1747. The Etiology and Clinical Presentation of Vertebral Osteomyelitis in Korean Children
Session: Poster Abstract Session: Pediatric Bacterial Infections
Saturday, October 10, 2015
Room: Poster Hall
Background: Vertebral osteomyelitis (VOM) is a rare disease that causes profound morbidity if left untreated. We sought to identify the common organisms responsible for VOM and understand its clinical presentation in children.

Methods: This was a retrospective study of children below 19 years old who were diagnosed with VOM at 2 tertiary hospitals in Korea between 1995 and 2014. The inclusion criteria were 1) symptoms compatible with vertebral infection, 2) evidence of radiologic findings (Spine MRI or CT) suggestive of spine involvement, and 3) microbiologically or histopathologically proven osteomyelitis. Electronic medical records were reviewed for clinical parameters and etiologic agents.

Results: During the 20-year period, 27 children with VOM were identified. The mean age of was 13.3 years old, and 63.0% were male. Microbial agents were documented in 21 cases: Staphylococcus aureus (37.0%), Mycobacterium tuberculosis (29.6%), Escherichia coli (7.4%), Streptococcus pneumoniae (3.7%), and Salmonella typhi (3.7%). Blood culture (74.1%, n=20), percutaneous biopsy (55.6%, n=15), and surgical biopsy (48.1%, n=14) were performed; having a detection sensitivity of 15.0%, 46.7%, and 64.3%, respectively (P=0.01). Fever of 38.0'C or higher was accompanied in 55.6% of the patients. Other associated symptoms were back pain (74.1%), limping gait (33.3%), refusal to bear weight (25.9%), and neurologic signs (22.2%). The lumbar area (70.4%) and 2 adjacent vertebral bodies (77.8%) were most commonly involved. Abscesses on the MRI were more frequently documented in tuberculous VOM than pyogenic VOM (88.9% vs 21.1%, P<0.001). Overall, 51.9% (n=14) received surgical treatment along with antimicrobial therapy. There was a significantly prolonged delay in diagnosis of patients who required surgery compared to those that did not (58 days vs. 31 days, P=0.03). Furthermore, the delay in diagnosis of >36 days after the onset of symptoms was significantly associated with the need for surgical treatment (P=0.02).

Conclusion: S. aureus and M. tuberculosis are the predominant causes of VOM in children in South Korea. The nonspecific symptoms of VOM in children may contribute to the delay in diagnosis leading to an increased risk for surgical treatment.

Hyun Mi Kang, MD1, In Ae Yoon, MD2, Jiyoung Park, MD1, Hyun Joo Jung, MD, PhD3, Mi Seon Han, MD1, Ki Wook Yoon, MD1, Hyunju Lee, MD, PhD4, Eun Hwa Choi, MD, PhD1 and Hoan Jong Lee, MD, PhD1, (1)Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea, (2)Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea, (3)Department of Pediatrics, Ajou University School of Medicine, Suwon, South Korea, (4)Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, South Korea

Disclosures:

H. M. Kang, None

I. A. Yoon, None

J. Park, None

H. J. Jung, None

M. S. Han, None

K. W. Yoon, None

H. Lee, None

E. H. Choi, None

H. J. Lee, None

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