Treatment and Clinical Outcomes of Osteoarticular Infections Among Pediatrics Admitted to Jimma University Medical Center, Ethiopia: A Prospective Observational Study

Abstract

Background

Despite the high burden of osteoarticular infections in sub-Saharan Africa, there is a paucity of data regarding the osteoarticular infections management approach and clinical outcomes in the region. Hence, this study aimed to evaluate a management protocol, clinical outcomes, and its determinants among pediatric patients with osteoarticular infections.

Methods

A pediatric patient admitted to Jimma University Medical Center (JUMC), Ethiopia, with a diagnosis of osteoarticular infections was enrolled prospectively from April 30 to October 30, 2019. Clinical characteristics, management modality, and in-hospital complications were recorded from admission to discharge. Data were analyzed by using SPSS v.23 and the p-value <0.05 was considered statistically significant.

Results

Among a total of 150 pediatric patients enrolled in this study, osteomyelitis was diagnosed in 111 (74%), while the rest 39 (26%) had septic arthritis. The majority 105 (70%) of the study participants were male with a mean age of 8.79 ± 4.2 years. The culture was performed for only 3.6% of the patients. Almost all (98.7%) of the patients received intravenous (IV) antibiotics, and ceftriaxone was the most common IV antibiotic used as a monotherapy 66 (44.6%) or in combination with metronidazole 47 (31.8%) or gentamicin (12.8%). Almost half (45.3%) of the patients had poor treatment outcomes. Factors associated with poor treatment outcome were comorbidity [AOR=3.3, 95% CI (1.08–10.16)] and use of combination antibiotics [AOR=2.9, 95% CI (1.16–7.3)]. Rural residence [AOR=0.39, 95% CI (0.168–0.92)] and surgical interventions [AOR=0.29, 95% CI (0.006–0.144)] were associated with good treatment outcomes.

Conclusion

Almost half of pediatric patients with osteoarticular infections had poor treatment outcome. Health providers should increase the accessibility of microbiological tests and diagnostic imaging, which can guide treatment decisions and improve outcomes of patients with osteoarticular infections.

Keywords:

• management
• infections
• osteomyelitis
• septic arthritis
• children
• sub-Saharan Africa

Acknowledgment

We would like to thank Jimma University for facilitating the study and covering stationery materials and data collection costs. We would also like to acknowledge all data collectors, supervisors, and respondents without whom this research would not have been realized.

Abbreviations

AOR, adjusted odds ratio; CBC, complete blood count; CI, confidence interval; COR, crude odds ratio; C-RP, C-reactive protein; ESR, erythrocyte sedimentation rate; IV, intra venous; JUMC, Jimma University Medical Center; OAI, osteoarticular; OM, osteomyelitis; PO, per oral; SA, septic arthritis; SF, Synovial Fluid; WBC, white blood.

Data Sharing Statement

The dataset that was used to support the finding of this study will be made available from the corresponding author upon reasonable request.

Ethics Approval and Consent to Participate

The study protocol was approved by the Institutional Review Board (IRB) of Jimma University, Institute of Health with a reference number of IHRPGD/567/19. Permission was obtained from responsible bodies of JUMC before interviewing the patients’ guardians and extracting data from active patient’s case records. Written and verbally informed assent was obtained from all the guardians of the study participants. All the study protocols were performed in accordance with the ethical principles of the Declaration of Helsinki.²⁸ The confidentiality and privacy of participant’s data were maintained by using different codes throughout the data collection tools.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare that there are no conflicts of interest regarding this work.