Project Information

Trends in the evaluation and management of hospitalized children with acute hematogenous osteomyelitis

Project Description: Osteomyelitis is a relatively common invasive bacterial infection in children requiring hospitalization and oftentimes surgical debridement. Most cases of acute osteomyelitis in children are hematogenous (acute hematogenous osteomyelitis, AHO) in origin with Staphylococcus aureus as the most commonly implicated pathogen. Diverse local antibiotic resistance and virulence patterns of S. aureus has made the creation of generalized guidelines challenging. Traditional management of these infections has consisted of prolonged administration of intravenous antibiotics via a peripherally inserted central catheter (PICC) for 4 to 6 weeks, though there is a high degree of variability in management amongst institutions and between clinical providers. Recent data has suggested that earlier transition from intravenous to orally administered antibiotics in uncomplicated cases yields similar outcomes and is associated with fewer adverse events related to PICC use. Anecdotally, there has been a shift in practice locally over the past decade favoring earlier transition to oral antibiotics prior to discharge from the children’s hospital. We have not, however, systematically investigated management of children with AHO over this timeframe in order to identify shifts in practice and adverse events related to care. Additionally, variability in management has not been formally assessed. We propose a quality improvement project focused on identifying 1) changes in AHO management at UF Health Children’s Hospital from 2010 to present, 2) changes in adverse events related to AHO care, and 3) variability in current care. Results of this QI project will be used to formulate guidelines for AHO management, including timing of initiation and choice of empirical antibiotics, imaging modalities, and laboratory markers.

QPI: Matthew, Washam, (

Collaborators: Michele, Lossius, (

Advisors: Matthew, Washam, (

UF Health Big Aims: Zero Harm None

MeSH Keywords: Osteomyelitis, Staphylococcal Infections, Central Venous Catheters