Musculoskeletal Infections


Lead Author(s): 

Scott B. Rosenfeld, MD
Brielle Payne Plost, MD

Supporting Author(s): 

Sylvia I. Watkins-Castillo, PhD

Musculoskeletal infections included in this section are osteomyelitis, septic arthritis, soft tissue infections (myositis), Lyme disease, and tuberculosis. Osteomyelitis and septic arthritis are the most common form of pediatric musculoskeletal infections, and most often occur in the first decade of life in previously healthy children. Infectious myositis refers to conditions causing inflammation in muscles and may be part of a systemic (whole body) infection, especially a viral infection. Lyme disease is caused by a bite from a deer tick and is less common than osteomyelitis and septic arthritis. It is more prevalent in the Northeastern and Midwestern regions of the United States.1 Tuberculosis (TB) has become much less common in the United States over the last few decades but has increased in incidence in developing countries secondary to immunodeficiency and multidrug resistance. TB infections involve the musculoskeletal system in 2% to 5% of cases.2

Community-acquired Staphylococcus aureus (CA-SA) is the most common infecting organism in pediatric musculoskeletal infections and is typically treated with a first-generation cephalosporin, such as cefazolin. Over the past decade, methicillin-resistant Staphylococcus aureus (MRSA) has become prevalent and requires treatment with second-line antibiotics such as clindamycin or vancomycin.3  As MRSA infections have become more prevalent, the disease course for patients with these infections have become much more severe, with greater systemic disease requiring multimodal and multidisciplinary treatments including medical, surgical, and critical care. Patients are often hospitalized for extended periods and most require continued care with long-term antibiotic treatment after discharge. Multiple surgical debridements are often required. Complications of musculoskeletal infections include growth deformity, fractures, and arthritis, and may result in long-term morbidity and dysfunction.

Healthcare Utilization

Musculoskeletal infections were diagnosed in 61,400 children and adolescent healthcare visits in 2013, of which 41,800 had a primary diagnosis of musculoskeletal infection. Of this total, 14,000 children and adolescents were hospital discharges, with 8,300 hospitalizations for a primary diagnosis of a musculoskeletal infection. (Reference Table 7C.1.1 PDF CSV and Table 7C.1.2 PDF CSV)

Males were more likely to be hospitalized with a musculoskeletal infection than females. The most common age group was between 5 and 9 years old. Musculoskeletal infections as a primary diagnosis accounted for 1.6% of hospital discharges for any musculoskeletal-related condition, but only 0.1% of hospital discharges for all healthcare reasons for children and adolescents age 20 years and younger. (Reference Table 7C.2 PDF CSV)

Hospital Charges

Total charges averaged $76,900 for a mean 8.5-day stay when children and adolescents were hospitalized with a diagnosis of musculoskeletal infection along with other medical conditions. With a primary diagnosis of infection, the stay was shorter (5.9 days), and mean charges were less at $48,300. Total hospital charges for all primary musculoskeletal infection discharges in 2013 were $400.9 million. (Reference Table 7C.2 PDF CSV)

  • 1. Willis AA, Widmann RF, Flynn JM, et al. Lyme arthritis presenting as acute septic arthritis in children. J Pediatr Orthop 2003;23(1):114-118.
  • 2. Rasool MN. Osseous manifestations of tuberculosis in children. J Pediatr Orthop 2001;21(6):749- 755.
  • 3. Copley LA. Pediatric musculoskeletal infection: Trends and antibiotic recommendations. JAAOS 2009;17(10):618-626. PubMed PMID: 19794219. Epub 2009/10/02.


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