Osteomyelitis

Pathway Background and Objectives

Acute hematogenous osteomyelitis is a relatively rare condition in children (incidence ranges from 1.2 to 13 per 100,000 children per year), but delayed diagnosis can result in significant morbidity.  Successful management requires coordination between multiple subspecialties including orthopedic surgery, infectious disease, and pediatric hospital medicine.  Many other conditions can mimic osteomyelitis, so proper work-up and imaging (including MRI) is crucial for proper diagnosis.  The role of surgical procedures can be controversial and often case-dependent, so it is important to define and standardize which children with osteomyelitis would benefit from surgical intervention.  Clinical prediction models can also be utilized to predict acute and chronic complications from osteomyelitis, which in turn can guide proper therapy.

The objectives of this pathway are to:

  • Engage in multi-specialty collaboration in management of acute hematogenous osteomyelitis
  • Clarify appropriate indications and timing of imaging
  • Consolidate sedated procedures in work-up & management whenever possible
  • Optimize empiric and targeted therapy for antimicrobial stewardship
  • Identify indications for biopsy +/- surgical drainage
  • Tailor therapy for patients at high risk for complications to reduce adverse long-term outcomes
  • Decrease length of stay
     

Algorithm  Educational Module

  • Percent of patients who undergo operative procedure for biopsy/drainage
  • Patients who require sedation for initial MRI and who require surgical drainage or percent who undergo imaging and drainage under the same sedation
  • Percent of patients treated per pathway:
    • Blood culture obtained prior to antibiotics
    • MRI obtained
    • Orthopedics and infectious disease consults (and notes) both obtained within 48h of admission
    • Initial antibiotics per pathway recommendation 
    • Discharge antibiotics per pathway recommendations 
  • Length of stay (days)
  • Duration of therapy (including outpatient antibiotics)
  • 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; 10:801. 
  • Alhinai Z, Elahi M, Park S, et al. Prediction of Adverse Outcomes in Pediatric Acute Hematogenous Osteomyelitis. Clin Infect Dis 2020; 71:e454.

The clinical pathways in the above links have been developed specifically for use at Connecticut Children’s and are made available publicly for informational and/or educational purposes only. The clinical pathways are not intended to be, nor are they, a substitute for individualized professional medical judgment, advice, diagnosis, or treatment. Although Connecticut Children’s makes all efforts to ensure the accuracy of the posted content, Connecticut Children’s makes no warranty of any kind as to the accuracy or completeness of the information or its fitness for use at any particular facility or in any individual case.