Hematogenous pyogenic osteomyelitis in children.

Early diagnosis of acute hematogenous osteomyelitis is difficult. The diagnosis can be positively established only by isolation of the organism from bone or by histologic confirmation. The diagnosis should always be suspected when clinical signs are suggestive. In these cases aspirated material should be obtained for culture and the patient should be treated with antibiotics and observed closely. If the clinical response is good and no bone destruction occurs, surgical intervention may not be necessary. If the clinical response is not satisfactory or if bone destruction occurs, surgical treatment should be carried out to drain the area and to identify the etiologic organism. When osteomyelitis is associated with joint involvement, the prognosis is poor, and our data show no obvious improvement even with long-term antibiotic therapy. The key is prevention by early recognition and treatment. If culture fails to isolate a pathogenic organism, the prognosis appears to be good. Overall, in recent years the prognosis of hematogenous osteomyelitis has continued to improve, probably as a result of early detection and better antibiotic therapy.