Anaerobic osteomyelitis in children.

Twenty-six pediatric patients with osteomyelitis caused by anaerobic bacteria are presented. The etiologic factors were chronic mastoiditis (7 patients), decubitus ulcers (5), chronic sinusitis (4), periodontal abscesses (3), bites (3), paronychia (2), trauma (1) and scalp infection after fetal monitoring (1). Seventy-four organisms (2.8 isolates/specimen), including 63 anaerobes (2.4/specimen), and 11 facultative and aerobic bacteria (0.4/specimen) were recovered. The predominant organisms were anaerobic cocci (29 isolates), Bacteroides sp. (21), Fusobacterium sp. (8), Streptococcus sp. (5) and Clostridium sp. (4). The organisms generally reflected the microbial flora of the mucous surface adjacent to the infected site. Ten beta-lactamase-producing organisms were recovered from 7 (27%) patients. These included all isolates of the Bacteroides fragilis (4) and of Staphylococcus aureus (3), 2 of the 12 Bacteroides melaninogenicus group and 1 of 3 Bacteroides oralis. The clinical, diagnostic and therapeutic aspects of anaerobic osteomyelitis in children are discussed.