700. Improving Bacterial Identification in Pediatric Acute Hematogenous Osteomyelitis
Session: Poster Abstract Session: They've Been Here a Billion Years! Pediatric Bacterial and Viral Infections
Thursday, October 27, 2016
Room: Poster Hall
Posters
  • IDSA Osteo Poster 2016 (final).pdf (417.3 kB)
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    Background: Our institution implemented an acute hematogenous osteomyelitis (AHO) guideline in September 2013 to standardize treatment for pediatric AHO using evidence-based recommendations. One goal of the guideline is to increase bacterial identification, allowing for directed antibiotic use. The guideline supports early biopsy and blood culture, with utilization of polymerase chain reaction (PCR) testing in the setting of negative cultures.

    Data on the effect of pre-biopsy antibiotics on bacterial yield is varied and nearly absent among pediatric populations.  Our guideline holds antibiotic administration until after biopsy for stable patients because the effect of antibiotic administration on bacterial yield was uncertain. This report describes the effects of the AHO guideline on bacterial identification and pre-biopsy antibiotics on bacterial yield.

    Methods: This is a single-site, retrospective study of patients hospitalized January 1, 2009 to December 31, 2015 with uncomplicated AHO, defined as acute onset bone or joint infection in healthy children age 6 months-18 years, and identified using ICD diagnosis codes. Methods for bacterial identification are described in Figure 1.  Variables were collected describing demographics, diagnosis, and treatment. 

    Results: Ninety-four cases met inclusion criteria; 54 pre and 40 post- guideline.  The overall rate of bacterial identification by culture and PCR increased significantly from 44% to 73% (p=0.007).  Details are described in Figure 2.  Among cases with a biopsy, bacterial yield was higher in those with pre-biopsy antibiotics at 83% (19/23) versus 33% (16/49) in patients with post-biopsy antibiotics (p <0.001). This group also had a higher median initial CRP of 6.6 mg/L compared with 2.8mg/L. The timing of antibiotics (< or > 24 hours) before biopsy did not affect bacterial yield.

               

    Conclusion: Implementation of the AHO guideline has increased the rate of bacterial identification. Timing of antibiotics did not affect bacterial yield. A higher acuity and burden of disease likely explains increased bacterial yield in the group with pre-biopsy antibiotics. This supports evidence that specimens from biopsy can yield positive results, even in the presence of prior antibiotic treatment. 

     

    Rachel Quick, RN, MSN, CNS1, Kathryn Merkel, PharmD, BCPS, AQ ID2, Patrick Boswell, BA3, Marisol Fernandez, MD1, Lynn Thoreson, DO4, Peter Cosgrove, MBBChBAO5, John Williams, MD6 and Sarmistha Hauger, MD1, (1)Pediatric Infectious Diseases, Seton Healthcare Family, Austin, TX, (2)Pharmacy, Seton Healthcare Family, Austin, TX, (3)Total Quality Management, Seton Healthcare Family, Austin, TX, (4)Pediatrcs, Seton Healthcare Family, Austin, TX, (5)Department of Pediatrics, Seton Healthcare Family, Austin, TX, (6)Pediatric Orthopedics, Seton Healthcare Family, Austin, TX

    Disclosures:

    R. Quick, None

    K. Merkel, None

    P. Boswell, None

    M. Fernandez, None

    L. Thoreson, None

    P. Cosgrove, None

    J. Williams, None

    S. Hauger, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.