Program Schedule

Treatment and Outcome of Culture-negative Osteomyelitis in Children

Session: Poster Abstract Session: Approach to Clinical Infections
Friday, October 10, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
  • IDSA culture negative osteo Poster Presentation-IDweek 100114 (1).pdf (377.9 kB)
  • Background: Treatment of acute hematogenous osteomyelitis (AHO) is controversial with regard to length of therapy and intravenous to oral therapy switch. Previous studies have reported changing from intravenous to oral therapy after only 3 days in patients with an identified pathogen. However, there is little data on the treatment and outcomes for culture-negative AHO especially in an era of methicillin-resistant Staphylococcus aureus (MRSA). 

    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.

    Felice C. Adler-Shohet, MD1, Antonio Arrieta, MD1, Kevin S. Kleis, DO2, Elizabeth a. Trent, MD3, Andrew Powers Davis4, Jasjit Singh, MD1, John a. Schlecter, DO2, Nathan M. Moroski3 and Jennifer Le, PharmD, BCPS-ID, FCCP5, (1)Infectious Diseases, Children's Hospital of Orange County, Orange, CA, (2)Orthopedics, Children's Hospital of Orange County, Orange, CA, (3)University of California, Irvine, Orange, CA, (4)Children's Hospital of Orange County, Orange, CA, (5)Clinical Pharmacy, University of California San Diego, Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, CA


    F. C. Adler-Shohet, None

    A. Arrieta, None

    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

    Findings in the abstracts are embargoed until 12:01 a.m. EDT, Oct. 8th with the exception of research findings presented at the IDWeek press conferences.

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