Management of acute hematogenous osteomyelitis in children

Abstract

In children, osteomyelitis is primarily hematogenous in origin and acute in nature. The principal cause of osteomyelitis in children is Staphylococcus aureus, and both the epidemiology and pathogenesis of S. aureus infections, including osteomyelitis, have changed in recent years owing to the emergence of community-associated methicillin-resistant S. aureus. This review focuses on advances in the diagnosis and overall management of acute hematogenous osteomyelitis in children with these changes in mind.

Figure 1. Algorithm for the suggested initial antibiotic therapy of acute hematogenous osteomyelitis in children 3 months of age or older

If cultures yield an organism, antimicrobial treatment should be adjusted immediately (as needed). *If Kingella kingae is of particular concern, add therapy with cefazolin. ^‡If clindamycin is considered for treatment, the inducible macrolide, lincosamide and streptogramin B resistance phenotype must be excluded by the D-test, as this phenotype is associated with treatment failure. AHO: Acute hematogenous osteomyelitis; CA-MRSA: Community-acquired methicillin-resistant Staphylococcus aureus.