423 - Impact of local antibiogram and infectious disease consult on the care of children with acute hematogenous osteomyelitis and septic arthritis

Poster Number: 423
Publication Number: 423.418

Stephanie Ihnow, University of Florida College of Medicine, Gainesville, FL, United States; Isabella Amador, UFHealth, Gainesville, FL, United States; Alexis Clifford, University of Florida College of Medicine, Gainesville, FL, United States; Aaron H. Jennings, University of Florida College of Medicine, Gainesville, FL, United States; Frances Saccoccio, University of Florida, Gainesville, FL, United States

Background: Pediatric infectious disease (PID) physicians play a crucial role in the treatment of patients with bone and joint infections.  In 2021, the Pediatric Infectious Disease Society and Infectious Disease Society of America published clinical practice guidelines for the treatment of Acute Hematogenous Osteomyelitis (AHO) in pediatric patients.  Recommendations for empiric antibiotic therapy are based on local resistance patterns bone isolates of Staphylococcus aureus to methicillin and clindamycin but these are not available at all institutions.

Objective: The primary goal of this study was to develop an institutional antibiogram specific to AHO and septic arthritis (SA).  Additionally, the impact of a PID consultation on length of stay and time to definitive treatment was determined. 

Design/Methods: Patients at a single institution age 0-18 years with AHO and SA from 2016-2021 were identified based on diagnosis code.  Patients with open/penetrating trauma, hardware, immunodeficiency, and NICU admission were excluded.  Retrospective chart review was performed to identify positive cultures, organism name, organism sensitivities, location of infection, empiric antibiotic choice, time to PID consult, antibiotic changes, type of antibiotic change, time to definitive antibiotic, and length of stay.

Results: 84 patients meet inclusion criteria, 47 with AHO (56%), 22 with SA (26%), and 15 (18%) with both.  Staphylococcus aureus was isolated in 54 (64%) of patients.  Of these isolates 25 (46%) were oxacillin resistant, 6 (11%) were clindamycin resistant, and 0 were resistant to trimethoprim-sulfamethoxazole.  Secondary analysis on the impact of PID consults included 74 patients.  57 (77%) cases had a PID consult at an average time of 3.05 +/-1.51 (range 2-8) hospital days.  Time to definitive antibiotics (3.09 vs 1.77 p=0.02) and length of stay (8.45+/-6.62 vs 4.12 +/- 2.26, p< 0.01) were longer in the PID consult group.

Conclusion(s): Our institution has a high (46%) rate of oxacillin resistant Staphylococcus aureus bone and joint infections with a low (11%) rate of clindamycin resistance.  Interestingly, PID consult lengthened the duration to definitive antibiotic choice and length of hospital stay.  This is likely due to an average time to consult of 3 hospital days.  These data emphasize the importance of timely PID consult in pediatric bone and joint infections.