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- Nathan Donaldson, DO*
- Julia Sanders, MD*
- Jason Child, PharmD†
- Sarah Parker, MD‡
- *Division of Orthopedic Surgery and
- ‡Division of Infectious Diseases, Department of Pediatrics, University of Colorado Denver School of Medicine, Aurora, CO
- †Department of Pharmacy, Children’s Hospital Colorado, Aurora, CO
AUTHOR DISCLOSURE
Drs Donaldson, Sanders, Child, and Parker have disclosed no financial relationships relevant to this article. This commentary does contain a discussion of an unapproved/investigative use of a commercial product/device.
- ADE:
- adverse drug event
- CRMO:
- chronic recurrent multifocal osteomyelitis
- CRP:
- C-reactive protein
- CT:
- computed tomography
- ESR:
- erythrocyte sedimentation rate
- MRI:
- magnetic resonance imaging
- MRSA:
- methicillin-resistant Staphylococcus aureus
- MSSA:
- methicillin-susceptible Staphylococcus aureus
- OAI:
- osteoarticular infection
- WBC:
- white blood cell
Practice Gaps
Management of pediatric acute hematogenous osteoarticular infections has changed in various ways during the past decade, including the description of new pathogens and updated diagnostic and treatment strategies (such as infected source sampling and an early switch to oral therapy).
Objectives
After completing this article, readers should be able to:
Understand what predisposes children of different age groups to acute hematogenous osteoarticular infections (OAIs), particularly the role of anatomy and differing pathogenic susceptibilities.
Recognize the symptoms present in children with OAIs and their most common differential diagnoses.
Understand the most effective imaging techniques and laboratory tests/cultures to diagnose an OAI and how to interpret them.
Understand the benefits and limitations of therapeutic surgery and source sampling (biopsy/aspirate) and when to commence antimicrobial drug therapy.
Recognize the most common causative pathogens and the most effective antimicrobial drugs for their treatment.
Determine how long a patient should be taking intravenous and oral therapy and under what conditions they should switch from intravenous to oral antimicrobial agents.
Understand the recommended follow-up after diagnosis, including when to expect normalization of laboratory values in patients with uncomplicated OAIs.
Recognize complicated OAIs and their possible long-term sequelae.
Introduction
Pediatric osteoarticular infections (OAIs) include infections of the bones (osteomyelitis) and joints (septic arthritis). Pathogenic organisms may be introduced into these normally sterile sites via direct inoculation (eg, trauma or surgery) or via erosion from a contiguously infected source (eg, chronic ulcer), but organisms are mostly hematogenously delivered. Bacteria are the most common pathogens to cause OAIs, but mycobacteria, fungi, and viruses can also infect these tissues. If diagnosed in the first 10 to 14 days, these infections are …
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In this issue
Jump to section
- Article
- Practice Gaps
- Objectives
- Introduction
- Anatomy and Pathogenesis of Infection
- History and Clinical Examination
- Laboratory Evaluation
- Differential Diagnosis
- Imaging
- Diagnosis
- Causative Pathogens and Their Identification
- Inpatient Medical and Surgical Management
- Management of Antimicrobial Drug Therapy
- Outcomes, Sequelae, and Follow-up Imaging
- Complicated OAIs
- Special Scenarios in OAI
- Acknowledgments
- References
- Figures & Data
- Info & Metrics
- Comments
- Quiz
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