Osteomyelitis In Children Research Articles

Investigating Osteomyelitis as a Rare Adverse Effect of Vaccination in the Pediatric Population.

Immunization is a preventive measure of crucial importance. As with any other medication, side effects are a possibility and include the rare occurrence of severe infections, such as osteomyelitis. We report an unusual case of pediatric osteomyelitis following vaccination and provide a review of similar reports submitted to the Vaccine Adverse Event Report System (VAERS), aiming to explore the association between the vaccination procedure and the occurrence of osteomyelitis in childhood. A previously healthy infant, with no history of trauma or infection, presented with hyperpyrexia, swelling, and functional impairment in the left leg and was eventually diagnosed with osteomyelitis of the left femur. An edema was noted at the site of the injection that he received days before for immunization purposes. The infection required surgical drainage and a four-week-long intravenous antibiotic treatment, and the patient was discharged upon showing improved clinical conditions. Forty-seven reports of similar cases submitted to VAERS between 1994 and 2023 were collected, and several cases from the literature, including a case of femoral osteomyelitis in a newborn vaccinated against Hepatitis B, attributed to improper injection technique. Another case was reported in a 15-year-old girl, which aligned with six similar cases of osteomyelitis in adolescents following HPV vaccines collected from VAERS. Despite the small sample number, the findings that in 77% of cases the infection was localized in the vaccinated limb and that symptoms appeared on average 4.3 days (IQR 1.0-5.7 days) post-vaccination suggest a possible link to the injection procedure and highlight the need to adhere to recommendations regarding skin preparation and the selection of the appropriate needle length and injection site.

A transformer-based deep learning model for identifying the occurrence of acute hematogenous osteomyelitis and predicting blood culture results.

Acute hematogenous osteomyelitis is the most common form of osteomyelitis in children. In recent years, the incidence of osteomyelitis has been steadily increasing. For pediatric patients, clearly describing their symptoms can be quite challenging, which often necessitates the use of complex diagnostic methods, such as radiology. For those who have been diagnosed, the ability to culture the pathogenic bacteria significantly affects their treatment plan. A total of 634 patients under the age of 18 were included, and the correlation between laboratory indicators and osteomyelitis, as well as several diagnoses often confused with osteomyelitis, was analyzed. Based on this, a Transformer-based deep learning model was developed to identify osteomyelitis patients. Subsequently, the correlation between laboratory indicators and the length of hospital stay for osteomyelitis patients was examined. Finally, the correlation between the successful cultivation of pathogenic bacteria and laboratory indicators in osteomyelitis patients was analyzed, and a deep learning model was established for prediction. The laboratory indicators of patients are correlated with the presence of acute hematogenous osteomyelitis, and the deep learning model developed based on this correlation can effectively identify patients with acute hematogenous osteomyelitis. The laboratory indicators of patients with acute hematogenous osteomyelitis can partially reflect their length of hospital stay. Although most laboratory indicators lack a direct correlation with the ability to culture pathogenic bacteria in patients with acute hematogenous osteomyelitis, our model can still predict whether the bacteria can be successfully cultured. Laboratory indicators, as easily accessible medical information, can identify osteomyelitis in pediatric patients. They can also predict whether pathogenic bacteria can be successfully cultured, regardless of whether the patient has received antibiotics beforehand. This not only simplifies the diagnostic process for pediatricians but also provides a basis for deciding whether to use empirical antibiotic therapy or discontinue treatment for blood cultures.

Chronic Non-bacterial Osteomyelitis (CNO) In Childhood: A Review.

Chronic non-bacterial osteomyelitis (CNO) is an autoinflammatory bone disorder mostly affecting children and adolescents. Although it is considered a rare disease, CNO is likely to be the single most common autoinflammatory bone disease in childhood, underdiagnosed and underreported due to a lack of awareness of the condition in both medics and patients and the absence of validated diagnostic criteria. The exact underlying pathogenesis of CNO remains unknown, making targeted treatment difficult. This issue is exacerbated by the lack of any randomised control trials, meaning that treatment strategies are based solely on retrospective reviews and case series. This review summarises the current concepts in pathophysiology, the clinical features that help differentiate important differential diagnoses, and an approach to investigating and managing children with CNO. Ultimately, the timely and thorough investigation of children and young people with CNO is vitally important to exclude important mimics and initiate appropriate management that can prevent the complications of persistent inflammatory bone disease.

Accelerated Severity of Illness Score Enhances Prediction of Complicated Acute Hematogenous Osteomyelitis in Children.

Severity of illness determination for children with acute hematogenous osteomyelitis should be accomplished during the earliest stages of evaluation to guide treatment and establish prognosis. This study objectively defines an outcome of complicated osteomyelitis and explores an illness severity-based model with an improved ability to predict this outcome as soon and accurately as possible, comparing it to existing models. Children with Staphylococcus aureus acute hematogenous osteomyelitis (n = 438) were retrospectively studied to identify adverse events and predictors of severity. The outcome of complicated osteomyelitis was ultimately defined as the occurrence of any major or at least 3 minor adverse events, which occurred in 52 children. Twenty-four clinical and laboratory predictors were evaluated through univariate and stacked multivariable regression analyses of chronologically distinct groups of variables. Receiver operating characteristic curve analyses were conducted to compare models. Accelerated Severity of Illness Score included: triage tachycardia [odds ratio: 10.2 (95% confidence interval: 3.48-32.3], triage tachypnea [6.0 (2.4-15.2)], C-reactive proteininitial ≥17.2 mg/dL [4.5 (1.8-11.8)], white blood cell count band percentageinitial >3.8% [4.6 (2.0-11.0)], hemoglobininitial ≤10.4 g/dL [6.0 (2.6-14.7)], methicillin-resistant S. aureus [3.0 (1.2-8.5)], septic arthritis [4.5 (1.8-12.3)] and platelet nadir [7.2 (2.7-20.4)]. The receiver operating characteristic curve of Accelerated Severity of Illness Score [area under the curve = 0.96 (0.941-0.980)] were superior to those of Modified Severity of Illness Score = 0.903 (0.859-0.947), Acute Score for Complications of Osteomyelitis Risk Evaluation = 0.878 (0.830-0.926) and Chronic Score for Complications of Osteomyelitis Risk Evaluation = 0.858 (0.811-0.904). Successive receiver operating characteristic curve analyses established an exponentially increasing risk of complicated osteomyelitis for children with mild (0/285 or 0%), moderate (4/63 or 6.3%), severe (15/50 or 30.0%) and hyper-severe (33/40 or 82.5%) acute hematogenous osteomyelitis (P<0.0001). This study improves upon previous severity of illness models by identifying early predictors of a rigorously defined outcome of complicated osteomyelitis.

Indicators for Osteomyelitis in Children With Sickle Cell Disease Admitted With Vaso-Occlusive Crises.

Sickle cell disease (SCD) is an autosomal recessive genetic disorder characterized by the presence of a mutated form of hemoglobin (Hb) known as sickle hemoglobin (HbS). Individuals withSCDare susceptible to a variety of osteoarticular complications. Osteomyelitisisa commonly seen infection affecting the tibia, diaphysis of the femur and humerus, and vertebras. The aim of this study was to define the indicators suggesting the diagnosis of osteomyelitis in patients with SCD. This study is a descriptive, analytical, non-interventional, prospective study of pediatric patients with SCD admitted with vaso-occlusive crisis (VOC) and/or osteomyelitis, which were identified by laboratory and radiological features. Retrospective data was included for patients who met the inclusion criteria. The statistical analysis included a description of the primary and secondary outcomes in the cohort. A total of 28 children were included in this study. Participants' ages ranged from 11 months to 13 years. Males represented the majority (64.3%) of the participants. The blood culture of most of the participants (89.3%) showed no growth; however, 7.1% had salmonella, and only 3.6% had Gram-positive cocci. Most cases (75%) had leukocytosis. Thrombocytosis was present mainly in patients with VOC (40%).CRP was 1-4.9 mg/dL, mainly in patients with osteomyelitis (50%). The ferritin level exceeded 5000 ng/mL in patients with osteomyelitis or both osteomyelitis and VOC (50%). Ultrasound examinations revealed no hip effusion in 24 of the 28 examined patients. A plain X-ray examination showed no abnormality in 24 out of the 28 examined cases; with MRI, three cases exhibited marrow edema with bone enhancement, two (66.7%) were complicated by osteomyelitis, and the last (33.3%) had osteomyelitis and VOC. Aspiration was performed only in seven of the 28 examined, of which six (85.7%) were complicated by osteomyelitis, while the last one (14.3%) had acute chest syndrome. Based on the outcomes of this study, we recommend an individualized multidisciplinary examination (hematology, infectious disease, orthopedic surgery, and interventional radiology) for SCD patients with suspected osteomyelitis admitted with VOC, considering the entire clinical history and laboratory and MRI results.

Incidence of chronic recurrent multifocal osteomyelitis in children and adolescents in the UK and Republic of Ireland.

Chronic Recurrent Multifocal Osteomyelitis (CRMO), also known as chronic nonbacterial osteomyelitis (CNO), is a rare autoinflammatory condition affecting the bones in children and teenagers. The actual incidence of CRMO remains uncertain. The objective of this study is to identify the incidence of CRMO in children and young people under the age of 16 years in the United Kingdom (UK) and Republic of Ireland (ROI). We also aim to delineate the demographics, clinical presentation, investigations, initial management and healthcare needs for children and adolescents with CRMO. We conducted monthly surveys among all paediatric consultants and paediatric orthopaedic surgeons to identify patients newly diagnosed with CRMO between October 2020 and November 2022. A standardised questionnaire was sent to reporting clinicians to collect further information. Over the surveillance period, 288 patients were reported, among which, 165 confirmed and 20 probable cases were included in the analysis. The highest incidences were among 8-10 year-olds. A two-to-one female-to-male difference in incidence was observed, and male patients were more likely to present with multifocal disease. A negative correlation was observed between reporting clavicular and leg pain. Investigation-wise, 80.0% of patients were reported to have undergone whole-body MRI and 51.1% had bone biopsies. The most common initial treatments were NSAIDs (93.9%) and bisphosphonates (44.8%). This study estimates an average annual CRMO incidence of 0.65 cases per 100 000 children and adolescents in the UK and ROI. These findings establish a crucial baseline for ongoing research and improvement in the care of individuals with CRMO.

Meta-analysis of the accuracy of the serum procalcitonin diagnostic test for osteomyelitis in children

ObjectiveThis study sought to assess the sensitivity, specificity, and predictive utility of serum procalcitonin (PCT) in the diagnosis of pediatric osteomyelitis.MethodsA systematic computer-based search was conducted for eligible literature focusing on PCT for the diagnosis of osteomyelitis in children. Records were manually screened according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Statistical analysis was performed using Review Manager software 5.3, Meta-disc software1.4, STATA 12.0, and R 3.4 software.ResultA total of 5 investigations were included. Of these, 148 children with osteomyelitis were tested for bacterial cultures in PCT. For PCT in the diagnosis of pediatric osteomyelitis, diagnostic meta-analysis revealed a pooled sensitivity and specificity of 0.58 (95% confidence interval (CI): 0.49 to 0.68) and 0.92 (95% CI: 0.90 to 0.93) respectively. The PCT had the greatest area under the curve (AUC) at 0.80 for the diagnosis of osteomyelitis in children. The Deeks’ regression test for asymmetry results indicated that there was no publication bias when evaluating publication bias (P = 0.90).ConcusionThis study provided a comprehensive review of the literature on the use of PCT in pediatric osteomyelitis diagnosis. PCT may be used as a biomarker for osteomyelitis diagnosis; however, its sensitivity was low. It still needs to be validated by a large sample study.

Characteristics of chronic non-bacterial osteomyelitis in children living in the Novosibirsk region

Characteristics of chronic non-bacterial osteomyelitis in children living in the Novosibirsk region

Arthritis and osteomyelitis in childhood and adolescence-Bacterial and nonbacterial

Bacterial arthritis and osteomyelitis are usually acute diseases, which in this way differ from the often insidious course of nonbacterial osteomyelitis; however, there is often an overlap both in less acute courses of bacterial illnesses and also in nonbacterial osteitis. The overlapping clinical phenomena can be explained by similar pathophysiological processes. In bacteria-related illnesses the identification of the pathogen and empirical or targeted anti-infectious treatment are prioritized, whereas no triggering agent is known for nonbacterial diseases. The diagnostics are based on the exclusion of differential diagnoses, clinical scores and magnetic resonance imaging (MRI). An activity-adapted anti-inflammatory treatment is indicated.

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.

Pediatric Tuberculosis Osteomyelitis on Proximal Tibia: A Case Report

Background: Tuberculosis of the bone is a serious problem in developing countries, extra-pulmonary tuberculosis is more common among children. The characteristics of tuberculosis osteomyelitis in children are different. Therefore, the disease is often neglected or diagnosis is delayed. Case Report: A 18-months-old female patients presented with history of pain and mass on right leg and also unable to bear weight. On Physical examination there was palpable fluctuant mass around proximal right leg. Histology examination revealed tuberculous granuloma. Patient treated with surgical drainage and anti-tuberculous drug for 12 months resulted satisfactory outcome in 6 months treatment. Conclusion: High suspicion for tuberculosis is required in children with musculoskeletal complaints of swelling and stiffness. Tuberculosis osteomyelitis can mimic other lesion but with prompt diagnosis and treatment the outcome was satisfactory. Keywords: Tuberculosis; osteomyelitis; tibia

Antibiotic Selection, Route of Administration, and Duration in Hematogenous Osteomyelitis in Children

Antibiotic Selection, Route of Administration, and Duration in Hematogenous Osteomyelitis in Children

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.

A case of emphysematous osteomyelitis in the pediatric practice

Introduction. Emphysematous osteomyelitis is a life-threatening and rare disease in the clinical practice. A distinctive feature of the disease is gas in bones and in surrounding soft tissues on the background of predisposing factors which significantly worsen patient’s general condition (malignant neoplasms, diabetes mellitus, immunodeficiency, injuries and fractures). The authors present a clinical observation of diagnostics and management of emphysematous osteomyelitis in the right femur head in a 12-year-old child. The disease developed two months after a closed right-sided fracture of the femoral trochanter. In the literature, one can meet not more than 50 cases of emphysematous osteomyelitis.&#x0D; Relevance. In the available medical literature, we have not found any description of emphysematous osteomyelitis in children, so we considered it appropriate to publish a rare clinical case.&#x0D; Purpose. To analyze a rare case of emphysematous osteomyelitis in a child and to identify possible diagnostic and therapeutic errors occurred in the discussed case in Children’s Republic Clinical Hospital in Saransk.&#x0D; Conclusion. Currently, hematogenous osteomyelitis in children has become less common, and therefore there is no alertness for this pathology in physicians. We also have faced emphysematous osteomyelitis in our practice for the first time. Therefore, only when child’s condition worsened on day 4 after hospitalization, additional diagnostic tools were added, namely, X-ray of the knee and CT of the hip joint. Antibacterial therapy was started as well.

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.

1307. Vaso-occlusive Crisis is Associated with Subsequent Osteomyelitis in Pediatric Sickle Cell Disease

Abstract Background Children with sickle cell disease (SCD) commonly develop microvascular infarcts of bone known as vaso-occlusive crisis (VOC) and are also at high risk of osteomyelitis (OM). VOC and OM can be challenging to distinguish due to overlapping clinical features. VOC might predispose to OM, or an initial misdiagnosis of OM as VOC might lead to delayed diagnosis of OM. This study aimed to test whether VOC was associated with subsequent development of OM in children with SCD. Methods A retrospective Pediatric Health Information System (PHIS) database study (2010-2021) was performed. ICD-code data related to common diagnoses in pediatric patients with SCD were extracted. The rate of VOC within 30 and 180 days preceding episodes of OM was compared to the rate preceding acute chest syndrome (ACS), another common diagnosis in children with SCD but unlikely to be anatomically related to OM. Odds ratios (OR) were used to evaluate the association between these diagnoses. Results Of 22,818 PHIS participants with SCD, 13,699; 450; and 7,327 had ≥ 1 episode of VOC, OM and ACS, respectively. The distribution of OM diagnoses was similar across pre-specified age groups (0-4, 5-12, and 13-18 years). The odds ratio of VOC preceding a diagnosis of OM vs. ACS was 2.15 within 30 days (95% CI: 1.82-2.54; p= 3.68 x 10-18), and within 180 days was 1.39 (95% CI: 1.20-1.62; p=2.04 x 10-5). VOC Preceding Osteomyelitis vs. Acute Chest Syndrome Conclusion VOC was significantly more common in the days preceding a diagnosis of OM than of ACS. The strength of association was stronger within 30 days prior to OM than 180 days. These results suggest possible misdiagnosis of OM since VOC might delay OM diagnosis in some cases, that recurrent VOC might be misdiagnosed as OM, or that VOC can directly contribute to risk of OM in some cases. Limitations of this study include possible incomplete adjustment for unmeasured variables which could confound the analysis. More research is needed to confirm and evaluate the mechanism behind this association. Understanding the relationship could lead to improved screening and treatment of both VOC and OM. Disclosures Joshua Wolf, MBBS, PhD, Karius Inc.: Grant/Research Support|Merck Inc.: Participation in industry-sponsored research Sandra Arnold, MD, Contrafect: Grant/Research Support|Enanta: Grant/Research Support|Moderna: Grant/Research Support|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.

Skull Base Osteomyelitis in Children: Clinical Characteristics and Potential Implications.

We describe 10 new cases of otogenic (n = 8) and nonotogenic (n = 2) skull base osteomyelitis (SBO) in previously healthy children and review the literature on SBO in the pediatric population. We retrospectively analyzed the medical records of 10 children (age range 0.9-12.8 years) discharged with a diagnosis of SBO between 2015 and 2020 in 2 children's hospitals in central Israel. Five patients presented with fever and 5 with otological signs and symptoms. All 10 children underwent a comprehensive clinical evaluation, imaging studies (computerized tomography or magnetic resonance imaging) and laboratory investigations. The physical examination revealed neurologic findings, including nuchal rigidity, papilledema, and apathy, in 4 patients. All 8 otogenic patients underwent surgical intervention and the 2 nonotogenic patients, who were diagnosed as having deep neck and throat infections, responded well to treatment consisting of antibiotics without surgery. Early diagnosis of pediatric SBO can be challenging because the symptoms are often nonspecific. The final diagnosis relies mainly on imaging, preferably magnetic resonance imaging. Surgical intervention is usually mandatory in the otogenic patients, whereas the nonotogenic patients respond well to medical management alone.