Osteomyelitis and septic arthritis in children: current concepts.

PURPOSE OF REVIEW The cause, epidemiology, diagnosis, and treatment of osteoarticular infections have changed considerably in recent years. The current review includes the most up to date literature on pediatric septic arthritis and osteomyelitis. RECENT FINDINGS There is controversy over whether osteoarticular infection rates are increasing or decreasing. Changes in epidemiology may be related to improved methods of diagnosis. The pathogens responsible for osteoarticular infections in children have changed with alterations in immunization practices, emergence of resistant bacteria, and changes in patterns of immune modulating diseases and medications in children. Special culture techniques and PCR may help to identify pathogens that are difficult to culture. Surgical debridement is typically required for joint infections and chronic osteomyelitis, whereas acute osteomyelitis can typically be treated with medication alone. Needle aspiration/irrigation alone has been described as an alternative to surgical incision/drainage for septic arthritis, but this practice has not been widely adopted. Intravenous antibiotic therapy for 2-4 days followed by 20 days of oral therapy is effective for treating uncomplicated cases of osteomyelitis, whereas 2-4 days of intravenous antibiotics followed by 10 days of oral therapy is sufficient for septic arthritis. Steroids have shown some improved short-term clinical outcomes in patients with septic arthritis. SUMMARY Up to date knowledge of emerging pathogens, utilization of modern diagnostic techniques and implementation of new shorter treatment regimens can optimize the treatment of pediatric septic arthritis and osteomyelitis.