Objective: The main objective was to determine the incidence and causative pathogens of osteomyelitis and septic arthritis in Icelandic children, as well as presenting symptoms and diagnosis.

Methods: A nationwide retrospective review was done of all children <18 year old, 1996-2005. Subjects were divided into three equal age groups, 0-5, 6-11 and 12-17 years old. Cultures were reviewed and postive and negative cases compared.
Results: Over the study period 220 cases were identified, 161 osteomyelitis and 59 septic arthritis cases. The incidence increased significantly over the period (p=0.019), mostly in the youngest age group (p<0.001) with osteomyelitis. Incidence of cases with a pathogen identified was unchanged over the period while culture negative cases increased significantly (p<0.001). Median age for osteomyelitis (6,1 years) was higher than in cases of septic arthitis (1,8 years) (p=0.003). A pathogen was identified in 59% of cases with osteomyelitis and 44% with septic arthritis. S. aureus was most common (65% and 27%, respectively) and K. kingae was second most common pathogen (7% and 11%, respectively). Methicillin resistant S. aureus was not identified. The tibia and knee were the predominant sites for osteomyelitis and septic arthritis respectively.

Conclusions: An increased incidence was found in the youngest age group with osteomyelitis, especially in cases without a pathogen identified. The most commonly cultured pathogen was S. aureus, followed by K. kingae. A more sensitive technique to identify pathogens might be indicated in culture negative cases.

 Fig. 1  -  Age distribution of osteomyelitis and septic arthritis.

Fig. 2  -  Incidence of osteomyelitis and septic arthritis during 1996-2005.

Fig. 3  - Age-specific incidence of osteomyelitis and septic arthritis 1996-2005 seen in age groups.

Fig. 4  -  Site of infection in osteomyelitis and septic arthritis. More than one bone may be infected at the same time.

Masson AT, Gudnason Th, Jonmundsson GK, Erlendsdottir H, Kristinsson KG, Kristjansson M, Haraldsson A.

Bactrial osteomyelitis and arthritis in Icelandic children 1996-2005.

Icel Med J 2011; 97: 91-6

Key words: Osteomyelitis, septic arthritis, Staphylococcus aureus, Kingellae kingae, children.

Correspondence: Ásgeir Haraldsson, asgeir@landspitali.is