Variability in Management of Acute Osteoarticular Infections at a Children’s Hospital and Favorable Outcomes with Increasing Early Transition to Oral Therapy

Abstract

Background To date, there is no established guideline for the treatment of acute pediatric osteoarticular infections (OAI), and considerable variability in management exists amongst providers and across institutions. This study analyzed the recent management and clinical outcomes of OAI at a children’s hospital.Methods Patients admitted with acute osteomyelitis and septic arthritis [OAI] aged 2 months to 18 years at the Women & Children’s Hospital of Buffalo, between 1/1/2013 and 12/31/2016, were identified via billing databases. Patients with select comorbidities or >2 positive blood cultures were excluded. Patient demographics, antibiotics used, culture results, time from intravenous (IV) to oral (PO) therapy, length of hospitalization (LOH), PICC (peripherally inserted central catheter) line use, and emergency room (ER) visits and readmissions within 6 months of discharge, were collected and analyzed. The study period was divided into 2-year groups, before and after 1/1/15, a juncture when a new provider began to promote early transition to oral therapy (through ID consults and informal discussion).ResultsThirty-one patients were admitted during Time#1 (2013–14) and 43 during Time#2 (2015–16). Time to PO therapy was widely distributed (Figure 1) throughout the 4 years, with 65% of patients in Time#2 transitioned ≤7 days, vs. 37% in Time#1 (P = 0.02). Specifically for osteomyelitis, mean time to PO decreased from Time#1 to #2 from 11.5 to 8.3 days. Sixty-one percent of patients in Time#1 vs 25% in Time#2 (P < 0.01) received a PICC line, and PICC use was associated with 1.5 day greater LOH (P = 0.02). There was no relationship between time to PO and repeat ER visit/readmission. Nearly 30% of patients in Time#1 had PICC or OAI-related ER visits/readmissions after discharge, while 0% did for Time#2 (P < 0.01).Conclusion Length of initial IV therapy and PICC line use continues to vary significantly for pediatric acute OAI. In our children’s hospital, a shift towards earlier transition to PO therapy has been adopted steadily – and prior to national and planned local guidelines – with a general decrease in LOH, duration of IV therapy, PICC line issues following discharge, and overall improved outcomes. Pediatric OAI management represents an ideal focus for institutional quality and antibiotic stewardship efforts.Disclosures S. Islam, Qiagen: Speaker’s Bureau, Speaker honorarium and travel support