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Clinical Epidemiology and Outcomes of Pediatric Musculoskeletal Infections
Jumi Yi1, James B Wood2, C Buddy Creech3
1Emory University School of Medicine and Children's Healthcare of Atlanta; Atlanta, GA; University of California San Francisco, San Francisco, CA.
Insights
Pediatric acute hematogenous osteomyelitis and septic arthritis are challenging infections. Concurrent infections indicate more severe disease, while oral therapy may reduce complications without impacting treatment success.
Area of Science:
- Pediatric infectious diseases
- Musculoskeletal infections
- Epidemiology of pediatric infections
Background:
- Acute hematogenous osteomyelitis (AHO) and septic arthritis (SA) are common pediatric musculoskeletal infections.
- Understanding their epidemiology, clinical features, and treatment outcomes is crucial for effective management.
- Staphylococcus aureus, including methicillin-resistant strains, is a primary pathogen.
Purpose of the Study:
- To elucidate the epidemiology of pediatric AHO and SA.
- To analyze clinical and demographic features, microbiology, and treatment approaches.
- To evaluate treatment complications and patient outcomes.
Main Methods:
- Retrospective cohort study involving 453 children diagnosed with AHO and/or SA between 2009 and 2015.
- Analysis of clinical data, microbiological findings, treatment strategies, and outcomes.
- Statistical comparison of outcomes based on disease type and treatment interventions.
Main Results:
- Of 453 children, 48% had AHO, 29% had SA, and 23% had concurrent AHO/SA.
- Staphylococcus aureus was identified in 51% of cases, with 50% being methicillin-resistant S aureus (MRSA).
- Concurrent AHO/SA was linked to longer hospital stays, prolonged antibiotic use, bacteremia, and intensive care needs. Treatment failure occurred in 9% of patients, with higher odds in AHO and concurrent AHO/SA compared to SA alone. More than one surgical procedure also increased treatment failure odds. Most complications arose during parenteral therapy, and early transition to oral therapy was not associated with treatment failure.
Conclusions:
- Pediatric AHO and SA present significant management challenges.
- S. aureus remains the predominant pathogen, with MRSA being a substantial contributor.
- Concurrent AHO/SA signifies more severe disease and poorer outcomes.
- Transitioning to oral antibiotic therapy may reduce treatment-related complications without compromising efficacy.
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 acute hematogenous osteomyelitis and/or septic arthritis from 2009 to 2015.
Results:
Among the 453 patients, 218 (48%) had acute hematogenous osteomyelitis, 132 (29%) had septic arthritis, and 103 (23%) had concurrent acute hematogenous osteomyelitis/septic arthritis. Treatment failure/recurrent infection occurred in 41 patients (9%). Patients with concurrent acute hematogenous osteomyelitis/septic arthritis 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%) patients, of which 114 (50%) were methicillin-resistant S aureus. Compared with septic arthritis, acute hematogenous osteomyelitis and concurrent acute hematogenous osteomyelitis/septic arthritis 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). The need for more than 1 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 methicillin-resistant S aureus accounting for 25% of all cases. Concurrent acute hematogenous osteomyelitis/septic arthritis 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.
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