Background: Recent data guiding treatment of acute hematogenous osteomyelitis (OM) suggests successful outcomes with earlier transition from intravenous (IV) to oral antibiotics. The goal of this study was to evaluate the impact of a recently implemented algorithm at our institution which recommends early transition (≤ 5 days) from IV to oral antimicrobial therapy for acute OM.
Methods : This is a single-center, retrospective study of previously healthy patients age 6 months to 18 years, hospitalized between 2009 and 2015 with a diagnosis of simple acute OM, presenting with fewer than 14 days of symptoms. Baseline demographics and variables were collected for the study population. The following variables were compared pre- and post-algorithm implementation: days of IV and oral antibiotics, peripherally inserted central catheter (PICC) utilization, length of stay, use of recommended diagnostic tests, and readmission rates. Data was analyzed using Mann-Whitney and Chi-Squared tests.
Results: The total number of cases was 107, with 64% male and a mean age of 7 years. After algorithm implementation, there was a significant decrease in the median length of IV antibiotics from 24.5 to 10 days (p<0.001), and an increase in the length of oral antibiotic treatment from 14 to 22 days (p<0.001) (Figure 1). Additionally there was a significant decrease in PICC line utilization (p<0.001) (Figure 2). Utilization of C-reactive protein, complete blood count, and erythrocyte sedimentation rate was 90%. Kingella kingae and Staphylococcus aureus polymerase chain reaction (PCR) testing increased from 8% to 32% post algorithm. There was no change in length of stay or 30-day readmission rate post-algorithm implementation.
Conclusion : By implementing an algorithm at our hospital, we were able to decrease the duration of IV antibiotics and PICC line utilization in the management of acute OM. There was no change in length of stay, however the median of 5 days is less than previously reported in other studies. These preliminary results highlight the value of standardization of care across disciplines through the use of evidence-based guidelines in the pediatric population.
K. Merkel, None
M. Fernandez, None
L. Thoreson, None
J. Williams, None
S. Hauger, None