Original StudiesThe Contemporary Epidemiology, Microbiology and Management of Chronic Osteomyelitis in US ChildrenMcNeil, J. Chase MD; Joseph, Marritta RN; Sommer, Lauren M. MS; Vallejo, Jesus G. MDAuthor Information From the Department of Pediatrics, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas. Accepted for publication December 18, 2020 J.C.M. receives grant funding from the Agency for Healthcare Research and Quality (AHRQ R01HS026896) and is the local PI on a multicenter clinical trial sponsored by Nabriva Therapeutics unrelated to osteomyelitis; J.G.V. is a coinvestigator in this study. J.C.M. and J.G.V. are subinvestigators on studies sponsored by Merck and Allergan. J.C.M. has also received a donation of laboratory materials from Allergan for work unrelated to this manuscript. The other authors have no conflicts of interest to disclose. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (www.pidj.com). Address for correspondence: J. Chase McNeil, MD, 1102 Bates Street, Suite 1150, Houston, TX 77030. E-mail: [email protected]. The Pediatric Infectious Disease Journal: June 2021 - Volume 40 - Issue 6 - p 518-524 doi: 10.1097/INF.0000000000003067 Buy SDC Metrics Abstract Background: While the majority of pediatric osteomyelitis cases are acute in nature, a significant subset present with prolonged symptoms often associated with substantial morbidity. Little data exist to guide clinicians in the management of these infections. We sought to describe the epidemiology, clinical features and management of chronic osteomyelitis (CO) in children. Methods: We reviewed hospital admissions for CO from 2011 to 2018 at Texas Children’s Hospital. Cases were included if symptoms lasted ≥28 days on presentation. Cases were classified as those associated with: (1) a contiguous focus of infection; (2) penetrating trauma; (3) orthopedic hardware; (4) postacute CO (PACO, those occurring after ≥28 days of therapy for acute osteomyelitis); and (5) primary hematogenous CO. Results: One hundred fourteen cases met inclusion criteria. The median patient age was 11.8 years and 35.9% had comorbidities. 70.2% of patients underwent ≥1 surgical procedure. A microbiologic etiology was identified in 72.8% of cases and Staphylococcus aureus was most common (39.4%). Contiguous focus of infection was more often associated with polymicrobial disease with or without Pseudomonas. Postacute CO was caused by S. aureus in 95%. The median duration of total therapy was 210 days. 26.3% of patients experienced treatment failure of which 46% underwent repeat hospital admission/surgery. There was no association between duration of intravenous therapy for CO and treatment failure. Conclusions: Children with CO represent a diverse group both in terms of pathogenesis and microbiology. Pathogenesis and clinical presentation can provide clues to microbiologic etiology. Prolonged intravenous therapy does not appear to improve outcomes in CO. Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.