Chronic Osteomyelitis in Children: Contemporary Epidemiology
While the majority of pediatric osteomyelitis cases are acute, a large subset has long-term effects that are often associated with significant morbidity. The aim of the study was to identify the epidemiology, clinical characteristics, and treatment options for children with chronic osteomyelitis (CO).

Hospital admissions for CO were reviewed. Cases were included if symptoms lasted more than 28 days on presentation. Cases were classified as those associated with: (1) A contiguous focus of infection; (2) Penetrating trauma; (3) Orthopedic hardware; (4) Postacute CO (PACO, those occurring after more than 28 days of therapy for acute osteomyelitis); and (5) Primary hematogenous CO.

--114 cases met inclusion criteria. The median patient age was 11.8 years and 35.9% had comorbidities.

--70.2% of patients underwent more than 1 surgical procedure. A microbiologic etiology was identified in 72.8% of cases and Staphylococcus aureus was most common (39.4%).

--Contiguous focus of infection was more often associated with polymicrobial disease with or without Pseudomonas.

--Postacute CO was caused by S. aureus in 95%. The median duration of total therapy was 210 days.

--26.3% of patients experienced treatment failure of which 46% underwent repeat hospital admission/surgery. There was no association between duration of intravenous therapy for CO and treatment failure.

Finally, in terms of pathogenesis and microbiology, children with CO are a complex group. Microbiologic etiology may be deduced from pathogenesis and clinical presentation. In the case of CO, long-term Intravenous treatment does not tend to improve outcomes.