Best Practice Case Studies-Clinical Practice Guideline Osteomyelitis

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The 2021 Clinical Practice Guideline, developed by the Pediatric Infectious Diseases Society (PIDS) and the Infectious Diseases Society of America (IDSA), details the diagnosis and management of acute hematogenous osteomyelitis (AHO) in children. It aims to assist healthcare professionals in making informed decisions when treating children with AHO. This guideline is informed by systematic literature reviews, the GRADE approach to assess the evidence, and expert consensus.

Key recommendations include:
1. <strong>Diagnosis:</strong> Blood cultures should be taken before starting antibiotics. Serum C-reactive protein (CRP) may be used initially to serve as a baseline for monitoring but has limited diagnostic accuracy. Imaging techniques like MRI are preferred over bone scans for diagnosing AHO when initial radiographs are inconclusive.
2. <strong>Antimicrobial Therapy:</strong> Early antibiotic treatment is critical for ill-appearing children and should be active against Staphylococcus aureus, including MRSA, based on local resistance patterns. Clindamycin or vancomycin is recommended in regions with higher MRSA prevalence.
3. <strong>Surgical Intervention:</strong> Surgical debridement is advised for rapidly progressing infections or when substantial abscesses are present to achieve source control.
4. <strong>Therapy Transition and Duration:</strong> After a positive initial response to intravenous antibiotics, children can often transition to oral agents, with a typical duration of therapy ranging from 3 to 4 weeks for uncomplicated cases.

Overall, this guideline emphasizes the need for a tailored approach to diagnosing and treating AHO, considering individual patient circumstances and the prevailing local microbiological environment. Follow-ups are suggested for those at high risk of long-term complications to ensure proper management and recovery.

Meta Tag

Edition 3rd Edition

Related Case 3rd Edition, CASE 26

Topic Infectious Disease

Keywords

3rd Edition, CASE 26

3rd Edition

Infectious Disease

Pediatric Infectious Diseases Society

Infectious Diseases Society of America

acute hematogenous osteomyelitis

children

diagnosis

antimicrobial therapy

surgical intervention

Staphylococcus aureus

MRSA

treatment guidelines