Management of Pediatric Acute Hematogenous Osteomyelitis, Part I: Antimicrobial Stewardship Approach and Review of Therapies for Methicillin‐Susceptible Staphylococcus aureus, Streptococcus pyogenes, and Kingella kingae

Abstract

Acute hematogenous osteomyelitis (AHO), often occurring in young children, is the most frequently diagnosed type of osteomyelitis in pediatric patients. Optimizing antibiotics is essential as delays to receipt of appropriate therapy can lead to chronic osteomyelitis, as well as impairments in bone growth and development. Antimicrobial stewardship programs (ASPs) are in a key position to help improve the care of patients with AHO as they contain a pharmacist with expertise in antibiotic drug selection, optimization of dosing, and microbiologic test review. A literature search of the MEDLINE database was conducted from initiation through January 2018. Articles selected for the review focus on pathogen identification, pharmacokinetics and pharmacodynamics, efficacy and safety in children, transition from intravenous to oral therapy, duration of treatment, and antimicrobial stewardship interventions. This review will highlight the potential roles ASPs can have in improving the management of AHO in pediatric patients. These roles include the creation of clinical pathways, improving testing algorithms, antibiotic choice and dosing, intravenous to oral transitions, duration of treatment, and therapy monitoring. Overall, patients are most effectively treated by focusing treatments on age, presentation, local sensitivities, and directed therapy with pathogen identification.

Characterization of Clinical MRSA Isolates from Northern Spain and Assessment of Their Susceptibility to Phage-Derived Antimicrobials

“…HA-MRSA is a very common cause of ventilator-associated pneumonia (VAP) and hospital-associated pneumonia (HAP), probably the most frequent infections in critically ill patients, with a mortality of 3–17% [ 8 ]. S. aureus is also the most common etiological agent of acute hematogenous osteomyelitis (AHO) in pediatric patients [ 9 ]. Moreover, MRSA, MSSA (methicillin-sensitive S. aureus ) and coagulase-negative staphylococci are the most frequent pathogens in surgical site infections after total hip and knee arthroplasty [ 10 ].…”

Decompression Surgery With Antibiotic-impregnated Calcium Sulfate Can Achieve More Satisfactory Results Than Decompression Alone in Pediatric Hematogenous Osteomyelitis

“…Hematogenous osteomyelitis(HO) can be cured by intravenous antibiotic in most of teenagers and children. [18] Therefore, most researchers concentrated on early diagnosis, antibiotic therapy and interdisciplinary cooperation instead of the right timing and method of surgery. [12,18] No consensus has been reached on the timing and method of surgery so far.…”

“…[18] Therefore, most researchers concentrated on early diagnosis, antibiotic therapy and interdisciplinary cooperation instead of the right timing and method of surgery. [12,18] No consensus has been reached on the timing and method of surgery so far. Copley presented a Severity of Illness Score [19] for pediatric acute HO in 2016.…”

“…Otherwise, the positive rate and accuracy rate were highest in intraoperative specimen culture than interventional radiology culture and blood culture. [18] A positive and accuracy culture is crucial for diagnosing osteomyelitis. Hence,to some extent, surgery is both diagnosis and treatment.…”

Antibiotic Treatment of Vertebral Osteomyelitis caused by Methicillin-Susceptible Staphylococcus aureus: A Focus on the Use of Oral β-lactams

“…Non-β-lactams such as linezolid, levofloxacin plus rifampin, or clindamycin can be used for oral switch therapy for native VO in adults [10]. Oral β-lactams have been widely used in children with acute hematogenous osteomyelitis [192021]. In contrast, oral therapy with β-lactams is generally not recommended in adults with staphylococcal osteoarticular infections; mostly parenteral administration of β-lactams, if needed, is used.…”