Pediatric Hospital Medicine

Chapter 43 • Bone and Joint Infections 259

Discharge criteria 1,2,3 : • Signs of clinical improvement • Ability to tolerate an oral antibiotic regimen or appropriate resources

for outpatient parenteral antibiotic therapy identified Please see Table 43.4 for a high-value approach to AHO.

TABLE 43.4 HIGH-VALUE APPROACH TO AHO DIAGNOSTIC STUDIES

TREATMENT

DO

DON’T

DO

DON’T

• Obtain

• Rule out AHO based solely

• Start IV antibi otic therapy as soon as possible. • Narrow antibi otic coverage once specific organism is identified and susceptibilities available. • Consult local an tibiogram when community acquired MRSA coverage needed. • Involve ortho pedic surgery

• Delay initiation of antibiotic therapy for sur gical interven tion if patient is septic and hemodynami cally unstable, or if procedure cannot be per formed within 72 h of hospital admission.

CBC, CRP, and blood culture.

on present ing clinical symptoms

• Obtain plain

and physical examination. • Obtain ESR. • Obtain procalcitonin. • Obtain end

radiograph of affected limb to rule out other causes. • Follow CRP

of-therapy imaging in uncomplicated AHO.

every 2-3 d to monitor response to therapy.

• Obtain daily CRP levels if clinically improving.

to evaluate/ plan for inva sive diagnostic or therapeutic procedure.

AHO, acute hematogenous osteomyelitis; CRP, C-reactive protein; CBC, complete blood count with differential; ESR, erythrocyte sedimentation rate; IV, intravenous; MRSA, methicillin resistant Staphylococcus aureus .

■ REFERENCES 1. Whyte NS, Bielski RJ. Acute hematogenous osteomyelitis in children. Pediatr Ann . 2016;45(6):e204-e208. 2. Donaldson N, Sanders J, Child J, Parker S. Acute hematogenous bacterial osteoarticular infections in children. Pediatr Rev . 2020;41(3):120-136. 3. 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 Guide line on diagnosis and management of acute hematogenous osteomyelitis in pediatrics. J Pediatric Infect Dis Soc . 2021;10(8):801-844.

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