Acute Hematogenous Osteomyelitis Research Articles

Predictive value of PAR and PNI for the acute complicated course of pediatric acute hematogenous osteomyelitis

ObjectivePlatelet to albumin ratio (PAR) and prognostic nutritional index (PNI) are potential indicators for evaluating nutritional and inflammatory status. This study aimed to examine the relationship between PAR and PNI and the acute complicated course of acute hematogenous osteomyelitis (AHO). MethodsAHO patients were divided into the simple course group and the acute complicated course group. The patient's gender, age, site of infection, body temperature, laboratory results, and pathogen culture results were collected and compared. Multivariate logistic regression analysis was used to determine the independent risk factors of the acute complicated course group. The receiver operating characteristic curve was applied to determine the optimal cut-off value. ResultsIn total, 101 AHO patients with a median age of 7.58 years were included. There were 63 cases (62.4%) in the simple course group and 38 cases (37.6%) in the complicated course group. Binary logistic regression analysis revealed that PAR and PNI were independent risk factors for predicting the acute complicated course of AHO (p = 0.004 and p < 0.001, respectively). Receiver operating characteristic curve analysis demonstrated that the combination of PAR and PNI had an area under the curve of 0.777 (95% CI: 0.680-0.873, p < 0.001) with a cut-off value of 0.51. ConclusionsThe incidence of acute complicated courses was significantly higher in patients with high PAR and low PNI. A combined factor greater than 0.51, derived from PAR and PNI measurements within 24 hours of admission, may be useful for predicting AHO patients who are likely to develop severe disease.

Clinical Utility of Repeat Magnetic Resonance Imaging Studies Among Children With Acute Hematogenous Osteomyelitis.

There is limited guidance for whether repeat magnetic resonance imaging (MRI) studies are clinically impactful among children with acute hematogenous osteomyelitis (AHO) who fail to improve as expected. This study aimed to determine whether repeat MRIs changed management among children with AHO and identify clinical characteristics predictive of which patients benefit from repeat MRIs. Children admitted to a quaternary care pediatric hospital with AHO were identified during a 9-year period. Patients with chronic symptoms, non-hematogenous infections, or significant contributing comorbidities were excluded. Medical records were retrospectively reviewed for all MRIs performed 3 weeks before admission to 24 months after discharge. An MRI was considered clinically impactful if it identified a new infectious process (eg, abscess not seen on the initial MRI) or if it resulted in surgical intervention within 24 hours. Bivariable comparisons of categorical variables were performed, and multivariable logistic regression was used to assess the clinical factors of impactful repeat MRIs. Among the 239 included patients, 41 (17%) had more than 1 MRI performed during their clinical course, the majority of whom (53.7%) had a repeat MRI that impacted care. Patients who underwent repeat MRIs had longer hospitalizations (7 vs. 5 d, P<0.01), were more likely to have C-reactive protein (CRP) levels >20mg/dL (41% vs. 10%, P<0.01), and were more likely to have a delayed transition to oral antimicrobials (8.4 vs. 3.3d, P<0.01). Peak CRP >20mg/dL and prolonged bacteremia were found to be associated with increased odds of having an impactful repeat MRI, with adjusted odds ratios of 3.9 (P=0.007) and 3.4 (P=0.03), respectively. When used judiciously among ill children with complicated AHO, repeat MRI can be clinically impactful. Prospective studies are needed to better define which children with AHO benefit from repeat MRI. Level II evidence-this is a retrospective cohort study interested in determining the clinical utility of repeat magnetic resonance imaging studies for children with osteomyelitis.

The role of preoperative appendicular magnetic resonance imaging in cases of acute bone and joint infection in the paediatric age group

Background: Acute haematogenous osteomyelitis is mainly a disease of children. It is a challenge to differentiate it from septic arthritis as they have overlapping signs and symptoms. Septic arthritis is a surgical emergency while acute osteomyelitis, when presenting early, can be treated with parenteral antibiotics. There is paucity in imaging guidelines and treatment for cases where acute septic arthritis is associated with osteomyelitis.Objectives: To analyse the role of preoperative magnetic resonance imaging (MRI) in cases of suspected acute bone and joint infection in the paediatric age group.Method: This is a prospective study in 38 children suspected to have acute bone and joint infections. All the patients underwent emergency appendicular MRI on suspicion of bone and joint infections. Based on the MRI findings, the patients were classified into cases of isolated septic arthritis and cases of septic arthritis with concomitant osteomyelitis. There was a change in the treatment modality between the two categories of patients. Results: In our study 14 (36.8%) cases of suspected bone and joint infection had concomitant osteomyelitis with septic arthritis. These 14 cases were seen involving the knee, hip, elbow and shoulder joints. The incidence of septic arthritis with coexisting osteomyelitis was 36.8% in our study, which was diagnosed with preoperative emergency appendicular MRI.Conclusions: Our study concludes that MRI should be included in the work up for suspected bone and joint infections provided MRI is done in a timely fashion without unnecessarily delaying surgical intervention if needed.

Multimodal approach in radiation diagnostics to determining the intramedullary phase of strictly hematogenic osteomyelitis in children: a prospective study

INTRODUCTION: Despite the fact that acute hematogenous osteomyelitis is classified as a sufficiently studied disease, the percentage of diagnostic errors is still quite high. Timely diagnosis is crucial for the successful outcome of the disease, therefore, visualization should be aimed at early diagnosis and, as a result, successful treatment of the disease.OBJECTIVE: To identify early patterns in the intramedullary phase of the course of acute hematogenous osteomyelitis (CSO) with a multimodal approach of radiation research methods.MATERIALS AND METHODS: Twenty patients underwent a comprehensive examination, including multispiral computed tomography (MSCT) using color mapping techniques.RESULTS: In the intramedullary phase of the course of CSF, no pathological changes were detected during X-ray examination of the affected limb. Ultrasound in 75% of observations revealed a thickening of the periosteum of more than 1 millimeter (mm) in the affected bone. When using MRI in 93% of cases, and with MSCT in 95% of patients, signs of bone marrow edema were detected.DISCUSSION: The role of computed tomography in the diagnosis of acute hematogenous osteomyelitis in children has received significant recognition in pediatric surgical practice in recent years, and the use of MSCT in the diagnosis of CSO has found application in domestic healthcare. At the same time, a fairly large number of researchers reported on the high informativeness of MSCT in the diagnosis of CSOs.CONCLUSION: MSCT using the color mapping technique has a higher specificity compared to MRI and can be used as an integral method of the first level in the diagnosis of the intramedullary phase of the CSF course.

Diagnostic efficacy of metaepiphyseal osteomyelitis in young children: a prospective study

INTRODUCTION: Modern and effective diagnosis of osteomyelitis is the basis for successful therapy; at the same time the problem of establishing this pathology, especially in the early stages of the development of the process, has not been completely resolved.OBJECTIVE: To develop of ultrasound imaging of metaepiphyseal osteomyelitis in young children, depending on the duration of the disease.MATERIAL AND METHODS: 108 children (boys — 65% (70/108), girls — 35 (38/108)) from 1 month to 2 years were examined. Children's age from 2 up to 8 months — 57% (62/108), newborns — 26% (27/108). The age of other children: 12% (13/108) — 9–12 months, 5% (6/108) — 1– 2 years. All children underwent x-ray and ultrasound study. The diagnosis of osteomyelitis was verified by joint puncture (n=102), bone puncture (n=57), drainage of periarticular phlegmon (n=12).Statistics: processing of the study results was carried out using the Statistica 13.0 application package (TIBCO Software Inc, 2017). To assess the effectiveness of ultrasound in the diagnosis of acute osteomyelitis, the diagnostic effectiveness and predictive value of positive or negative results were calculated, and the likelihood ratio was calculated.RESULTS: 3 groups were identified depending on the duration of the disease at the time of admission to the hospital: Ia — 1–3 days, Ib — 4–7 days, Group II — 8–14 days, Group III — 15–21 days from the onset of the disease. DE indicators for patients of group Ia: sensitivity — 81.8%, specificity — 60.0%, accuracy — 75%, PV(+)=81.82%; PV(–)=60.00%; OR=4.50. DE indicators for patients in group Ib: sensitivity — 86.6%, specificity — 66.6%, accuracy — 80.95%, PV(+)=87.5%; PV(–)=60.0%; OR=7.00. DE indicators for patients in group II: sensitivity — 92.98%, specificity — 80.0%, accuracy — 93.44%, PV(+)=98.15%; PV(–)=57.14%; OR=37.86. DE indicators for patients of group III: sensitivity — 91.66%, specificity — 91.0%, accuracy — 91.66%, PV(+)=100.0%.DISCUSSION: Ultrasound imaging of acute osteomyelitis in children of group Ia included nonspecific changes in periarticular tissues and had the lowest diagnostic accuracy (75%). Diagnostic accuracy increased in group Ib to 85% due to initial structural changes in the zone of preliminary calcification and hyaline cartilage of the epiphysis. Disease progression in group II was characterized by more distinct structural changes in the metaphysis with an increase in diagnostic accuracy to 93%. In patients of group III, the highest rates of diagnostic accuracy (91.67%) were obtained due to visualization of destructive changes in the epiphysis, metaphysis and zone of preliminary calcification.CONCLUSION: The ability to detect ultrasound signs of acute hematogenous metaepiphyseal osteomyelitis in children will allow the use of this method in the early diagnosis for the timely selection of an adequate treatment tactics.

Acute Hematogenous Osteomyelitis of the Pelvis in Children.

Pelvic involvement has been reported in 3%-14% of acute hematogenous osteomyelitis (AHO) cases in children. One guideline suggests need for a longer antibiotic course in pelvic AHO, however, recent data are lacking. We describe the clinical course of children with pelvic AHO and compare it to nonpelvic AHO. A retrospective review of patients with a diagnosis of AHO admitted to Texas Children's Hospital from January 2012 to December 2020 was conducted. Patients 6 months-<19 years old and with ≤14 days of symptoms at admission were eligible. Patients with sickle cell disease or immunocompromised were excluded. Wilcoxon rank-sum test assessed for differences between continuous variables and Fisher exact for categorical variables using STATA 17. We compared 104 cases of pelvic AHO to 314 cases of nonpelvic AHO. Patients had similar microbiology, length of stay and length of antibiotic therapy. Patients with pelvic AHO had pyomyositis identified by magnetic resonance imaging more often (28.8 vs. 9.4%, P < 0.001) and bone abscess less often (22.1 vs. 46.5%, P < 0.001). Rates of chronic complications were comparable between patients with pelvic AHO and nonpelvic AHO (8.4% vs. 15.1%, P = 0.1). Nineteen patients (18.3%) with pelvic AHO received ≤30 antibiotic days without complications, but they had less need for intensive care or bone abscesses than patients treated longer. Pelvic AHO in children may be more frequent than previously reported but is not associated with more complications. Four weeks of therapy may be sufficient in selected patients. Prospective studies to compare outcomes with different lengths of therapy are needed.

Microbiological Evaluation of Paediatric Chronic Haematogenous Osteomyelitis in a Tertiary Care Hospital in Northern India and its Association with Radiological Appearance: A Retrospective Study

Introduction: Chronic osteomyelitis in the paediatric age group is a frequent complication of improperly treated acute haematogenous osteomyelitis, leading to devastating complications such as pathological fractures and deformities in affected children. There is a growing need to comprehend the disease process and develop improved treatment strategies. Aim: To evaluate bacterial culture and antibiotic sensitivity patterns in children and adolescents with chronic haematogenous osteomyelitis in North India and to explore associations between radiological patterns and antibiotic sensitivity. Materials and Methods: The present retrospective study was conducted in the Department of Orthopaedics of tertiary care centre, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, North India, from July 2018 to June 2020. Total 100 children and young adolescents with chronic osteomyelitis who reported to OPD of hospital with pus discharge from an extremity persisting for more than six weeks, along with radiological features indicative of chronic osteomyelitis. Parameters such as site of infection, illness duration, blood parameters, bacteriological culture reports, etc., were examined. Radiological evaluation was performed using the Beit CURE (BC) classification. Data were analysed and represented in the form of frequencies and percentages. The Chi-square test was used to compare proportions, with significance set at p-value&lt;0.05. Results: The median age of the study population was 13 years, there were 32 (32%) females and 68 (68%) males. The majority of cases (70%) belonged to the B1-B3 group. Staphylococcus aureus was responsible for 86 (86%) cases, followed by Pseudomonas aeruginosa in 7 (7%) cases. Out of the 86 Staphylococcus aureus (S. aureus) isolates, 58 (67.44%) were Methicillin-resistant Staphylococcus aureus (MRSA). Multidrug resistance was observed among gram-negative species, as well. Pseudomonas aeruginosa showed resistance to fluoroquinolones in 4 (57%) cases, aminoglycosides in 2 (28%) cases, and carbapenem in 1 (14%) case, which is considered highly effective in treating serious infections caused by multidrug resistant Gram-negative species. No significant association was found between drug sensitivity patterns and radiological features in the present study. Conclusion: Staphylococcus aureus remains the most predominant organism isolated from deep tissue cultures. Among S. aureus isolates, MRSA was the most frequently identified. Identifying the causative organism may be challenging in some cases. Among cases where the offending microbe was identified, drug resistance was widespread among both Gram-negative and Gram-positive specimens. No significant relationship was found between the radiological appearance of infected bone and the pattern of antibiotic resistance.

Comparative analysis of the results of multispiral computed tomography using color mapping and magnetic resonance imaging in the diagnosis of acute hematogenous osteomyelitis in children

BACKGROUND: Although acute hematogenous osteomyelitis is considered a fairly well-studied disease, several articles emphasize that the frequency of diagnostic errors remains quite high. The clinical presentation of acute hematogenous osteomyelitis largely depends on its reactivity and localization. The latter has features of the clinical course in children of different age groups. Osteomyelitis can be difficult to detect because of the variability and nonspecificity of symptoms and physical and laboratory parameters. Rapid diagnosis is crucial for successful disease outcomes because untimely treatment increases the number of complications. Therefore, visualization should be aimed at early diagnosis and, ultimately, successful treatment.&#x0D; AIM: This study aimed to evaluate the informative value of magnetic resonance imaging and multispiral computed tomography (MSCT) in the diagnosis of the intramedullary phase of acute hematogenous osteomyelitis as its earliest stage.&#x0D; MATERIALS AND METHODS: Thirty patients suspected with acute hematogenous osteomyelitis underwent magnetic resonance imaging and MSCT using color mapping techniques and X-ray density assessment. At the final stage of the diagnostic algorithm, osteotonometry was performed. The contents of the bone marrow canal were taken for microbiological and bacteriological studies.&#x0D; RESULTS: In the intramedullary phase of acute hematogenous osteomyelitis, magnetic resonance imaging and MSCT revealed signs of bone marrow edema in 96% of the cases. The sensitivity of magnetic resonance imaging was 96%, the same as that of MSCT; however, the specificity was significantly lower than that of MSCT using the color mapping method and X-ray density assessment, which was 67% and 83%, respectively (p 0.05).&#x0D; DISCUSSION: In recent years, the role of computed tomography in the diagnosis of acute hematogenous osteomyelitis has received considerable recognition in pediatric surgical practice, and MSCT with color mapping and X-ray density assessment in the diagnosis of acute hematogenous osteomyelitis in children has been used relatively recently. Simultaneously, many researchers have reported the high informativeness of MSCT in the diagnosis of acute hematogenous osteomyelitis.&#x0D; CONCLUSIONS: The intramedullary phase of acute hematogenous osteomyelitis according to magnetic resonance imaging and MSCT indicates bone marrow edema as its earliest stage. According to the data of the present study, MSCT using color mapping and X-ray density assessment has high specificity and can be used with MRI as the main method for diagnosing the intramedullary phase of acute hematogenous osteomyelitis.

Bacteroides fragilis Acute Hematogenous Osteomyelitis in a Young Female with Sickle Cell Disease

Patients with sickle cell disease are at increased risk for multiple infections including osteomyelitis. The most reported causative organisms are Salmonella spp. and Staphylococcus aureus. Anaerobic infections including Bacteroides fragilis are not commonly seen. Here, we report the first case of a 28-year-old female patient with sickle cell disease and acute hematogenous Bacteroides fragilis tibial osteomyelitis. Diagnosis was made by isolating the organism from blood and tibial fluid cultures. The patient was successfully managed with a course of intravenous followed by oral antibiotics and percutaneous drainage of collection and responded well. This case report will shed light on the importance of Bacteroides fragilis as a causative organism for osteomyelitis in sickle cell disease patients, thereby affecting the management of these patients.

First-Generation Cephalosporins for Treatment of Acute Hematogenous Osteomyelitis in Children: A Study of Efficacy and Adverse Effects.

Acute hematogenous osteomyelitis (AHO) is a relatively infrequent but significant infection in pediatric patients. As Staphylococcus aureus is the most common cause of AHO, intravenous and oral first-generation cephalosporins are common therapies. Cephalexin is a commonly prescribed oral therapy for pediatric AHO, although it requires frequent dosing that may affect adherence. Cefadroxil is a comparable oral first-generation cephalosporin with a more desirable dosing schedule. We reviewed pediatric patients admitted to Mayo Clinic between March 2002 and September 2020 for management of AHO who received treatment with a first-generation cephalosporin. We reviewed timing of oral therapy transition, therapy-associated adverse effects, and recurrence of disease after completion of therapy. There were 59 patients included in the study. There was similar occurrence of adverse effects in patients receiving cefadroxil and cephalexin, although use of cefadroxil coincided with more gastrointestinal adverse effects and leukopenia and use of cephalexin with more rash and neutropenia. One secondary treatment failure occurred in our study, in a patient receiving cephalexin for treatment of septic arthritis. Cefadroxil may be a reasonable alternative oral therapy for methicillin-susceptible S aureus or culture-negative AHO in pediatric patients, particularly when a less frequent dosing schedule is desired. Future study with a larger sample size is warranted.

Identifying the Pathogen in Acute Hematogenous Osteomyelitis

Identifying the Pathogen in Acute Hematogenous Osteomyelitis

A review on the treatment of heamotogenoues osteomylitis

In clinical parlance, a new infection in the bone is referred to as acute osteomyelitis. This illness is more common in youngsters and spreads through the bloodstream rather than through direct contact. When it occurs in adulthood, osteomyelitis is typically a subacute or chronic infection that develops as a consequence of an open injury to the bone and the soft tissue that surrounds it. In cases of bacterial osteomyelitis, the patient's age or a typical clinical scenario is frequently connected to the particular organism that was isolated from the disease. (i.e., trauma or recent surgery). Staphylococcus aureus has been linked to the condition in the vast majority of patients who have experienced acute hematogenous osteomyelitis. Patients who have chronic osteomyelitis frequently have bacteria such as Staphylococcus epidermidis, Staphylococcus aureus, Pseudomonas aeruginosa, Serratia marcescens, and Escherichia coli isolated from their bodies. In order to achieve the optimum results, antibiotic treatment should begin as soon as feasible, and antimicrobial medications should be managed parenterally for a minimum of four to six weeks. Standard components of treatment include evaluation, staging, assessment of microbiological aetiology and susceptibilities, antibiotic therapy, and, if required, debridement, dead-space management, and bone stabilization.

2900. Clinical Utility of Repeat Magnetic Resonance Imaging Studies Among Children with Acute Hematogenous Osteomyelitis

Abstract Background Magnetic resonance imaging (MRI) is the diagnostic study of choice for children with acute hematogenous osteomyelitis (AHO). However, there is limited guidance for whether repeat MRIs are clinically impactful for children with AHO who fail to improve after initial treatment. This study aimed to determine whether repeat MRIs changed clinical management among children with AHO. Methods Children admitted to a quaternary care pediatric hospital with a discharge diagnosis of osteomyelitis were identified during a 9-year period. Patients with chronic symptoms, non-hematogenous infections, or significant contributing comorbidities were excluded. Medical records were retrospectively reviewed for all MRIs performed 3 weeks prior to admission to 24 months after discharge. An MRI was considered clinically impactful if it identified a new infectious process (e.g., abscess not seen on initial MRI) or if it resulted in surgical intervention within 24 hours. Categorical variables were compared using Fisher’s Exact or chi-square tests and continuous with Wilcoxon Rank-Sum tests. Results Among 239 included patients, 41 (17%) had more than 1 MRI performed during clinical care for their AHO. Twenty-nine repeat MRIs occurred during initial hospitalization and 27 during outpatient follow up. Children who underwent repeat inpatient MRIs had longer hospitalizations (9 vs 5 days, P&amp;lt; 0.01) and higher C-reactive protein levels (20 vs 7 mg/dL, P&amp;lt; 0.01), and were more likely to be critically ill (20% vs 6%, P=0.02) or to experience a therapeutic failure (20% vs 3%, P&amp;lt; 0.01). Among repeat inpatient MRIs, 19 (66%) were clinically impactful; 9 (31%) led to repeat surgical procedures and 13 (45%) identified new diagnoses. Repeat outpatient MRIs were more likely to be performed in children with vertebral AHO or multifocal infections (P=0.02). Among repeat outpatient MRIs, 7 (25%) were clinically impactful. Six (22%) led to repeat operative procedures and 3 (11%) identified new diagnoses. Conclusion When used judiciously among ill children with complicated AHO, repeat MRI can be clinically impactful in both the inpatient and outpatient setting. Prospective studies are needed to better define which children with AHO benefit from repeat MRI. Disclosures Julia S. Sanders, MD, OrthoPediatrics Corp: Advisor/Consultant

1304. Early Surgical Procedures and Clinical Outcomes Among Children Hospitalized with Acute Hematogenous Osteomyelitis

Abstract Background Surgical biopsy and drainage may have diagnostic and therapeutic benefits for children with acute hematogenous osteomyelitis (AHO). However, it remains unknown whether routinely expediting surgical procedures improves clinical outcomes compared to a “wait-and-see” approach. We aimed to determine whether hospitals that frequently perform early surgery for AHO have improved clinical outcomes compared to hospitals that rarely perform early surgery. Methods Admissions for AHO at 48 hospitals were identified in the Pediatric Health Information System from 1/2015 through 10/2022 for patients 6 months to 18 years with a discharge diagnosis of osteomyelitis using a previously validated algorithm to exclude chronic osteomyelitis, non-hematogenous infections, and significant comorbidities. Encounters assigned a surgical procedure code on hospital day 0 or 1 were classified as undergoing “early surgery” and hospitals were stratified based on proportion of AHO patients receiving early surgery. Clinical outcomes at the 16 hospitals with the lowest rates of early surgery (rare group) were compared to those from the 16 hospitals with the highest rates of early surgery (frequent group). Categorical variables were compared using chi-square tests and continuous with Wilcoxon Rank-Sum tests. Results There were 2102 encounters in the rare group and 2040 encounters in the frequent group. Median proportion of AHO patients undergoing early surgery was 20% in the rare group compared to 37% in the frequent group (Range 10% to 54%). Length of stay in the frequent group was marginally lower (4.4 vs 4.1 days, P &amp;lt; 0.001), as was length of intravenous antimicrobials (4.5 vs 4.3 days, P&amp;lt; 0.001). Patients were more likely to be critically ill at frequent early surgery hospitals (1% vs 5%, P&amp;lt; 0.001), more likely to have a central line placed (8% vs 11%, P=0.002), and more likely to have a pathogen identified (50% vs 59%, P&amp;lt; 0.001). Cost per admission was slightly higher in the frequent group ($12960 vs $13759, P&amp;lt; 0.001). Conclusion Frequency of early surgical procedures for pediatric AHO varies across institutions. Clinical outcomes and resource utilization for children with AHO are similar between institutions that rarely and frequently expedite surgical procedures. Disclosures Samuel R. Dominguez, MD, PhD, Biofire Diagnostics: Advisor/Consultant|Biofire Diagnostics: Grant/Research Support|Cobio Diagnostics: Board Member|Karius: Advisor/Consultant|Pfizer: Grant/Research Support

1303. Pelvic Acute Hematogenous Osteomyelitis in Children, from 2012-2020

Abstract Background Pelvic osteomyelitis has been reported to account for 1-11% of acute hematogenous osteomyelitis (AHO) cases in children. Higher complication rates and need for longer antibiotic courses have been suggested by experts, but recent data is lacking. In our retrospective study from 2012-2020, pelvis and tibia were the most frequent AHO sites (24.6% of cases each). We describe the clinical course of children admitted to Texas Children’s Hospital (TCH) with pelvic AHO. Methods A retrospective review of patients with diagnosis of AHO admitted to TCH from Jan. 2012 - Dec. 2020 was conducted. Patients 6 mo-&amp;lt; 19 years-old and with ≤ 14 days of symptoms on admission were eligible. Patients with sickle cell disease or those immunocompromised were excluded. Wilcoxon rank sum test for continuous variables and Fisher’s exact for categorical variables were performed using STATA 17. Results 103 cases of pelvic AHO were compared to 315 cases of non-pelvic AHO (Table 1). The pelvis areas involved were reviewed (Fig. 1). Fever was present in 91 cases of pelvis AHO (88.4%), localized pain in 78 (75.7%) and refusal to bear weight in 64 (62.1%). All patients with pelvic AHO had an abnormal C reactive protein ( &amp;gt; 0.5 mg/dl). Patients with pelvic AHO had overall similar microbiology (Fig. 2), length of stay and complication rates as non-pelvic AHO. Pelvic AHO patients had pyomyositis more often (29.1 vs 9.2%) and bone abscess less often (22.3 vs 46.3%). Need for bone debridement or bone abscess drainage was less common (17.5 vs 51.1%), but muscle abscess drainage (16.5 vs 5.1%) and percutaneous bone biopsy (22.3 vs 13.7%) were more common in pelvic AHO. 22 cases of pelvic AHO had bone biopsy only, leading to identification of etiology in 27% of them with no complications. Patients were treated with antibiotics for a similar time (median 41 vs. 38 days). 21 patients with pelvic AHO (20.4%) were treated for ≤ 30 days with no complications (2 were lost to follow up). Figure 1. Percentage of each area of pelvic bone involved in patients with pelvic AHO. Patients may have more than one area involved. Figure 2. Causative organism recovery and etiology of pediatric cases with pelvic and non-pelvic acute hematogenous osteomyelitis, Texas Children’s Hospital 2012-2022. Conclusion Pelvic AHO in children may be more frequent than previously reported but is not associated with more chronic complications. MRI use can aid in the prompt identification of associated pyomyositis and timely intervention. A conservative approach of bone biopsy in cases with a small bone abscess and no pyomyositis should be considered. 4 weeks of therapy may be sufficient. Disclosures J. Chase McNeil, MD, Allergan: Grant/Research Support|Nabriva Therapeutics: Grant/Research Support Kristina G. Hulten, PhD, Pfizer: Grant/Research Support Sheldon L. Kaplan, MD, MeMed: Grant/Research Support|Pfizer: Grant/Research Support|Pfizer: Honoraria

Assessing risk for complications in acute hematogenous osteomyelitis in children. Validation of two predictive scores.

Acute hematogenous osteomyelitis (AHO) can be associated with severe complications which can be difficult to predict in the clinical setting. The previously published predictive acute complication score ("A-SCORE") and chronic complication score ("C-SCORE") show promise, however, further external validation is needed. We performed a retrospective study of 418 children with AHO and analyzed the performance of A-SCORE (variables included bone abscess, fever after 48 hours of starting antibiotics, suppurative arthritis, disseminated disease and delayed source control) to predict risk for acute complicated course (treatment failure, prolonged admission, and/or need for ≥ 2 bone debridements) and C-SCORE (includes disseminated disease, bone debridement and CRP ≥10mg/dl at 2-4 days after starting antibiotics) to predict chronic complications (growth restriction, pathologic fracture, chronic osteomyelitis, avascular necrosis, joint deformity and/or frozen joint). An acute complicated course occurred in 106/418 (25.4%); 51/380 (13.5%) with complete follow-up data had a chronic complication. The A-SCORE performed with similar specificity (78%) and negative predictive value (NPV) (92%), and higher sensitivity (81%) and increased area under the receiver operating curve (AUC) (0.87) in our population. The C-SCORE performed with similar sensitivity (64%) and NPV (94%) but had lower specificity (86%) and AUC (0.71) than originally reported. Other variables associated with development of complications such as tibia involvement and bacteremia ≥ 2 days were identified but did not result in significantly improved predictive scores. Predictive A-SCORE and C-SCORE for AHO complications in children may help guide acute management and long-term follow up decisions. Prospective studies are needed to determine their applicability.

Effectiveness of Surgical Treatment Acute Hematogenic Osteomyelitis Children in the Complex With Ozone Therapy and Lymphogenic Technology

The results of operative treatment of acute hematogenous osteomyelitis in 96 children aged from 3 to 12 years are presented. The control group consisted of 52 patients who had traditional surgical treatment and 44 children who were operated according to the developed method in combination with ozone therapy and the use of lymphogenous technology. Transition to the chronic form in the control group was 13.4%, and in the primary group 6.8%.

Is Procalcitonin Superior to CRP in Diagnosing Children with Suspected Acute Hematogenous Osteomyelitis?

Is Procalcitonin Superior to CRP in Diagnosing Children with Suspected Acute Hematogenous Osteomyelitis?

Staphylococcus aureus isolates from children with clinically differentiated osteomyelitis exhibit distinct transcriptomic signatures.

There is substantial genomic heterogeneity among Staphylococcus aureus isolates of children with acute hematogenous osteomyelitis (AHO) but transcriptional behavior of clinically differentiated strains has not been previously described. This study evaluates transcriptional activity of S. aureus isolates of children with AHO that may regulate metabolism, biosynthesis, or virulence during bacterial growth and pathogenesis. In vitro growth kinetics were compared between three S. aureus clinical isolates from children with AHO who had mild, moderate, and severe illness. Total RNA sequencing was performed for each isolate at six separate time points throughout the logarithmic phase of growth. The NASA RNA-Sequencing Consensus Pipeline was used to identify differentially expressed genes allowing for 54 comparisons between the three isolates during growth. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment pathways were used to evaluate transcriptional variation in metabolism, biosynthesis pathways and virulence potential of the isolates. The S. aureus isolates demonstrated differing growth kinetics under standardized conditions with the mild isolate having higher optical densities with earlier and higher peak rates of growth than that of the other isolates (p<0.001). Enrichment pathway analysis established distinct transcriptional signatures according to both sampling time and clinical severity. Moderate and severe isolates demonstrated pathways of bacterial invasion, S. aureus infection, quorum sensing and two component systems. In comparison, the mild strain favored biosynthesis and metabolism. These findings suggest that transcriptional regulation during the growth of S. aureus may impact the pathogenetic mechanisms involved in the progression of severity of illness in childhood osteomyelitis. The clinical isolates studied demonstrated a tradeoff between growth and virulence. Further investigation is needed to evaluate these transcriptional pathways in an animal model or during active clinical infections of children with AHO.

The Diagnostic Value of MRI in Children with Acute Hematogenous Osteomyelitis

The Diagnostic Value of MRI in Children with Acute Hematogenous Osteomyelitis