Pediatric osteomyelitis fraught with clinical challenges
A recent single-center, retrospective study reported using a CRP lower than 2.0-3.0 mg/L and evidence of clinical response for oral step-down therapy among 194 children with culture-positive, acute bacterial osteomyelitis or acute bacterial arthritis. This combination strategy, in place at Rady Children’s Hospital in San Diego for more than a decade, yielded only one microbiologic failure and a long-term success rate with early transition to oral antibiotics that was similar to outcomes for long-term IV courses (Pediatrics 2012;130:e821-8).
A smaller prospective study in 44 children with AHOM reported that CRP values peaked 2 days after admission and normalized within a week of initiating therapy and transitioning to oral antibiotics within 4 days (Pediatrics 1994;93:59-62).
Regardless of the antibiotic plan, follow-up after discharge is key, said copresenter Dr. Lauren G. Solan, a hospital medicine fellow at Cincinnati Children’s. Hospitalists should ensure that the primary care physician is comfortable with the discharge plan and consider follow-up with an infectious disease specialist, particularly in children sent home on IV therapy. Catheter-associated complications requiring attention occur in about 30% of children with PICC lines at home, with malfunction or displacement reported in nearly one-fourth of those receiving more than 2 weeks of IV therapy, she observed. Notably, just five audience members acknowledged requesting an orthopedic follow-up, even in cases involving surgical procedures.
The presenters reported having no financial disclosures.
