Management of bone and joint infections in children: Recent experience at an urban medical center

BACKGROUND: The microbiology and treatment of bone and joint infections in children have changed over the past several decades. Uncertainty still exists as to the optimal duration of treatment, usually 1 to 2 months or longer, and the feasibility of outpatient treatment with either intravenously or orally administered antibiotics. The purpose of this study was to review the pathogens causing bone and joint infections and management of these infections in children seen in an inner-city medical center. METHODS: This was a retrospective chart review of children admitted to SUNY Downstate Medical Center and Kings County Hospital in Brooklyn, NY, with a diagnosis of either osteomyelitis or septic arthritis from October 2002 to July 2008. RESULTS: Medical records of 46 patients, aged 19 days to 18 years, were analyzed. A microbiologic diagnosis was made in 76.7% of children with acute osteomyelitis and 100% of children with septic arthritis. The predominant pathogen was Staphylococcus aureus, which was responsible for 22 cases (48%). Patients were initially treated as inpatients with intravenously administered antibiotics and then discharged home on either intravenous therapy via peripherally inserted central catheter line (46%) or oral antibiotics (54%). Home therapy was well tolerated and efficacious in all cases. CONCLUSIONS: The results demonstrated that tailoring an effective home therapy regimen is feasible but requires a specific microbiologic diagnosis.