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Management and Outcomes of Paediatric Bone and Joint Infections in a Regional Australian Hospital: A 10-Year
Niall Johnston1, Rani Bhatia2,3, Coen Butters1,4
1Department of General Paediatric and Adolescent Medicine, John Hunter Children's Hospital, New Lambton Heights, New South Wales, Australia.
Insights
Paediatric bone and joint infections (BJI) are common in young Indigenous children. Many received suboptimal oral antibiotic doses, indicating a need for standardized weight-based dosing guidelines for paediatric BJI.
Area of Science:
- Paediatric infectious diseases
- Musculoskeletal infections
- Antimicrobial stewardship
Background:
- Bone and joint infections (BJI) are significant causes of morbidity in children.
- Optimal management of paediatric BJI requires adherence to evidence-based guidelines.
- Regional Australian hospitals serve diverse populations, including Indigenous children who may have unique health needs.
Purpose of the Study:
- To evaluate clinical features, management, and outcomes of paediatric bone and joint infections (BJI) in a regional Australian hospital.
- To assess the appropriateness of weight-based oral antibiotic prescribing for paediatric BJI.
- To identify disparities in BJI occurrence and management among different demographic groups.
Main Methods:
- Retrospective study of 171 children (0-18 years) with septic arthritis and/or osteomyelitis (2011-2021).
- Data extracted on clinical presentation, microbiology, and treatment from medical records.
- Oral antibiotic doses evaluated against international evidence-based guidelines.
Main Results:
- Paediatric BJI predominantly affected children under 5 years (59.6%) and Aboriginal and Torres Strait Islander children (13.5%).
- Staphylococcus aureus and Kingella kingae were common pathogens.
- 43.3% of patients received oral antibiotic doses below guideline recommendations, particularly amoxicillin-clavulanate and cephalexin.
Conclusions:
- Paediatric BJI disproportionately affects young and Indigenous children in regional Australia.
- Suboptimal oral antibiotic dosing is a concern, highlighting the need for standardized weight-based dosing protocols.
- Further research is warranted to optimize antibiotic dosing strategies for paediatric BJI to improve outcomes.
Aim:
To evaluate clinical features, management, and outcomes of paediatric bone and joint infection (BJI) in a regional Australian hospital and assess weight-based oral antibiotic prescribing.
Methods:
We conducted a retrospective study of 171 children aged 0-18 years admitted with septic arthritis and/or osteomyelitis between 2011 and 2021. Cases were identified using ICD-10-AM codes, and data on clinical presentation, microbiology and treatment were extracted from medical records. Oral antibiotic doses were assessed against international evidence-based guidelines.
Results:
A total of 171 children were included (median age 27 months); 59.6% were aged ≤ 5 years, and 13.5% identified as Aboriginal or Torres Strait Islander. Staphylococcus aureus was the most frequently identified pathogen overall (53/108, 49.1%), and Kingella kingae in children < 5 years of age (20/57, 35.1%). Severe disease occurred in 29.8%. Oral antibiotic doses were below international guideline recommendations in 43.3% of cases, mostly with amoxicillin-clavulanate and cephalexin. Relapse (4.1%) and long-term sequelae (6.1%) were infrequent.
Conclusions:
Paediatric BJI mostly occurred in young and in Aboriginal and Torres Strait Islander children. Oral antibiotic weight-based dosing was often lower than international guideline recommendations for BJI. These findings highlight the need for standardised antibiotic dosing in BJI and further studies to optimise dosing in children.
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