Nonbacterial and bacterial osteomyelitis in children: a case-control retrospective study

Mikhail M Kostik; Alexey S Maletin; Veronika V Petukhova; Alexander Yu Mushkin

doi:10.3389/fped.2023.1067206

Nonbacterial and bacterial osteomyelitis in children: a case-control retrospective study

Front Pediatr. 2023 May 3:11:1067206. doi: 10.3389/fped.2023.1067206. eCollection 2023.

Authors

Mikhail M Kostik¹, Alexey S Maletin², Veronika V Petukhova^{1

2}, Alexander Yu Mushkin^{2

3}

Affiliations

¹ Hospital Pediatrics Department, Saint-Petersburg State Pediatric Medical University, Saint-Petersburg, Russia.
² Pediatric Orthopedics and Surgery Department, Saint-Petersburg Research Institute of Phthisiopulmonology, Saint-Petersburg, Russia.
³ Traumatology and Orthopedic Department, Pavlov First Saint Petersburg State Medical University, Saint-Petersburg, Russia.

Abstract

Purpose: Osteomyelitis is a group of bone infectious (bacterial osteomyeilitis-BO) and noninfectious inflammatory diseases (nonbacterial osteomyelitis-NBO) with similar clinical, radiology, and laboratory features. Many patients with NBO are misdiagnosed as BO and receive unnecessary antibiotics and surgery. Our study aimed to compare clinical and laboratory features of NBO and BO in children, to define key discriminative criteria, and to create an NBO diagnostic score (NBODS).

Methods: The retrospective multicenter cohort study included clinical, laboratory, and instrumental information about histologically confirmed NBO (n = 91) and BO (n = 31). The variables allowed us to differentiate both conditions used to construct and validate the NBO DS.

Results: The main differences between NBO and BO are as follows: onset age-7.3 (2.5; 10.6) vs. 10.5 (6.5; 12.7) years (p = 0.03), frequency of fever (34.1% vs. 90.6%, p = 0.0000001), symptomatic arthritis (67% vs. 28.1%, p = 0.0001), monofocal involvement (28.6% vs. 100%, p = 0.0000001), spine (32% vs. 6%, p = 0.004), femur (41% vs. 13%, p = 0.004), foot bones (40% vs. 13%, p = 0.005), clavicula (11% vs. 0%, p = 0.05), and sternum (11% vs. 0%, p = 0.039) involvement. The following four criteria are included in the NBO DS: CRP ≤ 55 mg/l (56 points), multifocal involvement (27 points), femur involvement (17 points), and neutrophil bands ≤ 220 cell/μl (15 points). The sum > 17 points allowed to differentiate NBO from BO with a sensitivity of 89.0% and a specificity of 96.9%.

Conclusion: The diagnostic criteria may help discriminate NBO and BO and avoid excessive antibacterial treatment and surgery.

Keywords: bacterial osteomyelitis; chronic recurrent multifocal osteomyelitis; diagnostic criteria; hematogenous osteomyelitis; nonbacterial osteomyelitis.