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Acute osteomyelitis is a common condition among children and is associated with intensive health care resource use. The practice of treating pediatric osteomyelitis with long-term intravenous antibiotic therapy, typically achieved through placement of a peripherally inserted central catheter (PICC), has been questioned in recent years. In multiple comparative effectiveness studies, researchers have failed to identify differences in patient outcomes when comparing prolonged intravenous therapy to oral antimicrobial therapy while at the same time bringing to light the harms associated with peripherally inserted central catheter lines. Although the available evidence supports a practice shift away from long-term parenteral therapy, less is known about the extent to which this evidence is influencing actual population-based trends. In this month’s Hospital Pediatrics, Shaikh et al identify important changes in pediatric osteomyelitis care over the last decade. The authors used the National Inpatient Sample database, a publicly available, all-payer database approximating a large sample of discharges from US hospitals, to derive weighted national estimates of health care use patterns for acute osteomyelitis from 2007 to 2016. They identified a rising proportion of osteomyelitis hospitalizations over this time period, from 42.9 to 81.5 per 100 000 hospitalizations, presumably related to increasingly sensitive diagnostic modalities, such as MRI. This increase in incidence coincided with a sharp decline in PICC placement rates in osteomyelitis patients, from 58.8% to 5.9%. Multivariate analysis failed to reveal any significant change in length of stay (LOS) or inflation-adjusted hospital cost over the study period, although PICC placement was associated with both increased LOS and cost. The work by Shaikh et al contributes important information around what appears to have been a paradigm shift occurring in pediatric osteomyelitis care.

Reducing PICC Placement in Pediatric Osteomyelitis: A Diamond in the Deimplementation Rough?