Epidemiological Trends in Pediatric Osteoarticular Infections-Results from a Single-Center Retrospective Study Covering 2015-2023.

BACKGROUND

Pediatric infectious disease epidemiology has changed since the COVID-19 pandemic. To investigate possible changes in the epidemiology of pediatric osteoarticular infections (pOAIs), entailing osteomyelitis (OM), septic or infectious arthritis (AR), and osteomyelitis combined with arthritis (OA), we aimed to assess the number of pOAI cases, pathogen distribution, and outcomes across the pre-, mid-, and post-pandemic periods.

METHODS

We conducted a single-center retrospective cohort study in the Dutch Juliana Children's Hospital, including patients aged 0-18 years diagnosed with OM, AR, or OA between 2015 and 2023. Cases were grouped into three periods: pre-pandemic (P1: 2015-2019), mid-pandemic (P2: 2020-2021), and post-pandemic (P3: 2022-2023). Data on demographics, clinical course, imaging, microbiology, and outcomes were extracted from medical records.

RESULTS

A total of 118 pOAI cases (median age 2 years, IQR 1-8) were included. OM occurred in 50%, AR in 42%, and OA in 8% of cases. Annual case counts increased from an average of 10/year in P1 to 21/year in P3. Although the difference between P1 and P2 was not statistically significant (IRR 1.20; 95% CI 0.70-2.06), there was a significant increase in P3 compared to P1 (IRR 1.97; 95% CI 1.31-2.97). Pathogen detection was achieved in 50% of cases. Staphylococcus aureus remained the most frequently identified pathogen overall. From P1 to P2, proportions of Kingella kingae and GAS declined, while Staphylococcus aureus remained stable. In P3, Kingella kingae increased, Staphylococcus aureus decreased, and GAS remained relatively unchanged. However, none of these changes were statistically significant. No patients required PICU admission or experienced fatal outcomes.

CONCLUSION

This study suggests an increase in pOAI after the COVID-19 pandemic. While patient characteristics and outcome remained similar over time, pathogen distribution seems to have changed throughout the periods.