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Master of Public Health

Clinical Epidemiology and Outcomes of Pediatric Musculoskeletal Infections

AUTHORS

Yi J , Wood JB , Creech CB , Williams D , Jimenez-Truque N , Yildirim I , Sederdahl B , Daugherty M , Hussaini L , Munye M , Tomashek KM , Focht C , Watson N , Anderson EJ , Thomsen I , . The Journal of pediatrics. 2021 3 23; ().

ABSTRACT

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 AHO and/or SA from 2009 – 2015.

RESULTS: Among the 453 patients, 218 (48%) had AHO, 132 (29%) had SA, and 103 (23%) had concurrent AHO/SA. Treatment failure/recurrent infection occurred in 41 (9%). Patients with concurrent AHO/SA 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%) of patients, of which 114 (50%) were methicillin-resistant S. aureus (MRSA). Compared with SA, AHO and concurrent AHO/SA 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). Need for more than one 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 MRSA accounting for 25% of all cases. Concurrent AHO/SA 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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