Pediatric Hospital Medicine

Chapter 43 • Bone and Joint Infections 257

TABLE 43.2 LABORATORY TESTING AND IMAGING CONSIDERATIONS IN AHO

DIAGNOSTIC TESTING RECOMMENDATIONS

YIELD

CBC

• May show leukocytosis, anemia, and/or reactive thrombocytosis vs normal values in mild or moderate infection • Useful in identifying a bacterial cause and directing appropriate antibiotic therapy • Useful for diagnosis ( < 4-10 mg/dL indicates a low suspicion for AHO) • Useful for evaluation of response to antibiotic therapy • Provides a higher diagnostic and response to therapy yield than erythrocyte sedimentation rate and/or procalcitonin • Recommended if concern for complicated AHO, or if lack of response to antibiotic therapy after 24-48 h • Can help direct surgical intervention • Repeat not recommended at end of therapy

Blood culture

CRP

Standard radiographic films • Useful to rule out other diagnoses MRI

■ MANAGEMENT All patients with suspected bone and joint infections should be hos pitalized initially. The primary goal of acute inpatient hospitalization is to halt the spread of infection and prevent complications by initi ating broad-spectrum intravenous (IV) antibiotics after blood culture and bone biopsy or aspirates are obtained. 1,2 Determining the need for a bone aspirate and/or biopsy specimen should consider the fol lowing: a patient’s hemodynamic stability, presence of a positive blood culture result, and timely coordination of this procedure with a sur gical team. IV antibiotic therapy recommendations in AHO are sum marized in Table 43.3. The effectiveness of antibiotic therapy is based on a patient’s clinical improvement (hemodynamic stability without fevers, lessening or resolved pain, and increased movement or use of the affected extremity) and a significant improvement in laboratory values (downtrending C-reactive protein obtained every 2-3 days). 3 AHO, acute hematogenous osteomyelitis; CBC, complete blood count with differential; CRP, C-reactive protein; MRI, magnetic resonance imaging Data from Woods CR, Bradley JS, Chatterjee A, et al. Clinical practice guideline by the pediatric infectious diseases society and the infectious diseases society of America: 2021 guideline on diagnosis and management of acute hematogenous osteomyelitis in pediatrics. J Pediatric Infect Dis Soc . 2021;10(8):801-844.

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