Acute haematogenous osteomyelitis in the paediatric population: a current concepts review

Acute haematogenous osteomyelitis (AHOM) is a bacterial infection localised in bone that usually occurs after an episode of bacteraemia. This infection is commonly encountered by doctors in low- and middle-income countries (LMICs) and, if not recognised early and managed appropriately, can harbour significant early and late complications, including death. This narrative review aims to summarise the current management of AHOM, highlight the controversies and report on new advances in diagnosis and treatment. AHOM is typically a monomicrobial disease. Staphylococcus aureus remains the most common pathogen globally, accounting for 70-90% of all cases. Diagnostic work-up includes complete blood cell count, serum C-reactive protein, erythrocyte sedimentation rate, imaging and blood culture. Management of AHOM includes empiric intravenous (IV) antibiotics based on the most likely causative agents; source control entailing surgery to drain any abscesses and obtain specimens for microscopy, culture and sensitivity (MCS), as well as debridement of any necrotic bone; and subsequent targeted antibiotic therapy effective against the identified pathogen with the narrowest spectrum. Treatment response is monitored with repeat CRP every 48-72 hours. The decision to switch from IV to oral antibiotics is made if there is clinical improvement and the CRP is < 20 mg/L. The total duration of antibiotics is six weeks. Treatment of paediatric AHOM is multidisciplinary and includes orthopaedic surgeons, paediatricians, infectious diseases specialists, physiotherapists, dieticians, nurses and social workers. AHOM can cause devastating destruction of the bone due to tissue necrosis, leading to late sequelae. These complications are more common in children in LMICs. Level of evidence: Level 5