Factors influencing the outcome of acute Haematogenous Osteomyelitis (AHO) at The University Teaching Hospital, Lusaka

This is a cross sectional review study of 112 patients with Acute Haematogenous Osteomyelitis (AHO) of long bones of the upper and lower extremities who were seen in the orthopaedic clinic at the University Teaching Hospital in Lusaka between July, 2002 and August, 2003. The results show that AHO is more common in children than in adults; ratio 4:1 and in males than females, ratio 2:1.Delayed Presentation (one week after onset of symptoms) was seen in 64% (72) patients and Early Presentation (within 5 days after onset of symptom) in 36% (40) patients. The results show a poor outcome of AHO in 48% patients in the Delayed Presentation group compared to 6% in the Early Presentation group. Delayed Presentation was caused by high poverty levels and failures of the referral health system. Lower socioeconomic status was seen in 69% of AHO patients. All the patients in the Delayed Presentation group had inappropriate initial treatment because Primary Medical Attendants , Clinical Officers (63%) and Traditional Healers (37%) failed to recognise AHO and refer for adequate initial treatment. Poor outcome was seen in 61% of the inappropriate treatment group. In the Early Presentation group, 68% patients had inadequate treatment (no admission, no surgery and oral antibiotics) and 22%) had adequate treatment (admission, surgical drainage and intravenous antibiotics). The results showed good outcome in 44% in the adequate initial treatment group compared to 13% in the inadequate initial treatment group.Associated HIV infection was seen in 72% of the adults with AHO. The result showed 78% poor outcome of AHO associated with HIV. Sickle cell disease was seen in 14% children. The results showed that 83% of patients with AHO associated with sickle cell disease had a poor outcome. Poor nutrition status was seen in 26% of all children in the study. The results record 43% poor outcome in the poor nutritional status groups.

Bacteriological studies yielded 73% aerobic gram positive staphylococcus. The results showed 100% sensitivity to Ceftaxime and Vancomycin. These drugs are expensive and not available in state sponsored hospitals. The prohibitive cost and non-availability of appropriate antibiotic treatment contributed to poor outcome in all treatment groups.