Overview
Acute hematogenous osteomyelitis (AHO) is an infection of the bone that occurs when bacteria spread through the bloodstream to the bone 1. It is most common in children and can lead to significant morbidity if not promptly diagnosed and treated 1.Diagnosis
Diagnosis is based on clinical presentation, laboratory findings, and imaging 1.
Key symptoms include localized bone pain, swelling, erythema, warmth, and fever 1.
Laboratory tests may include complete blood count (CBC), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) 1.
Imaging modalities include plain radiography, ultrasound, MRI, and bone scintigraphy 1. MRI is often the most sensitive and specific imaging modality for diagnosing AHO 1.
Blood cultures and bone aspirate cultures are crucial for identifying the causative pathogen and guiding antibiotic therapy 1.Management
Initial management involves prompt administration of empiric intravenous antibiotics 1.
Antibiotic selection should be based on the most likely pathogens, local resistance patterns, and patient factors 1.
Commonly used empiric antibiotics include nafcillin, oxacillin, clindamycin, or cefazolin for suspected Staphylococcus aureus* infection 1. Vancomycin may be considered in areas with high rates of MRSA or for patients with risk factors for MRSA 1.
Surgical intervention, such as drainage of abscesses or debridement of necrotic bone, may be necessary in some cases 1.
Treatment duration is typically 4 to 6 weeks, with a transition from intravenous to oral antibiotics once the patient is clinically improving and inflammatory markers have normalized 1.Special Populations
This guideline specifically addresses AHO in pediatrics 1.Key Recommendations
Empiric antibiotic therapy should be initiated as soon as possible, ideally within 24 hours of presentation, for suspected AHO 1. (Evidence: Strong)
Blood cultures should be obtained prior to antibiotic administration 1. (Evidence: Strong)
MRI is the preferred imaging modality for diagnosis when available and feasible 1. (Evidence: Moderate)
The choice of empiric antibiotic therapy should consider local epidemiology of pathogens and antibiotic resistance patterns 1. (Evidence: Strong)
Surgical consultation should be obtained for patients with suspected AHO, particularly if there is concern for abscess formation or significant bone destruction 1. (Evidence: Expert opinion)References
1 Woods CR, Bradley JS, Chatterjee A, Copley LA, Robinson J, Kronman MP et al.. Clinical Practice Guideline by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America: 2021 Guideline on Diagnosis and Management of Acute Hematogenous Osteomyelitis in Pediatrics. Journal of the Pediatric Infectious Diseases Society 2021. link