Invasive diagnostic tests play an important role in the treatment of bone infections in children, but these tests may not always be necessary or feasible, according to a new guideline from the Pediatric Infectious Diseases Society (PIDS) and the Infectious Diseases Society of America (IDSA). Published today in the Journal of the Pediatric Infectious Diseases Society, the clinical practice guideline is the first-ever developed on the diagnosis and management of acute hematogenous osteomyelitis in pediatric patients.
These infections occur when bacteria in the blood enters the bone and spreads, causing symptoms such as pain, fever, a limp, or swelling, and can lead to serious, disabling complications if not treated appropriately. Bone specimens or other samples can help confirm the type of bacteria causing an infection and the appropriate antibiotics for treatment. The new guideline recommends such testing but acknowledges that collecting these specimens, which may involve invasive surgical procedures requiring sedation or anesthesia, often may not be possible.
"We prefer being able to know the identity of the microbe causing the infection, as well as the antimicrobial agents to which it is susceptible," said Charles R. Woods, MD, MS, lead author of the guideline, chair of the Department of Pediatrics at the University of Tennessee College of Medicine in Chattanooga and chief medical officer at Children's Hospital at Erlanger in Chattanooga. "However, we realize there are times when getting a specimen that may provide us with these answers is not feasible, and, fortunately, we usually can provide appropriate care for the child when this information is not available to us."
The recommendation is one of 14 in the new guideline, which addresses key questions related to diagnosing and treating acute hematogenous osteomyelitis in otherwise healthy patients between 1 month and 18 years of age in North America, in addition to identifying areas where more research is needed. The new guidance includes a discussion of when to transition hospitalized children with bone infections from intravenous (IV) to oral antibiotic therapy, an area of wide variation in current practice among, and even sometimes within, different medical centers.
"As soon as there is significant clinical improvement, the child is able to tolerate oral therapy, and there is a reasonable oral option, then we recommend switching to oral therapy as a preference over continuing IV treatment either in the hospital or at home," Dr. Woods said.
The guideline is intended for all clinicians and health care providers who care for children with bone infections, including specialists in pediatric infectious diseases, orthopedics, and emergency care medicine. Developed by a multidisciplinary panel of physician experts using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology, the PIDS-IDSA guideline has also been endorsed by the Pediatric Orthopaedic Society of North America and by relevant sections and committees of the American Academy of Pediatrics.
"Bone infections in children can cause severe complications if left untreated," said PIDS President Kristina Bryant, MD, professor of pediatrics at the University of Louisville and hospital epidemiologist at Norton Children's Hospital. "This new guideline provides thoughtfully reasoned recommendations based on a careful review of the current evidence to help clinicians across multiple disciplines identify and manage these infections."
In addition to Dr. Woods, the guideline panel includes John S. Bradley, MD; Archana Chatterjee, MD, PhD; Lawson A. Copley, MD; Joan Robinson, MD; Matthew P. Kronman, MD, MSCE; Antonio Arrieta, MD; Sandra L. Fowler, MD, MSc; Christopher Harrison, MD; Maria A. Carrillo-Marquez, MD; Sandra R. Arnold, MD; Stephen C. Eppes, MD; Laura P. Stadler, MD, MS; Coburn H. Allen, MD; Lynnette J. Mazur, MD, MPH; C. Buddy Creech, MD, MPH; Samir S. Shah, MD, MSCE; Theoklis Zaoutis, MD, MSCE; David S. Feldman, MD; and Valéry Lavergne, MD, MSc.
