Clinical Epidemiology and Outcomes of Pediatric Musculoskeletal Infections

J Pediatr. 2021 Jul;234:236-244.e2. doi: 10.1016/j.jpeds.2021.03.028. Epub 2021 Mar 24.

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 acute hematogenous osteomyelitis and/or septic arthritis from 2009 to 2015.

Results: Among the 453 patients, 218 (48%) had acute hematogenous osteomyelitis, 132 (29%) had septic arthritis, and 103 (23%) had concurrent acute hematogenous osteomyelitis/septic arthritis. Treatment failure/recurrent infection occurred in 41 patients (9%). Patients with concurrent acute hematogenous osteomyelitis/septic arthritis 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%) patients, of which 114 (50%) were methicillin-resistant S aureus. Compared with septic arthritis, acute hematogenous osteomyelitis and concurrent acute hematogenous osteomyelitis/septic arthritis 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). The need for more than 1 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 methicillin-resistant S aureus accounting for 25% of all cases. Concurrent acute hematogenous osteomyelitis/septic arthritis 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.

MeSH terms

  • Acute Disease
  • Administration, Oral
  • Adolescent
  • Anti-Bacterial Agents / therapeutic use*
  • Arthritis, Infectious / diagnosis
  • Arthritis, Infectious / epidemiology*
  • Arthritis, Infectious / microbiology
  • Arthritis, Infectious / therapy
  • Child
  • Child, Preschool
  • Combined Modality Therapy
  • Female
  • Gram-Negative Bacterial Infections / diagnosis
  • Gram-Negative Bacterial Infections / epidemiology*
  • Gram-Negative Bacterial Infections / microbiology
  • Gram-Negative Bacterial Infections / therapy
  • Gram-Positive Bacterial Infections / diagnosis
  • Gram-Positive Bacterial Infections / epidemiology*
  • Gram-Positive Bacterial Infections / microbiology
  • Gram-Positive Bacterial Infections / therapy
  • Humans
  • Infant
  • Logistic Models
  • Male
  • Methicillin-Resistant Staphylococcus aureus / isolation & purification
  • Orthopedic Procedures*
  • Osteomyelitis / diagnosis
  • Osteomyelitis / epidemiology*
  • Osteomyelitis / microbiology
  • Osteomyelitis / therapy
  • Retrospective Studies
  • Staphylococcal Infections / diagnosis
  • Staphylococcal Infections / epidemiology
  • Staphylococcal Infections / microbiology
  • Staphylococcal Infections / therapy
  • Treatment Outcome
  • United States / epidemiology

Substances

  • Anti-Bacterial Agents