Early transition to oral antimicrobials prevents treatment failure in children with SAB, AHO

Children with Staphylococcus aureus bacteraemia (SAB), a common complication of acute hematogenous osteomyelitis (AHO), are vulnerable to a wide range of illnesses, suggests a study. Thus, classifying its severity may aid in treatment decision-making.

Moreover, “[e]arly transition to oral antimicrobial therapy appears safe in children with mild or moderate AHO despite the presence of SAB,” the researchers said.

Using a previously validated severity of illness score (SIS), children with AHO and SAB admitted to the hospital between 1 January 2009 and 31 December 2018 were retrospectively reviewed and stratified into mild (0‒3), moderate (4‒7), and severe (8‒10) cohorts.

The researchers evaluated these groups for differences in treatment (eg, parenteral and oral antibiotic durations, surgeries) and clinical outcomes (eg, bacteraemia duration, acute kidney injury, and length of stay, and treatment failure).

A total of 246 children with AHO and SAB were identified, among whom parenteral antibiotic duration significantly differed between those with mild (n=80), moderate (n=98), and severe (n=68) conditions (3.6 vs 6.5 vs 14.3 days; p≤0.001).

Differences were also noted among SIS cohorts in terms of the number of surgeries (0.4 vs 1.0 vs 2.1; p≤0.001), duration of bacteraemia (1.0 vs 2.0 vs 4.0 days; p≤0.001), acute kidney injury (0.0 percent vs 3.0 percent vs 20.5 percent; p≤0.001), hospital length of stay (4.8 vs 7.4 vs 16.4 days; p≤0.001), and total duration of antibiotics (34.5 vs 44.7 vs 60.7 days; p≤0.001).

Of note, patients in the mild and moderate SIS cohorts who transitioned early to oral antimicrobial therapy achieved treatment success despite SAB.