1518. The Microbiology of Osteoarticular Infections in Patients with Sickle Hemoglobinopathies at Texas Children’s Hospital, 2011–2018

Abstract

Background

Osteoarticular infections (OAI) are common in patients with major sickle hemoglobinopathies (Hemoglobin [Hgb] SS, Hgb SC, and Hgb Sβ thalassemia). Although Salmonella spp. cause a substantial number of OAIs in these patients, contemporary data regarding the most common etiology in the era of community-acquired methicillin-resistant Staphylococcus aureus (MRSA) are lacking. This introduces challenges for selecting empiric antimicrobial therapy. We evaluated the microbiology and management of OAI in children with sickle hemoglobinopathies.

Methods

Children with sickle hemoglobinopathies admitted to Texas Children’s Hospital with acute hematogenous OAI from 2011 to 2018 were identified based on ICD10 codes and the consult database of the pediatric infectious diseases service. Culture-negative cases were included if treated for OAI. Medical records were reviewed. Statistical analyses were conducted with STATA ver. 13.

Results

36 patients met inclusion criteria; 53% were diagnosed with isolated osteomyelitis and 47% with osteomyelitis and septic arthritis. In 42% a microbial etiology was identified (Figure 1) with Salmonella spp. being the most common ( n = 7, 47%) followed by S. aureus ( n = 5, 33%).11 (31%) patients had subperiosteal or intraosseous abscesses and 26 (72%) underwent diagnostic and/or therapeutic surgical procedures; 36% had positive blood cultures. Children with Salmonella spp. infections had a longer duration of fever (median-5, range: 4–9 days) compared with those caused by other pathogens (median-2, range: 0–6 days; P = 0.04). The median duration of IV therapy was longer in culture-positive than culture-negative cases (30 vs.10 days, P = 0.009); the total duration of therapy was similar for all cases (32 days, IQR: 28–42). No patients were readmitted due to OAI.

Conclusion

At our institution, Salmonella spp. were the most common cause of OAI among children with sickle hemoglobinopathies. Subperiosteal/intraosseous abscess formation and the need for surgical procedures were common. The role of oral antibiotics for the treatment of Salmonella OAI in patients with sickle hemoglobinopathies warrants further study.

Disclosures

All authors: No reported disclosures.