Osteomyelitis in the neonate: A 22-year experience

Over 22-year period (1975-1996), 31 infants (17 boys & 14 girls) aged 2-42 days with osteomyelitis were admitted to our hospital. All patients had clinical and radiological evidence of osteomyelitis. Microorganisms were isolated from blood, bone, or joint fluid in 25 patients. Eleven (35%) patients were premature (<37 week gestation), most of whom had multiple complications of prematurity. S. aureus was recovered in 12 patients (39%), group B streptococcus (GBS) in 8 (26%), coagulase negative staphylococcus in 2, and S. pneumoniae, E. coli, and group A streptococcus (GAS) in 1 patient each. The most common presentations were local swelling (20/31) and decreased movement of extremities (17/31). Forty three bones were infected including the femur (18 times), tibia (8), and humerus (8). Multiple bones were affected in 5 patients (16%). A contiguous joint was infected in 11 patients (35%). Microorganisms were recovered from bone in 15 patients, blood 14, joint fluid 8, abscess/skin lesion 5. One of the 8 patients with GBS osteomyelitis had scalp electrode during labor. In contrast, 9 of the 12 patients with 5. aureus osteomyelitis had manipulative procedures predisposing to infection. Mean hospitalization was 36 days (range 14-122 days). Surgical drainage was done in 10 of the 31 patients (7 with S. aureus, 1 S. pneumoniae, 1 GAS, and 1 E. coli). Functional impairment, mostly limb length discrepency, was noted in 5 (26%) of 19 patients evaluated at a mean of 17 months after discharge. Our data indicate that S. aureus is the leading pathogen of osteomyelitis in the neonatal period, however GBS continues to maintain a major role in this disease. Long term sequelae occurs in a significant number of this patient population.