984. Pediatric acute hematogenous osteoarticular infections in central Missouri

Abstract Background Acute hematogenous osteoarticular infections (AOI), including osteomyelitis (OM) and/or septic arthritis (SA), are a frequent cause of hospitalization and morbidity in children. In this retrospective observational study, we aim to describe the epidemiology, presentation, and management of children diagnosed with AOI at a Midwest academic healthcare center in central Missouri. Methods Systematically reviewing medical records from July 2015 to March 2021, we identified 73 pediatric patients (age < 18 years) diagnosed with AOI. Cases related to trauma, surgery, or chronic recurrent multifocal osteomyelitis were excluded. Information was collected on clinical course and management, and a descriptive analysis was performed. Results Children meeting the inclusion criteria included 46 males (63%) and a median age at presentation of 6.9 years (IQR 2.8 – 11.9). Presenting symptoms included localized pain (n=72, 99%), refusal to move or bear weight (n=64, 88%) and fever (n=49, 63%); 42 (56%) had all three symptoms. 32 (44%) had OM, 17 (23%) had SA, and 24 (33%) had both; lower extremity long bones/joints were often involved. Definitive bacterial etiology was identified in 49 (67%) patients: 39 (76%) Staphylococcus aureus (16 methicillin resistant [MRSA], 23 methicillin susceptible [MSSA]), 4 (8%) Streptococcus pyogenes, and 3 (6%) Kingella kingae; and blood cultures identified an etiology in 29 of the 69 obtained (42%; 25 MSSA, 2 MRSA, 2 S pyogenes). Surgical management in an operating room was performed in 44 (60%). Median hospitalization was for 5 days (IQR 4-8), and 5 cases (7%) required intensive care, with no mortality. 62 were successfully transitioned from intravenous (IV) antibiotics to oral at discharge (85%) – 10 were discharged with IV antibiotics and one infant received full IV course in hospital. Definitive oral antibiotics used included cephalexin (35), clindamycin (24), and amoxicillin (3). 8 (11%) required hospital readmission for various reasons. Conclusion Our trends in AOI are comparable to those reported nationally – blood cultures remain key in identifying etiology and empiric therapy should continue to target S aureus. Most children can be successfully transitioned to oral antibiotics at discharge. This data will guide us in preparing a clinical pathway at our center. Disclosures All Authors: No reported disclosures.