Antibiotic Stewardship in Pediatric Bone and Joint Infections: A Retrospective Study in Casablanca

Abstract

Introduction: Pediatric bone and joint infections are frequent and require rapid empirical antibiotic therapy, which must be adapted to the local microbiological ecology in order to limit unjustified use of broad-spectrum agents. Our study focuses on pediatric bone and joint infections (BJIs) managed in Casablanca, describing their epidemiological and microbiological characteristics and examining how well empirical antibiotic regimens align with subsequent targeted therapy. Methods: We conducted a retrospective, single-center observational study including all children aged 0 - 15 years hospitalized for a bone or joint infection between January 2020 and December 2023. Information was extracted from medical files using a standardized data collection sheet and covered clinical presentation, microbiological findings and details of empirical and targeted antibiotic treatment. Descriptive statistics were produced, and univariate analyses were performed to explore the relationships between the empirical regimen, pathogen isolation and the later need for broadened targeted therapy. Results: 161 children were included (mean age 6.38 ± 4.56 years; median 6 years), with most patients belonging to the 1 - 9-year age range and very few presenting significant comorbidities. Septic arthritis was the leading diagnosis (46.0%), followed by soft-tissue collections (16.8%) and subperiosteal abscesses (15.5%). Microbiological samples were obtained in 99.4% of cases; cultures were negative in 46.6%, demonstrated susceptible pathogens in 40.4% and resistant strains in 8.7%. The empirical antibiotic therapy was predominantly amoxicillin-clavulanic acid combined with gentamicin (AC + G) (87.6%), while broader-spectrum combinations were only exceptionally prescribed. Targeted therapy also mainly relied on AC + G (88.8%), with vancomycin, imipenem-amikacin or ceftriaxone-gentamicin reserved for specific situations. Among patients started on standard AC + G, 96.5% continued on simple AC + G after adaptation, and only 3.5% required escalation to a broader regimen. In contrast, 60.0% of children who initially received a broad-spectrum empirical treatment ultimately required broadened targeted therapy (OR 40.8; 95% CI 11.5–144.4; p < 0.0001). Isolation of a pathogen was significantly associated with the use of escalated targeted treatment, whereas the link between pathogen isolation and the initial choice of a broad-spectrum empirical regimen did not reach statistical significance. Conclusion: Our study shows that a standardized narrow-spectrum empirical regimen, adapted to the local microbiological ecology, is sufficient in most cases and supports the implementation of strict antimicrobial stewardship.