Treatment and Outcome of Culture-negative Osteomyelitis in Children
Methods: Cases of AHO admitted to our pediatric hospital from 2008-2013 were retrospectively reviewed. Clinical and laboratory data collected included age, gender, symptoms prior to admission, culture results, complete blood counts, erythrocyte sedimentation rates (ESR) and C-reactive proteins (CRP). Medical and surgical treatment regimens, as well as outcomes, were also recorded.
Results: There were 93 children admitted with AHO including 49 with methicillin-susceptible S. aureus (MSSA), 16 with MRSA, and 16 with negative blood and/or bone cultures diagnosed by imaging and a compatible clinical and laboratory picture. There were no significant differences between culture-negative and culture-positive children with regard to age (7.6 vs 8.2 years), preceding trauma (25% vs 24%), presenting symptoms of fever (75% vs 79%), pain (100% vs 96%), swelling (44% vs 57%) and erythema (38% vs 40%), and maximum CRP (12.3 vs 16.2 mg/dL) and ESR (73.4 vs 76.9 mm/hr). Of 77 children with culture-positive AHO, 19 had concomitant septic arthritis while none of the 16 culture-negative children did (p=0.036). Eleven children (68.8%) with negative cultures were transitioned to oral antibiotic therapy in ≤ 7 days compared to 35 (45.5%) with positive cultures (p=0.90). Nine of 11 were sent home on cephalexin to complete therapy; the other 2 received linezolid and clindamycin. Thirteen of these 16 were not treated for MRSA. Mean length of treatment was 40.7 days for culture-negative children vs 37.2 days for those with positive cultures (p=0.26). Of 14 patients seen in follow-up, all but one had complete resolution of their symptoms.
Conclusion: Culture-negative AHO has a similar clinical presentation to culture-positive disease. In areas where MRSA is infrequent, early switch to an MSSA oral regimen appears safe and effective with close follow up and avoids the added expense and toxicity of MRSA coverage.
F. C. Adler-Shohet,
K. S. Kleis, None
E. A. Trent, None
A. Powers Davis, None
J. Singh, None
J. A. Schlecter, None
N. M. Moroski, None
J. Le, None