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Epidemiological Trends in Pediatric Osteoarticular Infections-Results from a Single-Center Retrospective Study

Evelien B van Kempen1, Ayla Scholma1, Nam Nam Cheung2

  • 1Department of Pediatrics, Juliana Children's Hospital Haga Hospital, 2509 AB The Hague, The Netherlands.

Children (Basel, Switzerland)
|September 27, 2025
PubMed

Insights

Pediatric osteoarticular infections (pOAIs) significantly increased post-pandemic. While patient outcomes remained stable, pathogen distribution shifted, indicating evolving trends in pediatric bone and joint infections.

Area of Science:

  • Pediatric Infectious Diseases
  • Epidemiology
  • Musculoskeletal Infections

Background:

  • The COVID-19 pandemic has altered pediatric infectious disease patterns.
  • Pediatric osteoarticular infections (pOAIs), including osteomyelitis (OM), septic arthritis (AR), and combined OA, require ongoing epidemiological surveillance.
  • Understanding changes in pOAI incidence and causative agents is crucial for clinical management.

Purpose of the Study:

  • To investigate changes in the incidence, pathogen distribution, and outcomes of pediatric osteoarticular infections (pOAIs) before, during, and after the COVID-19 pandemic.
  • To assess trends in osteomyelitis (OM), septic arthritis (AR), and osteomyelitis with arthritis (OA) cases.
  • To analyze shifts in microbial etiology and clinical outcomes over different pandemic periods.

Main Methods:

  • A retrospective cohort study was conducted at a single Dutch children's hospital.
  • Included patients aged 0-18 years diagnosed with OM, AR, or OA between 2015 and 2023.
  • Cases were categorized into pre-pandemic (2015-2019), mid-pandemic (2020-2021), and post-pandemic (2022-2023) periods for comparative analysis.

Main Results:

  • A total of 118 pediatric osteoarticular infection cases were analyzed.
  • Annual pOAI case counts significantly increased in the post-pandemic period (2022-2023) compared to the pre-pandemic era (2015-2019).
  • While *Staphylococcus aureus* remained common, shifts in the proportions of *Kingella kingae* and Group A Streptococcus (GAS) were observed, though not all statistically significant. Patient outcomes remained consistent.

Conclusions:

  • This study indicates a notable rise in pediatric osteoarticular infections following the COVID-19 pandemic.
  • Patient characteristics and clinical outcomes for pOAIs remained largely unchanged across the study periods.
  • The distribution of pathogens causing pediatric osteoarticular infections appears to have evolved, necessitating continued monitoring.
Abstract

Keywords:
Group A streptococcusKingella kingaeepidemiologyosteoarticular infectionpost-COVID-19 pandemic

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