusion. VO is a common manifestation of osteomyelitis in adults, representing 2-7% of all cases of osteomyelitis. Staphylococcus aureus is the most common causative aetiological agent in haematogenous spinal infections, accounting for between 40 - 60% of cases. Despite the fact that Gram negative bacteria infections represent a minor proportion of all cases of VO, around 15 - 23%, recent evidence suggests that the microbiology of this disease may be changing and the incidence of Gram-negative bacterial infections are increasing. This has been attributed a variety of factors including, an increasing proportion of individuals with predisposing risk factors such as advanced age, diabetes mellitus, malignancy and better diagnostic techniques. Results from our study show an incidence of Gram-negative VO of 12%, which is less than results quoted in the literature and does not confirm recent evidence that these types of spinal infections are increasing in incidence

Pyogenic haematogenous spinal infection in the elderly, described as spondylodiscitis, vertebral osteomyelitis and epidural abscess is considered a rare but life threatening condition. Our objective was to test the hypothesis that low index of suspicion leads to delayed diagnosis and referral for definitive treatment resulting in increased and perhaps avoidable medical morbidity, social drift including early mortality and to analyse pathological entities, complications and optimum treatment options. We performed a retrospective review of medical records over 10-year period. Post-operative infections and patients under 65 years old excluded. Initial presentation, investigations and differential diagnosis, time to diagnosis, date and day of referral, mode of definitive treatment, pathologic entities, complications and outcomes were noted. Patient outcomes were measured as duration of treatment, length of hospital stay, complications, ambulatory status, complications, discharge destination and death. Outcomes were correlated with delayed diagnosis and referral. 46 elderly (age> 65) patients with a mean age of 71 years (range=65–91). 62% referral from physicians. Fever with malaise associated with chronic LBP was the commonest presenting complaint. There were 31 patients with discitis, 12 epidural abscess and 3 osteomyelitis. Lumbar spine was affected in 63% patients. Time to diagnosis ranged from 2–17 days with mean of 8 days. Mean referral time was 9 days with 39% referrals on Friday. Staphylococcus aureus (47%) was the commonest organism isolated. Duration of hospitalisation ranged from two to twelve weeks. 46% required surgical decompression with four cases of related mortality during acute hospital stay. Time duration to spinal referral had direct correlation with increase in morbidity, social drift and mortality. The incidence of haematogenous spinal infection in the elderly has increased over the years in our series, contrary to popular belief. A high index of suspicion in elderly patients with PUO promotes early diagnosis and optimises outcome

Background: Pyogenic haematogenous spinal infection in the elderly, described as spondylodiscitis, vertebral osteomyelitis and epidural abscess is still considered a rare but life threatening condition. Objective: To test our hypothesis that low index of suspicion leads to delayed diagnosis. Late referral for definitive treatment may result in increased and perhaps avoidable medical morbidity, social and psychological drift, including early mortality. Method: Retrospective review of medical records over 10-year period. Patient pool obtained from theatre records, radiology and coding departments. Post-spinal operative infections and patients under 65 years old excluded. Initial presentation, admitting speciality, initial investigations and differential diagnosis, time to diagnosis, date and day of referral, mode of definitive treatment, pathologic entities, complications and outcomes were noted. Patient outcomes were measured as duration of treatment, length of hospital stay, complications, ambulatory status, complications, discharge destination and death. Outcomes were correlated with delayed diagnosis and referral. Results: Single largest series [n=46] of elderly [age> 65] patients with pyogenic spinal infections to our knowledge. Age ranged from 65–91 with mean of 71. 62% referral from Physician colleagues. Fever with malaise associated with chronic LBP was the commonest presenting complaint. 34 patients had discitis and 12 had epidural abscess. Time to diagnosis ranged from 2–17 days with mean of 8 days. Mean referral time to spinal team was 9 days with 39% referrals on Friday. Duration of hospital ranged from two weeks to three months. 46% required surgical decompression with four cases of related mortality during acute hospital stay. Conclusions: Time duration to Spinal referral had direct correlation with increase in morbidity, social and psychological drift, and mortality. The incidence of haematogenous spinal infection in the elderly has increased over the years in our series, contrary to popular belief. A high index of suspicion in elderly patients with PUO promotes early diagnosis and optimises outcome

This is an ongoing retrospective study of 35 children treated from 1986 to 2001 for chronic osteomyelitis following acute haematogenous osteomyelitis. The purpose was to validate the use of a modified Cierny classification to predict behaviour, to assess the timing of sequestrectomy in relation to involucrum formation, and to evaluate the results of dealing with the resultant defect by conventional methods of bone grafting. The mean age of the patients was 7 years (1 to 12). All except 18, who were treated within five days of acute onset, were delayed presentations or transfers. In 14 children the tibia was involved, in 13 the femur, in five the humerus and in three the fibula. Monthly radiographs were taken and the size and location of the sequestrum and involucrum was documented. Our classification represents the size and location of the sequestrum. We divided the patients into cortical (one), medullary (three), corticomedullary (12) and structural (19) types. Fractures occurred in all the structural types, as well as in five of the 12 corticomedullary types. A sequestrum was apparent at a mean of 2.4 months (1 to 3). The mean length of the sequestrum at diagnosis was 8.5 cm and at surgery 5.8 cm, suggesting partial resorption. Involucrum formed in 69% of patients at a mean of 1.9 months (1 to 3) after sequestrum. In 31% of patients no involucrum formed from 4 to 12 months after surgery. This suggests that involucrum formation depends on viable periosteum and not on the sequestrum, and in the absence of involucrum early rather than late sequestrectomy is warranted. The resultant incomplete bone defects in the corticomedullary type ranged from 1 cm to 15 cm, but had an intact cortical bed on one or more sides. These and complete defects of less than 6 cm in the structural type united after autogenous cancellous bone grafting, with or without an exoskeleton. Four structural defects greater than 6 cm united after fibular strut grafting (humerus) or bone grafting from fibula to tibia via a posterolateral approach (tibia). Patients were followed up both clinically and radiologically for a mean of 2.9 years. Twenty patients (57%) had an excellent result and 15 (43%) a good result

Aim. We report our ten year experience of primary haematogenous non-tuberculous spinal infection. Method. Retrospective case note review of 42 patients presented to our institution with primary spinal infection during 1995-2005 was carried out. Demographic data, timing and modes of presentation, investigations, and methods of treatment were analysed. The cost benefit of Home Intravenous Antibiotics Service (HIAS) was also investigated. Results. Mean age was 59.9 years (1-85) with almost equal gender distribution (M 20: F 22). Axial pain was universal. Pyrexia was seen in 62% and major neurological deficit in 10% of cases. Time from presentation to diagnosis averaged 19 days (range 0-172). Sensitivity for MRI and plain x-ray was 100% and 46% respectively. Blood culture was as sensitive as percutaneous biopsy in patients with pyrexia. Staphylococcus Aureus was the most common organism. Treatment ranged from intravenous antibiotics alone to combined anterior and posterior surgery depending on the presence or absence of significant abscess collection, neurological deficit and structural threat. Mean duration of intravenous antibiotics was 54 days (range 13-240). At mean follow up of 5.4 years (0.6-10.5) there was no mortality directly related to the infection. Recurrence rate was 14%. Significant past medical history (p=0.001), constitutional symptoms (p=0.001) and pyrexia at presentation (p=0.001) and possible male gender (p=0.01) were positively associated with recurrence. Although firm conclusions can not be drawn due to sample size, duration of symptoms (p=0.27) did not appear to affect the risk of recurrence. When inpatient days were subtracted from days on IV antibiotics for all the patients, HIAS was found to have saved a total of 940 inpatient days. Conclusion. In spinal infection, disease and patient characteristics dictate the management strategy. Longer antibiotic therapy in patients with positive risk factors for recurrence may be indicated. Finally, HIAS was cost effective in this group of patients

Aim

Melioidosis is a significant public health problem in endemic regions such as India. Lack of awareness, predominant empiric antibiotic use reducing culture yields, morphotypic variability of cultures and frequent misidentification by automated blood culture systems, pose myriad challenges in diagnosis and treatment. Through this series, we present our experience of Hematogenous Osteomyelitis with Burkholderia pseudomallei.

Haematogenous vertebral osteomyelitis (HVO) is a relatively rare disorder which accounts for 2–4% of all cases of infectious bone disease. In recent years, the incidence of spinal infections seems to have increased according to the growing number of intravenous drug users in young people and with the use of intravenous access devices, genitourinary surgery and manipulation in the elderly. Men are more frequently affected than women, with an average age of onset in the fifth and sixth decade of life. The onset of symptoms is typically insidious, with neck or back pain often underestimated by the patient. The early diagnosis is also difficult due to the non-specific nature of laboratory and radiographic findings. The frequent observation of back pain also makes the diagnosis a challenge in most cases. Several studies in the literature report an average delay in the diagnosis of HVO from 2 to 6 months after the beginning of the symptoms. In this article we review the clinical features and the diagnostic approach to HVO in order to optimise treatment strategies and follow-up assessment. From 1997 to 2003 we treated 153 patients affected by vertebral osteomyelitis. The localisation was cervical in 11.5% of the cases, thoracic in 31% and lumbar in 57.5% cases. In all, 92 CT needle biopsies were performed without any complications. We were able to identify the microbiological pattern in 57% of cases (the most represented bacteria were Staphylococcus aureus and Mycobaterium tuberculosis) whereas in 47% of cases we could not identify any micro-organismus. Treatment was conservative in 112 cases and surgical in 41 cases. Most of the studies in the literature consider HVO as a challenge for the physician: symptoms are not specific and sub-acute or chronic presentation is most common. In general, a delay in diagnosis is the rule rather than the exception. This is an easily missed infectious process, particularly in the elderly, in whom degenerative radiographic changes and conditions resulting in back pain, such as osteoporotic fractures or spinal metastases, are common and signs of sepsis may not become manifest. However, persisting localised back pain and tenderness with elevated ESR should prompt the physician to also consider HVO, although fever and leucocytosis may often not be present. Once HVO is suspected, a long series of imaging and laboratory tests, and if necessary surgical procedures, must be initiated. The purpose of this study is to formulate a systematic, comprehensive and simple approach to the management of this disease following the diagnostic algorithm suggested

Aim

The gold standard treatment for late acute hematogenous (LAH) periprosthetic joint infection (PJI) is surgical debridement, antibiotics and implant retention (DAIR). However, this strategy is still controversial in the case of total knee arthroplasty (TKA) as some studies report a higher failure rate. The aim of the present study is to report the functional outcomes and cure rate of LAH PJI following TKA treated by means of DAIR at a long-term follow-up.

Aim

Acute hematogenous periprosthetic joint infection (AHI) is a diagnosis on the rise. The management is challenging and the optimum treatment is not clearly defined. The purpose of this study was to evaluate the characteristics of AHI, and to study risk factors affecting treatment outcome.

Introduction: MRSA spondylodiscitis is an increasingly common phenomenon. Despite this there is very little reported on it.

Objectives: Our objective was to present relevant demographics, clinical presentations and outcomes for this condition from our institution.

Methods: We performed a retrospective review of patients presenting over a six year period from 2000 to 2005.

Results: 13 cases were identified. The mean age was 65 years (range 36–92), 85% were male. All cases presented with back pain, spinal tenderness and systemic upset. Neurological deficit was present initially in 38% and a further 8% developed neurological deterioration during treatment. The thoracic spine (53%) was most commonly affected followed by the lumbar (33%), thoracolumbar junction (7%) and cervical spine (7%); 16% of cases were multilevel. The WCC, ESR and CRP were elevated in all cases with means of 17.3 ×10-9/L, 102 mm/hr and 236 mg/L respectively. In cases cured of infection, the WCC, ESR and CRP normalised at a mean of 10 weeks, 14 weeks and 19 weeks respectively. Radiological diagnosis was established with MRI in all cases. The most common risk factors were diabetes mellitus (62%), mal-nourishment (54%), cirrhosis (31%), end stage renal failure (15%) and intravenous drug use (15%). Multiple risk factors were present in 76% of cases and 15% had no identifiable risk factors. The main sources of sepsis were intravenous catheters (23%), urinary tract (15%) and intravenous drug use (15%). In cases cured of infection treatment consisted of intravenous vancomycin mono-therapy for a mean period of four weeks followed by oral combination or monotherapy antimicrobials for a mean period of 8 weeks. Operative intervention was required in 38% of cases. At six months 54% of cases were clinically free of infection, 38% had died and 8% required ongoing treatment. Neurological deficit was present in 50% of survivors. At one year 29% of survivors suffered from MRSA bacteraemia and spondylodiscitis recurrence.

Conclusion: This is a devastating condition. Clinical suspicion should remain high and prompt diagnosis and treatment is essential.

Aim

The incidence of hematogenous periprosthetic joint infections (hPJI) is unknown and the cases probably largely underreported. Unrecognized and untreated primary infectious foci may cause continuous bacteremia, further spread of microorganisms and thus treatment failure or relapse of infection. This study aimed at improving knowledge about primary foci and microbiological characteristics of this entity to establish preventive measures and improve diagnostic and therapeutic strategies to counteract hPJI.

Aim: To present the features and management of Pyogenic myositis in children.

Method: Two boys of four and six years old presented to our hospital within 6 months. The initial presentation suggested septic arthritis of the hip with pain, pyrexia and limited hip movements. Serum inflammatory markers were significantly raised. Hip rotation, however, was not severely reduced when examined carefully. Neither case demonstrated an effusion on ultrasound of the hip joint. The diagnosis was made on magnetic resonance imaging which produced striking images. Staphylococcus aureus was isolated from blood cultures in each case.

Results: Both children settled with antibiotic treatment alone. The bacterial strain in the second case was of a type requiring combination antibiotic therapy for effective treatment.

Conclusions: Pyogenic myositis is not a common diagnosis in previously healthy children presenting with hip pain. It is a condition that has been reported more frequently recently and which should have a higher profile since it is probably under-diagnosed. Urgent magnetic resonance imaging is recommended for atypical cases of musculoskeletal infection in children. Care must be taken to prescribe antibiotic therapy appropriate to the particular bacterial strain.