J Pediatr. 2021 Mar 23:S0022-3476(21)00266-3. doi: 10.1016/j.jpeds.2021.03.028. Online ahead of print.
OBJECTIVES: To understand the epidemiology of acute hematogenous osteomyelitis and septic arthritis, including clinical and demographic features, microbiology, treatment approaches, treatment-associated complications, and outcomes.
STUDY DESIGN: Retrospective cohort study of 453 children with AHO and/or SA from 2009 - 2015.
RESULTS: Among the 453 patients, 218 (48%) had AHO, 132 (29%) had SA, and 103 (23%) had concurrent AHO/SA. Treatment failure/recurrent infection occurred in 41 (9%). Patients with concurrent AHO/SA had longer hospital stays, longer duration of antibiotic therapy, and were more likely to have prolonged bacteremia and require intensive care. Staphylococcus aureus was identified in 228 (51%) of patients, of which 114 (50%) were methicillin-resistant S. aureus (MRSA). Compared with SA, AHO and concurrent AHO/SA were associated with higher odds of treatment failure (OR 8.19, 95% CI 2.02, 33.21; p=.003; and OR 14.43, 95% CI 3.39, 61.37; p<.001, respectively). Need for more than one surgical procedure was also associated with higher odds of treatment failure (OR 2.98, 95% CI 1.18, 7.52; P = .021). Early change to oral antibiotic therapy was not associated with treatment failure (OR 0.64, 95% CI 0.24, 1.74; p=.386). Most (73%) medically-attended treatment complications occurred while on parenteral therapy.
CONCLUSIONS: Musculoskeletal infections are challenging pediatric infections. S. aureus remains the most common pathogen, with MRSA accounting for 25% of all cases. Concurrent AHO/SA is associated with more severe disease and worse outcomes. Fewer treatment-related complications occurred while on oral therapy. Early transition to oral therapy was not associated with treatment failure.