Abstract:
Background: Pediatric orthopedic infections are a significant cause of morbidity in low-income
countries, yet data from Eastern Ethiopia are limited.
Objectives: To assess the microbiological spectrum, clinical outcomes, and determinants of
outcome in pediatric orthopedic infections at Hiwot Fana Comprehensive Specialized University
Hospital, Harar, Ethiopia.
Methods: A retrospective cross-sectional review was conducted on medical records of 311
pediatric patients (≤18 years) diagnosed with orthopedic infections between January 2022 and
December 2024. Data were collected using a structured checklist and analyzed with SPSS
version 27. Bivariate and multivariable logistic regression analyses were performed to identify
predictors of poor treatment outcomes, with statistical significance set at p<0.05
Results: Orthopedic infections accounted for 32.0% of pediatric orthopedic consultations. The
mean age was 11.2 years (SD=4.86), with a predominance of males (72.0%) and rural residents
(71.7%). Chronic osteomyelitis was the most common diagnosis (29.3%), followed by septic
arthritis (16.4%) and acute osteomyelitis (10.6%). Cultures were positive in 58.0% of cases with
Staphylococcus aureus as the predominant pathogen (45.1%). Notably, 72.3% of Staphylococcus
aureus isolates were methicillin-resistant (MRSA). Resistance to commonly used antibiotics was
high: ceftriaxone (69.2% resistant), ampicillin (81.5%), while Vancomycin (>90%), clindamycin
(83.1%), and gentamicin (81.5%) retained good activity. Combined surgical and medical therapy
was used in 97.1% of patients, but only 41.5% received culture-guided definitive antibiotics.
Median time to emergency surgery was 8 hours, with 72.0% experiencing delay >6 hours.
Complete recovery without complications was achieved in 60.8%, while 15.8% had
complicated/unresolved infections, and mortality was 0.6%. Multivariable analysis identified late
presentation >7 days (AOR=2.41; 95% CI: 1.24-4.67), multifocal involvement (AOR=2.70; 95%
CI: 1.33-5.50), prior antibiotic exposure (AOR=2.75; 95% CI: 1.54-4.90), malnutrition
(AOR=2.45; 95% CI: 1.26-4.79), MRSA infection (AOR=3.27; 95% CI: 1.56-6.85), and delay in
emergency surgery >6 hours (AOR=1.82; 95% CI: 1.01-3.25) as independent predictors of poor
outcome.
Conclusion: Pediatric orthopedic infections at HFCSUH are characterized by high prevalence,
advanced disease at presentation, alarming antimicrobial resistance (particularly MRSA at
72.3%), and suboptimal outcomes. Current empirical therapy (ceftriaxone-based) is inadequate.
Delayed presentation, malnutrition, MRSA, and surgical delays independently predict poor
outcomes. Updated local treatment guidelines, strengthened diagnostic capacity, and improved
surgical access are urgently needed.
