PIDS/IDSA: New Guidelines on Bone Infection in Children

The Pediatric Infectious Diseases Society (PIDS) and the Infectious Diseases Society of America (IDSA) have released the first clinical practice guideline on the diagnosis and management of acute hematogenous osteomyelitis (AHO) in infants, children, and adolescents.

Using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, a multidisciplinary panel examined systematic literature reviews to develop the 14 recommendations. These recommendations are intended for patients with suspected AHO aged 1 month to <18 years, who are otherwise considered healthy.

Among the recommendations:

• A blood culture is strongly recommended to be done prior to antimicrobial therapy in patients with suspected AHO (strong recommendation, moderate certainty of evidence)
• A plain radiography of the potentially infected bone is strongly recommended over not performing plain radiographs (strong recommendation, moderate certainty of evidence)
• Empiric antimicrobial therapy is strongly recommended to be started immediately in patients who appear ill or have a rapidly developing infection, instead of waiting for invasive diagnostic procedures to be performed (strong recommendation, moderate certainty of evidence)
• Empiric antimicrobial therapy against Staphylococcus aureus is strongly recommended in patients with suspected AHO (strong recommendation, moderate certainty of evidence)
• Debridement of the infected area is strongly recommended to be done as soon as possible after diagnosis in patients with sepsis or with a rapidly developing infection (strong recommendation, moderate certainty of evidence)

—Leigh Precopio

Reference:

Woods CR, Bradley JS, Chatterjee A, 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 osteomuelitis in pediatrics. Pediatr Infect Dis J. Published online August 5, 2021. https://doi.org/10.1093/jpids/piab027