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Musculoskeletal infections originate from pathogens introduced into the tissues via direct inoculation, through hematogenous spread, or via contiguous extension from adjacent areas of infection. In pediatric patients, these infections are a common cause of morbidity, with the possibility of long-term functional impairment. Prompt diagnosis and treatment are important to prevent irreversible damage to the bones and joint space, to decrease length of hospital stay, and to minimize treatment morbidity. While pediatric orthopaedic surgeons may definitively manage these cases, multidisciplinary collaboration provides the best outcomes for patients.
Cases of severe musculoskeletal infection should be managed urgently or emergently. However, management decisions often vary between physicians and institutions, including when to perform imaging, whether to use sedation or contrast with MRIs, and whether to take these cases during daytime operating room block hours or overnight. Increasing data about bacteria, the immune response, and antibiotic susceptibility have influenced and standardized many hospital practice guidelines. However, interinstitutional variation in care pathways still exists and may be attributed to differences in endemic bacteria. Standardization of treatment algorithms and protocols improves patient outcomes, but they must be modified for regional bacterial prevalence and antibiograms. This manuscript addresses the management of common pediatric musculoskeletal infections through a case-based, roundtable approach with national experts.