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The status of acute osteomyelitis in sickle cell disease. A 15-year review.

BACKGROUND: This 15-year review presents the status of acute osteomyelitis in sickle cell disease so as to assess the type of infection, infecting organism, mode of treatment and complications.

DESIGN: Retrospective analysis of patients seen in the last fifteen years.

SETTING: King Fahd Hospital of the University at Al-Khobar and College of Medicine and Medical Sciences, King Faisal University, Dammam, Saudi Arabia.

RESULTS: Two-hundred and one patients were treated for acute osteomyelitis in sickle cell disease. These patients had 327 episodes. There were 125 males and 76 females with a mean age of 9.6 years (range 6 months to 33 years). Forty-eight (23.8%) patients had multifocal infection. The most common infecting organism was salmonella species in 84 patients (41.7%) and 71/84 patients were below the age of 12 years. In 39/45 patients who as children grew salmonella species initially had acute osteomyelitis due to other organisms in adult life. In 41 patients more than one organism was cultured and in 11 patients the pus/medullary canal fluid did not grow any organism. Blood culture grew infective organism in 46.80%. Tibia was the commonest site of infection 76/201. The incidence of chronic osteomyelitis was 2.48%.

CONCLUSIONS: Even with the improvement of socioeconomic status of the community, acute osteomyelitis is still common and severe in patients with sickle cell disease. In children, the antibiotics should be aimed at the salmonella species, whereas in adults antibiotics must be given to cover other organisms. Aggressive treatment with incision, drilling of bone, drainage and antibiotics for six weeks is required to keep the incidence of chronic osteomyelitis low in these compromised patients.

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