Published online April 3, 2006
PEDIATRICS Vol. 117 No. 4 April 2006, pp. 1210-1215 (doi:10.1542/peds.2005-1465)

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Complications of Central Venous Catheters Used for the Treatment of Acute Hematogenous Osteomyelitis

Rebecca Ruebner, MD^a, Ron Keren, MD, MPH^a,d, Susan Coffin, MD, MPH^a,e, Jaclyn Chu, MHS^e, David Horn, MD^b,f and Theoklis E. Zaoutis, MD, MSCE^a,c,e

^a Departments of Pediatrics
^b Surgery
^c Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
^d Divisions of General Pediatrics
^e Infectious Diseases
^f Orthopedic Surgery, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania

OBJECTIVE. To determine the complications and risk factors for complications associated with using central venous catheters (CVCs) for the treatment of acute hematogenous osteomyelitis (AHO).

METHODS. We conducted a retrospective cohort study of all patients admitted to the Children’s Hospital of Philadelphia between January 1, 2000, and December 31, 2003, with a diagnosis of AHO.

RESULTS. Eighty patients with AHO met inclusion criteria. The median age was 5 years, and 66% of the patients were male. The most commonly affected bones were the femur (25%), tibia (20%), and pelvis (16%). Staphylococcus aureus was the most common organism identified from cultures of bone (67%) and blood (30%). Seventy-five patients (94%) received >2 weeks of intravenous (IV) antibiotic therapy via a CVC and 5 (6%) received <2 weeks of IV antibiotic therapy before conversion to oral therapy for a median of 25 days. None of the patients who switched to oral therapy within 2 weeks was rehospitalized or returned to the emergency department. Of the 75 patients who received >2 weeks of IV therapy, 41% had 1 CVC-associated complication. Seventeen patients (23%) had a CVC malfunction or displacement, 8 (11%) had a catheter-associated bloodstream infection, 8 (11%) had fever with negative blood culture results, and 4 (5%) had a local skin infection at the site of catheter insertion. Older age was protective against the development of a CVC-associated complication, whereas the lowest median household income was associated with development of a CVC-associated complication.

CONCLUSIONS. Interventions to reduce CVC-associated complications should be developed and evaluated, particularly for young children and those from families with low household incomes. Clinical trials are needed to evaluate the safety and efficacy of oral antibiotic therapy after a short course of IV therapy as an alternative to prolonged IV therapy.

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Key Words: osteomyelitis • central venous catheters • treatment • antibiotic use • pediatric

Abbreviations: AHO—acute hematogenous osteomyelitis • IV—intravenous • CVC—central venous catheter • IQR—interquartile range • CHOP—Children’s Hospital of Philadelphia • ED—emergency department • PICC—peripherally inserted central catheter • OPAT—outpatient parenteral antibiotic therapy

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Accepted Aug 30, 2005.

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