Comparison of Empiric Antibiotics for Acute Osteomyelitis in Children.

TitleComparison of Empiric Antibiotics for Acute Osteomyelitis in Children.
Publication TypeJournal Article
Year of Publication2018
AuthorsMcBride S, Thurm C, Gouripeddi R, Stone B, Jaggard P, Shah SS, Tieder JS, Butcher R, Weiser J, Hall M, Keren R, Landrigan CP
JournalHosp Pediatr
Volume8
Start Page280
Issue5
Pagination280-287
Date Published2018 Apr
ISSN2154-1663
Abstract

OBJECTIVES: Broad-spectrum antibiotics are commonly used for the empiric treatment of acute hematogenous osteomyelitis and often target methicillin-resistant(MRSA) with medication-associated risk and unknown treatment benefit. We aimed to compare clinical outcomes among patients with osteomyelitis who did and did not receive initial antibiotics used to target MRSA.

METHODS: A retrospective cohort study of 974 hospitalized children 2 to 18 years old using the Pediatric Health Information System database, augmented with clinical data. Rates of hospital readmission, repeat MRI and 72-hour improvement in inflammatory markers were compared between treatment groups.

RESULTS: Repeat MRI within 7 and 180 days was more frequent among patients who received initial MRSA coverage versus methicillin-sensitive(MSSA)-only coverage (8.6% vs 4.1% within 7 days [= .02] and 12% vs 5.8% within 180 days [< .01], respectively). Ninety- and 180-day hospital readmission rates were similar between coverage groups (9.0% vs 8.7% [= .87] and 10.9% vs 11.2% [= .92], respectively). Patients with MRSA- and MSSA-only coverage had similar rates of 72-hour improvement in C-reactive protein values, but patients with MRSA coverage had a lower rate of 72-hour white blood cell count normalization compared with patients with MSSA-only coverage (4.2% vs 16.4%;= .02).

CONCLUSIONS: In this study of children hospitalized with acute hematogenous osteomyelitis, early antibiotic treatment used to target MRSA was associated with a higher rate of repeat MRI compared with early antibiotic treatment used to target MSSA but not MRSA. Hospital readmission rates were similar for both treatment groups.

DOI10.1542/hpeds.2017-0079
Alternate JournalHosp Pediatr
PubMed ID29626010