298 - Epidemiology and Management of Pediatric Spondylodiscitis

Poster Number: 298
Publication Number: 298.114

Ankhi Dutta, Baylor College of Medicine, Houston, TX, United States; Danielle Comeaux, Texas Children's Hospital, Tomball, TX, United States; Teena Hadvani, Texas Children's Hospital, Houston, TX, United States; Angela I. Foyt, Texas Children's Hospital, Houston, TX, United States; Megan James, Texas Children's Hospital, The Woodlands, TX, United States; Nicole A. Wunderlich, Texas Children's Hospital, Tomball, TX, United States

Background: Spondylodiscitis (SD) (vertebral osteomyelitis and/or discitis) is a rare entity in children but causes significant morbidity owing to non-specific presentation and delayed diagnoses. Management is variable among providers and incurs prolonged hospital stays and high health care costs.

Objective: To determine the epidemiology, clinical presentation and management of pediatric spondylodiscitis

Design/Methods:
This was a retrospective observational study describing the epidemiology, clinical presentation, diagnosis, management of SD in children admitted to a quaternary hospital in the United States from 2010-2021.  Pediatric patients (0-18 years) who were admitted to the hospital with SD as per ICD 9/10 coded were included in this study. Information regarding demographic, clinical, laboratory, microbiological, radiological, antibiotic use, surgical intervention and outcome were collected from electronic medical records. Descriptive statistical analyses were performed.

Results: Forty four patients met the inclusion criteria. The median age of patients was 10.7 years (0.5-18 years), with 61% male (n=27), 68% White (n=30) and 56.8% non-hispanic (n=25).
The most common clinical presentation was fever 56.8% (n=25), back pain 45.4% (n=20) or hip/gluteal or leg pain in 29.4% (n=13). Six patients presented with abnormal gait only. Median duration of symptoms at presentation was 9.5 days (2-120 days). Spinal X-rays were normal in all but 2 patients. MRI was diagnostic for SD in all. Lumbar involvement was most common in 47.7% (n=21). Twenty-five (56.8%) did not have a tissue biopsy done. Fourteen out of 19 patients who had tissue cultures done had no growth (73.6%).  Blood culture was positive in 10 (22.7%). Most common bacterial pathogen isolated were MSSA (n=9); MRSA (n=4); Salmonella (2); Bartonella (1), Brucella (1); Streptococcus pneumoniae (1) and Streptococcus intermedius (1). The most common initial antibiotic was vancomycin (54.5%, n=24), ceftriaxone (36.3%, n=16) or clindamycin (47.7%, n=21). Median duration of intravenous antibiotics were 8 days (1-45 days). Median oral antibiotics were 28 days (0-81 days). Median length of hospital stay was 7 days (2-43 days).  Conclusion(s): Delayed diagnosis is common among children with SD. In children with back pain and/or hip pain with fever, SD should be considered and MRI ordered. Spinal Xrays are not diagnostic and may delay treatment. Tissue cultures are often non-diagnostic. Of those with positive cultures, MSSA was the most common. Future research should focus on reducing treatment variability among providers.