Epidemiology of bone and joint infection in Pacific children from the Auckland Region, 2018–2023

background: Children of Pacific ethnicity living in New Zealand have the second highest incidence of bone and joint infections (BJI) globally. This paper reports illness characteristics and outcomes for Pacific children diagnosed with acute haematogenous osteomyelitis (AHO) or septic arthritis (SA) from the Auckland Region over a 5-year period. It also reports features associated with severe and complex disease. methods: Cases included all children aged ≤15 years hospitalised for AHO or SA in the Auckland Region, 1 January 2018–31 September 2023. Prioritised ethnicity was identified from hospital records. Direct medical hospitalisation costs, treatment type and outcomes were described up to 1 year following discharge. Complex illness was defined as recurrence/chronic infection, readmission, intensive care admission, complication following treatment or >1 surgical procedure. results: Of 563 cases of acute BJI, 152 were children identifying as Pacific ethnicity. Compared with NZ European children with BJI, Pacific children had more eczema (34% vs 19%, p=0.002), multifocal sepsis (30% vs 10%, p=<0.05) and surgical intervention (61% vs 47%, p=0.01) with lengthier hospitalisations (14 days vs 9 days, p=0.001). Most Pacific children experienced complex illness (66%). Complex illness was associated with cultures positive for Staphylococcus aureus and eczema diagnosis. In regression analysis, complex illness was less likely for children with a previous throat swab positive for group A Streptococcus (GAS). conclusion: Pacific children with BJI experience more severe illness compared with NZ European children with BJI. Eczema is common among Pacific children with BJI. Proactive eczema management may represent suitable focus for disease prevention. Prior GAS throat swab appears associated with reduced rates of complex illness.