2317. Multicenter Retrospective Cohort Study of Pediatric Osteomyelitis
Session: Poster Abstract Session: Pediatric Bacterial Infections
Saturday, October 6, 2018
Room: S Poster Hall
Posters
  • OsteoPoster_IDWfinal_HDD copy.pdf (2.0 MB)
  • Background: There is controversy about the appropriate management of acute osteomyelitis in children.

    Methods: Retrospective cohort study of presentation, management and outcomes of all patients admitted with acute osteomyelitis (<2 weeks duration) during 2010-2016 at 4 US and Canadian tertiary care hospitals (hosp). Long-term complications (LTC) were defined as amputation, limp, chronic or secondary infection, or readmission. Overall complications included LTC, admission to ICU and delayed surgery (>72hours).

    Results: 712 patients were admitted, with a median age of 8.0 years (yrs). There were significant differences in rates of initial use of MRI for diagnosis, MRSA, PICC insertion, hosp stay and IV antibiotic duration (Table 1). Clindamycin (45.7%), cefazolin (24.1%) and vancomycin (13.7%) were the most common IV antibiotics used while clindamycin (47.1%) and cephalexin (38.6%) predominated for oral. The median age of patients with MRSA was similar to those without MRSA (8.2 vs 7.8 yrs, P=0.18), but MSSA patients were older (9.6 versus 6.9 yrs, P<0.0001). Contiguous septic arthritis was more common in younger children (6.8 versus 8.5 yrs, P<0.001). MRSA patients had higher overall complication rates (25.2% versus 10.0%, P <0.0001), but long-term complications were unrelated to duration of IV or total antibiotics.

    Table 1: Summary Results of Multi-center Study of Pediatric Osteomyelitis

    Children’s Hosp. of Omaha

    Children’s Mercy, Kansas City

    Norton Children’s

    Children’s Hosp. of Eastern Ontario

    P-value

    # of Patients Enrolled

    137

    398

    127

    46

    -

    M: F ratio (%)

    58.7:41.2

    64.8:35.1

    51.5:48.4

    69.5:30.4

    0.02

    Median age (years)

    7.6

    7.6

    8.2

    8.6

    0.32

    % of All Initial Imaging MRI

    38.1%

    89.8%

    45.9%

    20.4%

    <0.0001

    % Abnormal, all Initial Imaging

    75.8

    87.4

    80.0

    68.8

    <0.001

    MSSA rates (%)

    40.3

    46.0

    45.0

    50.0

    <0.19

    MRSA rates (%)

    10.7

    17.1

    23.0

    0

    <0.0001

    Median Hospital Stay (days)

    4.0

    4.0

    4.0

    6.0

    <0.0001

    Median Days of IV Antibiotics

    18.0

    4.0

    3.0

    9.5

    <0.0001

    Median Days of Total Antibiotics

    42.0

    34.0

    33.0

    41.5

    <0.0001

    Frequency of PICC Insertion

    67.7%

    8.5%

    8.7%

    45.8%

    <0.0001

    Long-term Complications

    6.1%

    4.3%

    7.1%

    10.5%

    0.18

    Conclusion:

    Despite significant variation in management, long-term complication rates were similar across US and Canadian sites with different MRSA rates. These data support equivalence of shorter (≤ 4 days) duration of IV antibiotics and reduced need for PICC insertion for pediatric osteomyelitis.

    Charles Treinen, BSc1, William Otto, MD2, Kari Simonsen, MD, FIDSA, FPIDS3, Nicole Le Saux, MD4, Jennifer Bowes, M Sc5, Julianne Green, MD, PhD6, Mary Anne Jackson, MD, FIDSA, FPIDS2, Charles Woods, MD, MS, FIDSA, FSHEA, FPIDS6, Jessica Snowden, MD7, Elizabeth Lyden, MS8 and H. Dele Davies, MD, MS, FIDS, FPIDS1, (1)Pediatrics, University of Nebraska Medical Center, Omaha, NE, (2)Pediatrics, Children's Mercy Hospital, Kansas City, MO, (3)Pediatric Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, (4)Infection Prevention and Control, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada, (5)Infectious Diseases, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada, (6)Pediatrics, University of Louisville School of Medicine, Louisville, KY, (7)University of Nebraska Medical Center, Omaha, NE, (8)Epidemiology, University of Nebraska Medical Center, Omaha, NE

    Disclosures:

    C. Treinen, None

    W. Otto, None

    K. Simonsen, None

    N. Le Saux, None

    J. Bowes, None

    J. Green, None

    M. A. Jackson, None

    C. Woods, None

    J. Snowden, None

    E. Lyden, None

    H. D. Davies, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.