Shortened hospital stay for childhood bone and joint infections: Analysis of 265 prospectively collected culture-positive cases in 1983–2005

Abstract

Background: In recent decades the treatment of childhood acute bone and joint infections has shifted towards shorter antibiotic courses and rapid transition to oral therapy. Methods: We prospectively collected 265 culture-positive cases of non-neonatal bone and joint infections in Finnish children during 1983–2005. The duration of antimicrobial treatment and the extent of surgery were defined in the study protocol, but for ethical reasons, the liaison clinician determined the time of discharge using normalization of the serum C-reactive protein (CRP) level as a yardstick. We examined changes during the study in the distribution of causative organisms, severity of disease, and length of hospital stay. Results: Staphylococcus aureus was overwhelmingly the most common causative agent throughout the study, whereas Haemophilus influenzae type b was eliminated soon after the introduction of vaccination. The mean time from initial symptoms to presentation remained the same at 4 days, and no significant change was observed in the severity of disease, CRP, or the rate of sequelae. The mean duration of intravenous antibiotic administration was only 4 days. The average hospital stay shortened significantly from 13 days to 9 days (p = 0.0001). Conclusions: The shortened hospital stay was not due to a change in the anatomical site of these infections, but to simplified treatment. Considerable savings in hospital stay, and thus costs, are feasible in osteoarticular infections of childhood by using CRP in monitoring the disease and shortening intravenous treatment by a swift move to per oral administration.

Keywords::

• Septic arthritis
• osteomyelitis
• child
• hospitalization
• LOS

Declaration of interest: All authors declare no conflicts of interest. Markus Pääkkönen has received a grant from the Foundation for Paediatric Research, Finland.

Appendix

Participating hospitals and the liaison persons

• Aurora Hospital, Helsinki: Kari Aalto.

• Children's Hospital, Helsinki University Central Hospital, Helsinki: Juhani Merikanto and Eeva Salo.

• Etelä-Saimaa Central Hospital, Lappeenranta: Anita Hiippala and Niilo Kojo.

• Jorvi Hospital, Espoo: Pekka Ojajärvi.

• Kuopio University Hospital, Kuopio: Marja Heikkinen.

• Päijät-Häme Central Hospital, Lahti: Ilkka Anttolainen and Pentti Lautala.

• Seinäjoki Central Hospital, Seinäjoki: Ulla Kaski (deceased).