Clinical Care Guideline for Improving Pediatric Acute Musculoskeletal Infection Outcomes

J Pediatric Infect Dis Soc. 2017 Sep 1;6(3):e86-e93. doi: 10.1093/jpids/pix014.


Background: Acute pediatric musculoskeletal infections are common, leading to significant use of resources and antimicrobial exposure. In order to decrease variability and improve the quality of care, Children's Hospital Colorado implemented a clinical care guideline (CCG) for these infections. The purpose of this study is to evaluate clinical and resource outcomes PRE and POST this CCG.

Methods: Retrospective chart review evaluated patients admitted to a large pediatric quaternary referral center (CHCO) diagnosed with acute osteomyelitis, septic arthritis, pyomyositis, and/or musculoskeletal abscess prior to and after guideline implementation. Primary outcomes included length of stay and overall antibiotic use, with additional secondary clinical, process, and therapeutic outcomes examined.

Results: 82 patients were identified in both the pre-CCG and post-CCG cohorts. There was a reduction in the median of all primary outcomes, including length of stay (0.6 median days decrease, P = .04), length of IV antibiotic therapy (4.9 median days decrease, P < .0001), and days of IV antibiotic therapy (6.4 median days decrease, P = .0004). Our median length of stay post-CCG was 4.9 days, the shortest reported length of stay for pediatric acute musculoskeletal infections to date. Additionally, there was a 24.5 hour reduction in median length of fever (P = .02), faster CRP normalization (P < .0001), 50% decrease in the number of related readmissions (P = .02), 34% decrease in central venous catheters placed (P < .0001), decreased time to first culture (P = .02), and 79% pathogen identification post-CCG (P = .056).

Conclusions: Implementation of a CCG for acute musculoskeletal infections improves patient, process and resource outcomes.

Keywords: antibiotic; guideline; infection; osteomyelitis; pediatric.

MeSH terms

  • Abscess / drug therapy
  • Acute Disease
  • Anti-Bacterial Agents / therapeutic use*
  • Arthritis, Infectious / drug therapy
  • Central Venous Catheters / statistics & numerical data
  • Child
  • Child, Preschool
  • Drug Utilization
  • Drug Utilization Review / standards
  • Drug Utilization Review / statistics & numerical data*
  • Female
  • Fever
  • Guideline Adherence / statistics & numerical data*
  • Hospitals, Pediatric
  • Humans
  • Infections / drug therapy*
  • Length of Stay / statistics & numerical data
  • Male
  • Medical Records
  • Musculoskeletal Diseases / diagnosis
  • Musculoskeletal Diseases / drug therapy*
  • Osteomyelitis / drug therapy
  • Patient Readmission / standards
  • Patient Readmission / statistics & numerical data
  • Practice Guidelines as Topic*
  • Pyomyositis / drug therapy
  • Quality of Health Care / standards
  • Quality of Health Care / statistics & numerical data
  • Retrospective Studies
  • Treatment Outcome


  • Anti-Bacterial Agents