Childhood osteomyelitis complicated by adjacent septic arthritis

If acute osteomyelitis (OM) of childhood is complicated by adjacent septic arthritis (OM+SA), more aggressive treatment is traditionally favored. In our large prospective randomized trial on childhood osteoarticular infections, we kept the treatment same for both entities, but discontinued the antimicrobial only if most symptoms and signs had subsided, and the serum C-reactive protein (CRP) level had decreased to 20 mg/l or less. In all, 117 children aged from 3 months to 15 years had culture-positive OM. These were retrospectively allocated into two groups: OM without (n=92; 79%), and with joint involvement (n=25; 21%). Staphylococcus aureus, invariably methicillin-susceptible, was isolated in 107 (91%) cases. The initial CRP levels and the erythrocyte sedimentation rates were higher and remained increased longer in OM+SA than in OM. This difference led to administration of antimicrobials 7 days longer in the OM+SA group (32 vs. 25 days, P<0.05). No death, recrudescence, or chronic disease occurred, but one mild sequela developed in both groups. High initial CRP and long duration of symptoms predicted slower recovery. Despite slightly slower decline of CRP and erythrocyte sedimentation rate, and thus, longer antimicrobial treatment in OM+SA, the need for surgery and the final outcomes were comparable, no matter whether OM or OM+SA.