Clinical guideline highlights for the hospitalist: Diagnosis and management of acute hematogenous osteomyelitis in children

Palmer, Brandon; Wang, Marie E.

doi:10.1002/jhm.2742

Cited by 2 publications

(7 citation statements)

References 7 publications

(8 reference statements)

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“…Despite a low positive yield (10-50%), a blood culture should be performed before starting empiric antibiotics. [2][3][4]7,12,19,[39][40][41][42]45,46 When blood cultures are taken before the administration of systemic antibiotics, the positive yield improves from 69-95%. 45,47 If the blood culture is positive, it should be repeated every 48 hours until negative.…”

Section: Bacteriologymentioning

confidence: 99%

“…Radiographs of the affected limb should be requested to exclude other diagnoses such as fractures and malignancy. [2][3][4]11,12,39,41,46,48 X-rays are often normal in early AHOM as it takes up to two weeks for radiographic changes to appear, because lytic changes in bone require 50% of the bone mineral density to be depleted before becoming evident on X-rays. 3,7,16,37,42,48,94 Ultrasound is a cheap, readily available and non-ionising investigation.…”

Section: Imagingmentioning

confidence: 99%

“…4,7,18,37,39,42,48,56,68,93,95,96 MRI sensitivity is 80-100%, and the specificity is 50-100% compared to X-rays or bone scintigraphy. 2,7,12,19,38,40,46,94 The MRI criteria to diagnose AHOM includes: 20,41,96 • Alteration of normal signal intensity (low signal on T1-weighted images and high signal of STIR or T2-weighted images). On fat-suppressed gadolinium-enhanced T1-weighted images, it is seen as increased enhancement relative to the adjacent marrow • Subperiosteal collection…”

Section: Imagingmentioning

confidence: 99%

“…46 In children who appear severely ill, starting empiric antibiotics is recommended as the yield of positive cultures obtained within 24-48 hours of initiation of antibiotics is equivalent to those obtained before the administration of antibiotics. 39,46 Van der Merwe et al reported that, in matched groups, antibiotic administration before surgery did not decrease surgical culture yield. 33 Some children with AHOM can be severely ill with septicaemia.…”

Section: Managementmentioning

confidence: 99%

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Acute haematogenous osteomyelitis in the paediatric population: a current concepts review

Thiart

Nansook

2023

SA orthop. j.

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Acute haematogenous osteomyelitis (AHOM) is a bacterial infection localised in bone that usually occurs after an episode of bacteraemia. This infection is commonly encountered by doctors in low- and middle-income countries (LMICs) and, if not recognised early and managed appropriately, can harbour significant early and late complications, including death. This narrative review aims to summarise the current management of AHOM, highlight the controversies and report on new advances in diagnosis and treatment. AHOM is typically a monomicrobial disease. Staphylococcus aureus remains the most common pathogen globally, accounting for 70-90% of all cases. Diagnostic work-up includes complete blood cell count, serum C-reactive protein, erythrocyte sedimentation rate, imaging and blood culture. Management of AHOM includes empiric intravenous (IV) antibiotics based on the most likely causative agents; source control entailing surgery to drain any abscesses and obtain specimens for microscopy, culture and sensitivity (MCS), as well as debridement of any necrotic bone; and subsequent targeted antibiotic therapy effective against the identified pathogen with the narrowest spectrum. Treatment response is monitored with repeat CRP every 48-72 hours. The decision to switch from IV to oral antibiotics is made if there is clinical improvement and the CRP is < 20 mg/L. The total duration of antibiotics is six weeks. Treatment of paediatric AHOM is multidisciplinary and includes orthopaedic surgeons, paediatricians, infectious diseases specialists, physiotherapists, dieticians, nurses and social workers. AHOM can cause devastating destruction of the bone due to tissue necrosis, leading to late sequelae. These complications are more common in children in LMICs. Level of evidence: Level 5

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Section: Bacteriologymentioning

confidence: 99%

Section: Imagingmentioning

confidence: 99%

Section: Imagingmentioning

confidence: 99%

Section: Managementmentioning

confidence: 99%

See 2 more Smart Citations

Acute haematogenous osteomyelitis in the paediatric population: a current concepts review

Thiart

Nansook

2023

SA orthop. j.

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“…Despite the fact that no clear indications have been established, general guidelines recommend surgical drainage for patients who present multifocal disease, who do not respond to antibiotics after 48-72 h, where ther is radiological evidence of a substantial pus collection, and sequestration as well as in patients with septic aspect at onset (1,23,(27)(28)(29)(30). Data regarding abscess size that mandates surgical drainage are very limited, although drainage of abscesses 2 cm or more in diameter has been suggested (23).…”

Section: Acute Osteomyelitismentioning

confidence: 99%