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Background There is controversy about the appropriate management of acute osteomyelitis in children. Methods Retrospective cohort study of presentation, management and outcomes of all patients admitted with acute osteomyelitis (<2 weeks duration) during 2010–2016 at 4 US and Canadian tertiary care hospitals (hosp). Long-term complications (LTC) were defined as amputation, limp, chronic or secondary infection, or readmission. Overall complications included LTC, admission to ICU and delayed surgery (>72 hours). Results 712 patients were admitted, with a median age of 8.0 years. There were significant differences in rates of initial use of MRI for diagnosis, MRSA, PICC insertion, hosp stay and IV antibiotic duration (Table 1). Clindamycin (45.7%), cefazolin (24.1%) and vancomycin (13.7%) were the most common IV antibiotics used while clindamycin (47.1%) and cephalexin (38.6%) predominated for oral. The median age of patients with MRSA was similar to those without MRSA (8.2 vs. 7.8 years, P = 0.18), but MSSA patients were older (9.6 vs. 6.9 years, P < 0.0001). Contiguous septic arthritis was more common in younger children (6.8 vs. 8.5 years, P < 0.001). MRSA patients had higher overall complication rates (25.2% vs. 10.0%, P < 0.0001), but long-term complications were unrelated to duration of IV or total antibiotics.Table 1: Summary Results of Multi-center Study of Pediatric Osteomyelitis Children’s Hosp. of Omaha Children’s Mercy, Kansas City Norton Children’s Children’s Hosp. of Eastern Ontario P-value No. of patients enrolled 137 398 127 46 – M: F ratio (%) 58.7:41.2 64.8:35.1 51.5:48.4 69.5:30.4 0.02 Median age (years) 7.6 7.6 8.2 8.6 0.32 % of all initial imaging MRI 38.1% 89.8% 45.9% 20.4% <0.0001 % Abnormal, all initial imaging 75.8 87.4 80.0 68.8 <0.001 MSSA rates (%) 40.3 46.0 45.0 50.0 <0.19 MRSA rates (%) 10.7 17.1 23.0 0 <0.0001 Median hospital stay (days) 4.0 4.0 4.0 6.0 <0.0001 Median days of IV antibiotics 18.0 4.0 3.0 9.5 <0.0001 Median days of total antibiotics 42.0 34.0 33.0 41.5 <0.0001 Frequency of PICC insertion 67.7% 8.5% 8.7% 45.8% <0.0001 Long-term complications 6.1% 4.3% 7.1% 10.5% 0.18 Conclusion Despite significant variation in management, long-term complication rates were similar across US and Canadian sites with different MRSA rates. These data support equivalence of shorter (≤ 4 days) duration of IV antibiotics and reduced need for PICC insertion for pediatric osteomyelitis. Disclosures All authors: No reported disclosures.

2317. Multicenter Retrospective Cohort Study of Pediatric Osteomyelitis