Pediatric Pseudomonas aeruginosa Bone and Joint Infection at Queensland Children's Hospital 2014-2024 : Retrospective...

Pseudomonas aeruginosa is responsible for approximately 2% of pediatric bone and joint infections globally, and with its wide range of virulence factors, can be challenging to manage. Contemporary descriptions are minimal, and optimal management is poorly described. This single-center review and literature review aims to characterize this further.

Retrospective observational study of all children with P. aeruginosa isolated in bone or joint fluid at Queensland Children's Hospital, 2014-2024.

Thirty-four children with P. aeruginosa osteomyelitis and/or septic arthritis were identified over a 10-year period, with a median of 3 cases per year. Median age was 7 years 1 month; 61.8% were male, and 14.7% identified as Aboriginal. Most infections were non-hematogenous (67.6%). Polymicrobial infection occurred in 41.2% of cases and exclusively in non-hematogenous infections ( P < 0.001). Staphylococcus aureus (6/14; 42.9%) was the most common co-pathogen. The lower limb was most affected (70.6%), with 52.9% involving the foot. There were no cases with classic "puncture wound" injuries. Fever and bacteremia were rare (8.8% and 2.9%, respectively). Median hospital stay was 11 days. The median intravenous antibiotic duration was 8 days, with a total antibiotic duration of 42 days. All patients had surgical debridement.

Pediatric P. aeruginosa bone and joint infections are uncommon, typically involve the lower limbs, particularly the foot, and are usually non-hematogenous without classic puncture-wound exposure. Systemic features and bacteremia are rare. Early surgical debridement with prolonged targeted therapy appears to be important for diagnostic and clinical outcomes.