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Diagnosis and Management of Acute Osteoarticular Infections: Summary of New Guidelines
Kate Shapiro1, Maria A Carrillo-Marquez1, Sandra R Arnold1
1Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee.
Insights
This review summarizes recent guidelines for managing acute hematogenous osteomyelitis (AHO) and acute bacterial arthritis (ABA) in children. Prompt diagnosis and appropriate antibiotic therapy are crucial for treating these common pediatric invasive bacterial infections.
Area of Science:
- Pediatric Infectious Diseases
- Musculoskeletal Infections
Background:
- Acute hematogenous osteomyelitis (AHO) and acute bacterial arthritis (ABA) are frequent invasive bacterial infections in children.
- Diagnosis relies on clinical suspicion, laboratory tests, and imaging, especially in febrile children with musculoskeletal pain.
Purpose of the Study:
- To review and synthesize recommendations from two recent guidelines for managing AHO and ABA in children.
- To provide an overview of diagnostic and therapeutic strategies for pediatric osteoarticular infections.
Main Methods:
- Review of two recently published clinical guidelines.
- Synthesis of recommendations regarding diagnosis, empirical antibiotic selection, and treatment duration.
Main Results:
- Empirical antibiotic choice for AHO and ABA requires knowledge of local Staphylococcus aureus susceptibility patterns.
- Treatment duration typically ranges from 2-4 weeks, with parenteral to oral antibiotic transition based on clinical and laboratory response.
- Guidelines emphasize a high index of suspicion and judicious use of diagnostic studies.
Conclusions:
- Effective management of pediatric AHO and ABA necessitates early recognition and adherence to evidence-based guidelines.
- Tailoring antibiotic therapy based on local resistance patterns and patient response is essential for optimal outcomes.
Abstract:
Acute hematogenous osteomyelitis (AHO) and acute bacterial arthritis (ABA) are among the most common invasive bacterial infections in otherwise healthy children. The diagnosis of AHO and ABA requires a high index of suspicion in children presenting with fever and musculoskeletal pain and judiciously chosen laboratory and imaging studies. Choosing the appropriate empirical antibiotic requires familiarity with local susceptibility patterns, especially for Staphylococcus aureus. Typical antibiotic duration for osteoarticular infection is 2-4 weeks depending on the type of infection, response to therapy, and presence of complications. Transitioning from parenteral to oral antibiotics is guided by clinical and laboratory evidence of resolving infection. This review will provide an overview of the recommendations contained in the 2 recently published guidelines for the management of AHO and ABA.
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