. 2021 Aug 28;47(1):179.

doi: 10.1186/s13052-021-01130-4.

Italian consensus on the therapeutic management of uncomplicated acute hematogenous osteomyelitis in children

Andrzej Krzysztofiak¹, Elena Chiappini², Elisabetta Venturini², Livia Gargiullo³, Marco Roversi⁴, Carlotta Montagnani², Elena Bozzola³, Sara Chiurchiu⁴, Davide Vecchio⁵, Elio Castagnola⁶, Paolo Tomà⁷, Gian Maria Rossolini⁸, Renato Maria Toniolo⁹, Susanna Esposito¹⁰, Marco Cirillo⁷, Fabio Cardinale¹¹, Andrea Novelli¹², Giovanni Beltrami¹³, Claudia Tagliabue¹⁴, Silvio Boero¹⁵, Daniele Deriu⁴, Sonia Bianchini¹⁶, Annalisa Grandin³, Samantha Bosis¹⁴, Martina Ciarcià², Daniele Ciofi², Chiara Tersigni², Barbara Bortone², Giulia Trippella², Giangiacomo Nicolini¹⁷, Andrea Lo Vecchio¹⁸, Antonietta Giannattasio¹⁹, Paola Musso², Elena Serrano², Paola Marchisio¹⁴, Daniele Donà²⁰, Silvia Garazzino²¹, Luca Pierantoni²², Teresa Mazzone²³, Paola Bernaschi²⁴, Alessandra Ferrari²⁵, Guido Castelli Gattinara²⁶, Luisa Galli², Alberto Villani³

Affiliations

¹ Paediatric and Infectious Disease Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy. andrzej.krzysztofiak@opbg.net.
² Paediatric Infectious Disease Unit, Anna Meyer Children's University Hospital, Florence, Italy.
³ Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
⁴ Paediatric and Infectious Disease Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
⁵ Rare Disease and Medical Genetics, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, Rome, Italy.
⁶ Infectious Disease Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy.
⁷ Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
⁸ Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
⁹ Surgery Department, Traumatology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
¹⁰ Pediatric Clinic, Pietro Barilla Children's Hospital, University of Parma, Parma, Italy.
¹¹ Department of Pediatrics and Emergency, Pediatric Allergy and Pulmunology Unit, Azienda Ospedaliera-Universitaria "Consorziale-Policlinico", Ospedale Pediatrico Giovanni XXIII, Bari, Italy.
¹² Department of Health Sciences, Section of Clinical Pharmacology and Oncology, University of Florence, Florence, Italy.
¹³ Department of Orthopaedic Oncology and Reconstructive Surgery, AOU Careggi, Florence, Italy.
¹⁴ Pediatric Highly Intensive Care Unit, Fondazione Ca' Granda Ospedale Maggiore Policlinico, IRCCS, Milan, Italy.
¹⁵ Department of Pediatric Orthopaedics, IRCCS Istituto 'Giannina Gaslini', Children's Hospital, Genova, Italy.
¹⁶ Department of Pediatrics, ASST Santi Paolo e Carlo Hospital, Milan, Italy.
¹⁷ Pediatric Unit, San Martino Hospital, Belluno, Italy.
¹⁸ Section of Paediatrics, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy.
¹⁹ Pediatric Emergecy Department, AORN Santobono-Pausilipon, Naples, Italy.
²⁰ Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Padua, Italy.
²¹ Pediatric Infectious Disease Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy.
²² Pediatric Emergency Unit, Policlinico di Sant'Orsola, Bologna, Italy.
²³ , Rome, Italy.
²⁴ Microbiology Unit, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy.
²⁵ Pediatric Unit, Cremona, Italy.
²⁶ Child and Adolescent Health Institute, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.

PMID: 34454557
PMCID: PMC8403408
DOI: 10.1186/s13052-021-01130-4

Italian consensus on the therapeutic management of uncomplicated acute hematogenous osteomyelitis in children

Andrzej Krzysztofiak et al. Ital J Pediatr. 2021.

. 2021 Aug 28;47(1):179.

doi: 10.1186/s13052-021-01130-4.

Authors

Affiliations

¹ Paediatric and Infectious Disease Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy. andrzej.krzysztofiak@opbg.net.
² Paediatric Infectious Disease Unit, Anna Meyer Children's University Hospital, Florence, Italy.
³ Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
⁴ Paediatric and Infectious Disease Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
⁵ Rare Disease and Medical Genetics, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, Rome, Italy.
⁶ Infectious Disease Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy.
⁷ Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
⁸ Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
⁹ Surgery Department, Traumatology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
¹⁰ Pediatric Clinic, Pietro Barilla Children's Hospital, University of Parma, Parma, Italy.
¹¹ Department of Pediatrics and Emergency, Pediatric Allergy and Pulmunology Unit, Azienda Ospedaliera-Universitaria "Consorziale-Policlinico", Ospedale Pediatrico Giovanni XXIII, Bari, Italy.
¹² Department of Health Sciences, Section of Clinical Pharmacology and Oncology, University of Florence, Florence, Italy.
¹³ Department of Orthopaedic Oncology and Reconstructive Surgery, AOU Careggi, Florence, Italy.
¹⁴ Pediatric Highly Intensive Care Unit, Fondazione Ca' Granda Ospedale Maggiore Policlinico, IRCCS, Milan, Italy.
¹⁵ Department of Pediatric Orthopaedics, IRCCS Istituto 'Giannina Gaslini', Children's Hospital, Genova, Italy.
¹⁶ Department of Pediatrics, ASST Santi Paolo e Carlo Hospital, Milan, Italy.
¹⁷ Pediatric Unit, San Martino Hospital, Belluno, Italy.
¹⁸ Section of Paediatrics, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy.
¹⁹ Pediatric Emergecy Department, AORN Santobono-Pausilipon, Naples, Italy.
²⁰ Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Padua, Italy.
²¹ Pediatric Infectious Disease Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy.
²² Pediatric Emergency Unit, Policlinico di Sant'Orsola, Bologna, Italy.
²³ , Rome, Italy.
²⁴ Microbiology Unit, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy.
²⁵ Pediatric Unit, Cremona, Italy.
²⁶ Child and Adolescent Health Institute, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.

PMID: 34454557
PMCID: PMC8403408
DOI: 10.1186/s13052-021-01130-4

Abstract

Background: Acute hematogenous osteomyelitis (AHOM) is an insidious infection of the bone that more frequently affects young males. The etiology, mainly bacterial, is often related to the patient's age, but it is frequently missed, owing to the low sensitivity of microbiological cultures. Thus, the evaluation of inflammatory biomarkers and imaging usually guide the diagnosis and follow-up of the infection. The antibiotic treatment of uncomplicated AHOM, on the other hand, heavily relies upon the clinician experience, given the current lack of national guidelines for the management of this infection.

Methods: A systematic review of the studies on the empirical treatment of uncomplicated AHOM in children published in English or Italian between January 1, 2009, and March 31, 2020, indexed on Pubmed or Embase search engines, was carried out. All guidelines and studies reporting on non-bacterial or complicated or post-traumatic osteomyelitis affecting newborns or children older than 18 years or with comorbidities were excluded from the review. All other works were included in this study.

Results: Out of 4576 articles, 53 were included in the study. Data on different topics was gathered and outlined: bone penetration of antibiotics; choice of intravenous antibiotic therapy according to the isolated or suspected pathogen; choice of oral antibiotic therapy; length of treatment and switch to oral therapy; surgical treatment.

Conclusions: The therapeutic management of osteomyelitis is still object of controversy. This study reports the first Italian consensus on the management of uncomplicated AHOM in children of pediatric osteomyelitis, based on expert opinions and a vast literature review.

Keywords: Antibiotic therapy; Bone infections; Children; Paediatric infectious diseases; Paediatric osteomyelitis; Paediatrics.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

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Italian consensus on the therapeutic management of uncomplicated acute hematogenous osteomyelitis in children

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Italian consensus on the therapeutic management of uncomplicated acute hematogenous osteomyelitis in children

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