1125. In-Depth Analysis of Oral vs Parenteral Therapy in Pediatric Acute Hematogenous Osteomyelitis
Session: Poster Abstract Session: Clinical Infectious Diseases: Bone and Joint, Skin and Soft Tissue
Friday, October 28, 2016
Room: Poster Hall
Posters
  • IDweek 2016 Poster - Osteomyelitis 3x6.pdf (133.7 kB)
  • Background: Early transition from parenteral to oral antibiotics for uncomplicated pediatric acute hematogenous osteomyelitis (AHOM) is becoming the standard of care. We set out to describe in depth the clinical characteristics, therapy duration and adverse events (AE) in pediatric patients with AHOM at our center, the sole pediatric hospital in Rhode Island.

    Methods:Children 18 years or younger without comorbidities were eligible. We enrolled all children with diagnostic codes associated with osteomyelitis from July 1, 2012 through December 31, 2014. We confirmed eligibility criteria by reviewing the medical records, and systematically collected clinical and laboratory data.

    Results:41 children met inclusion criteria. Pathogenic bacteria were isolated in 66% of the cases. Staphylococcus aureuswas the most common organism (85% of isolates). The MRSA rate was 13%, differing significantly from our institution's MRSA rate during the same period (42%, p<0.01). Table 1 summarizes our findings:
    Table 1 - Results

    Discharged on Oral Antibiotics

    n (%)

    Discharged with PICC

    n (%)

    P Value

    N

    21 (51)

    20 (49)

    Median Age (years)

    10.8

    8.3

    0.9

    Male:Female Ratio

    1.6

    2.3

    0.8

    Presence of Fever

    15 (71)

    18 (90)

    0.24

    Mean Duration of Fever (days from presentation)

    2.48

    4.01

    0.03

    Mean Maximum ESR

    48.5

    75.3

    <0.01

    Mean Maximum CRP

    87.5

    126.6

    0.04

    Septic Joint

    3 (14)

    10 (50)

    0.02

    Complicated Infection*

    7 (33)

    14 (70)

    0.04

    Surgical Intervention

    8 (38)

    15 (75)

    0.02

    Bacteremia

    7 (33)

    11 (55)

    0.16

    Median LOS (days)

    3.93

    5.91

    <0.01

    Median Duration of Parenteral Therapy (days)

    3.48

    42.4

    <0.01

    Median Total Duration of Antibiotics (days)

    30.5

    46

    <0.01

    Chronic Osteomyelitis

    0 (0)

    2 (10)

    0.23

    PICC-Related AE**

    -

    12 (60)

    -

    Other AE (GI, Allergy, Neutropenia)

    2 (10)

    6 (30)

    0.25

    ED Visits Due to AE

    0 (0)

    7 (35)

    <0.01

    Medication Adherence Issue

    3 (14)

    0 (0)

    0.24

    Loss to Follow-up

    4 (19)

    1 (5)

    0.34

    *Cases involving abscess, thrombus, or spinal osteomyelitis.

    **There were no CLABSIs or thrombosis related to PICCs

    Conclusion: The MRSA rate for pediatric AHOM is lower than the MRSA rate for other infections at our center, which may reflect a different pathogenesis. Children discharged with PICCs had more severe and complicated infections, but also had more treatment-related AEs. Discharge on oral antibiotics was safe and effective, but was associated with less adherence and more loss to follow-up, though not statistically significant.

    Zaid Alhinai, MD1, Brian Lee, MPH, PhD2, Penelope H. Dennehy, MD, FIDSA, FPIDS1, Michael Koster, MD2 and Ian C. Michelow, MD, DTM&H1,3, (1)Pediatric Infectious Diseases, Hasbro Children's Hospital, Brown University, Providence, RI, (2)Pediatrics, Hasbro Children's Hospital, Brown University, Providence, RI, (3)Center for International Health Research, Rhode Island Hospital, Medical School of Brown University, Providence, RI

    Disclosures:

    Z. Alhinai, None

    B. Lee, None

    P. H. Dennehy, None

    M. Koster, None

    I. C. Michelow, 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.