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Acute Hematogenous Osteomyelitis in Children
Nimmy Thakolkaran1, Avinash K Shetty2
1Department of Family Medicine, Mount Sinai Hospital, Chicago, IL.
Insights
Acute hematogenous osteomyelitis (AHO) in children is evolving, with Staphylococcus aureus as the primary pathogen. Management requires an individualized, multidisciplinary approach considering pathogen changes and disease complexity.
Area of Science:
- Pediatric Infectious Diseases
- Orthopedic Surgery
- Microbiology
Background:
- Epidemiology of acute hematogenous osteomyelitis (AHO) in children has shifted.
- Increasing recognition of community-associated methicillin-resistant Staphylococcus aureus (MRSA) as a cause of severe pediatric AHO.
Purpose of the Study:
- To review current literature on pediatric AHO.
- To outline epidemiology, microbiology, pathogenesis, clinical presentation, diagnosis, and antimicrobial management.
Main Methods:
- Literature review of current research on pediatric AHO.
- Analysis of epidemiological trends, causative pathogens, diagnostic modalities, and treatment strategies.
Main Results:
- Staphylococcus aureus is the most common pathogen, followed by group A Streptococcus (GAS).
- MRSA infections can lead to severe, complicated AHO.
- Culture and PCR are key for pathogen identification; MRI is the preferred imaging modality.
- Antibiotic choices vary based on pathogen (MRSA, MSSA, K. kingae, GAS, S. pneumoniae) and disease severity.
Conclusions:
- Management of pediatric AHO requires an individualized, multidisciplinary approach due to evolving pathogens and variable disease presentations.
- Treatment duration and modality (medical vs. surgical) depend on disease complexity and causative organism.
Abstract:
Background: The epidemiology of acute hematogenous osteomyelitis (AHO) in children has changed. Methods: We reviewed the current literature regarding the epidemiology, microbiology, pathogenesis, clinical presentation, diagnosis, and antimicrobial management of AHO in children. Results: Staphylococcus aureus is the most common microorganism causing pediatric AHO, followed by group A Streptococcus (GAS). AHO due to community-associated methicillin-resistant Staphylococcus aureus (MRSA) can cause severe and complicated disease. Pathogen isolation by culture is key for targeted antibiotic therapy. Polymerase chain reaction assay in tissue sample or joint fluid may enhance the yield of Kingella kingae. C-reactive protein is useful in diagnosis and monitoring the course of AHO. Magnetic resonance imaging is the preferred diagnostic imaging study for AHO. Clindamycin or vancomycin (for serious disease) is recommended for empiric therapy of suspected AHO due to MRSA depending on the geographic prevalence. Penicillinase-stable penicillins or first-generation cephalosporins are preferred antibiotics to treat methicillin-sensitive S aureus (MSSA) infection. Beta-lactam agents are the drugs of choice for treating AHO due to K kingae, GAS, or Streptococcus pneumoniae. For uncomplicated AHO due to MSSA, a short parenteral antibiotic course followed by oral therapy for a minimum total duration of 3-4 weeks is adequate. Complicated AHO due to MRSA may warrant prolonged therapy with surgical intervention. Conclusion: Given the evolution of pathogens, the variability in clinical presentations and course ranging from simple to complex disease, and response to treatment, the management of AHO continues to evolve and warrants an individualized, multidisciplinary approach.
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