title: Acute bacterial osteoarticular infections: eight-year analysis of C-reactive protein for oral step-down therapy.
abstract: BACKGROUND
  One of the most important decisions in the treatment of osteoarticular infections is the time at which parenteral therapy can be changed to oral therapy. C-reactive protein (CRP) is an acute inflammatory indicator with a half-life of 19 hours and thus can be helpful in assessing the adequacy of therapy for bacterial infections. At our institution, a combination of CRP and clinical findings is used to determine the transition to oral therapy.
  
  
  METHODS
  A search of 8 years of electronic records identified children with osteoarticular infections. Only children with culture-positive acute bacterial arthritis (ABA) or acute bacterial osteomyelitis (ABO) were studied further. A primary chart review of demographic and clinical data was conducted, and a secondary chart review of complicated outcomes was performed.
  
  
  RESULTS
  Of 194 total patients, complicated outcomes occurred in 40, of which 35 were prolonged therapy. Only 1 microbiologic failure occurred, presumably due to a retained intra-articular fragment of infected bone. CRP was highest initially among patients with simultaneous ABO + ABA and among those with complicated outcomes, and was lower at the transition to oral therapy in the complicated outcome group (1.5 vs 2.1 mg/dL; P = .012).
  
  
  CONCLUSIONS
  The combination of clinical findings and CRP is a useful tool to transition children with osteoarticular infections to oral therapy. Complicated outcomes were associated with higher early CRP at diagnosis and lower CRP at the end of parenteral therapy, suggesting that clinicians were more conservative with prolonged initial parenteral therapy in this group.
authors.affiliation: Department of Pediatrics, Division of Infectious Diseases, Naval Medical Center, San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134, USA. john.arnold@med.navy.mil
authors.forename: John C
authors.initials: JC
authors.lastname: Arnold
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Cannavino
authors.forename: Mindy K
authors.initials: MK
authors.lastname: Ross
authors.forename: Ben
authors.initials: B
authors.lastname: Westley
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Miller
authors.forename: Robert H
authors.initials: RH
authors.lastname: Riffenburgh
authors.forename: John
authors.initials: J
authors.lastname: Bradley
mesh_terms: D000208:Acute Disease; D000284:Administration, Oral; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D001170:Arthritis, Infectious / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D002648:Child; D002675:Child, Preschool; D002981:Clindamycin / Q000008:administration & dosage / Q000627:therapeutic use; D003661:Decision Support Techniques; D004334:Drug Administration Schedule; D016903:Drug Monitoring; D005260:Female; D005500:Follow-Up Studies; D016905:Gram-Negative Bacterial Infections / Q000097:blood / Q000188:drug therapy*; D016908:Gram-Positive Bacterial Infections / Q000097:blood / Q000188:drug therapy*; D006801:Humans; D007223:Infant; D007262:Infusions, Intravenous; D008297:Male; D010019:Osteomyelitis / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014640:Vancomycin / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D015415:Biomarkers; D002981:Clindamycin; D014640:Vancomycin; D002097:C-Reactive Protein