Link To CPA Position Statement “Diagnosis and management of acute osteoarticular infections in children”

In addition to the resource below, please see “Septic Arthritis vs Transient Synovitis” From EM Quick Hits 34 Carr’s Case, Septic Arthritis vs Transient Synovitis, Managing Tracheostomies, Ethylene Glycol Poisoning, Ketamine for Agitation.

The CPA Position Statement linked to below is an outstanding resource on the subject and is worth frequent review.

In this post, I link to and excerpt the abstract from the Canadian Pediatric Association Position Statement [This link is to the search by topic page] Diagnosis and management of acute osteoarticular infections in children. PODCAST Posted: Jul 18, 2018.

 Principal author(s)

Nicole Le Saux; Canadian Paediatric Society, Infectious Diseases and Immunization Committee

Paediatr Child Health 2018, 23(5):336–343.


Acute hematogenous osteomyelitis and septic arthritis are not uncommon infections in children and should be considered as part of the differential diagnosis of limb pain and pseudoparalysis. Most bone infections in children arise secondary to hematogenous seeding of bacteria into bone. The most common pathogens are Staphylococcus aureus and Kingella kingae. Children with septic arthritis should be evaluated promptly by orthopedic specialists for aspiration and possible debridement of concomitant osteomyelitis. Optimal empiric therapy after appropriate cultures continues to be intravenous cefazolin. In most cases, conversion to oral antimicrobials should occur when the patient has clinically improved and has decreasing inflammatory markers. For most uncomplicated cases of osteomyelitis, current recommendations are 3 to 4 weeks of antimicrobial therapy compared with the 6 weeks previously recommended.

Keywords: Acute osteomyelitis; C-reactive protein test; Methicillin-resistant Staphylococcus aureus; Methicillin-susceptible Staphylococcus aureus; Septic arthritis

Hematogenous osteomyelitis presents frequently in physician offices and emergency departments. The incidence in developed countries ranges from 1 to 13/100,000 children (or 2.38 cases per 1000 admissions), and is more frequent in young children [1][3].

This position statement focuses on acute osteomyelitis (AO) and acute septic arthritis (SA) resulting from hematogenous seeding of bacteria into bone and joints in previously healthy children. It excludes infections of the head and neck, infections associated with prostheses and those caused by direct or contiguous spread (e.g., secondary to trauma, surgery or fractures). Nor does it address infections with symptoms present for more than one month or SA resulting from disseminated gonococcal infection.

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