Our ten-year-old daughter developed cellulitis that went to the bone. She’s in the hospital for treatment. We’re trying to figure out how serious this is and how long she might be hospitalized. We both work full-time and need to make arrangements. What can you tell us?

There are many factors that go into the decision when to release a child from the hospital after a serious infection like cellulitis and now osteomyelitis (bone infection). Age, type of organism causing the infection, and response to antibiotic therapy are the main considerations.

If the child doesn’t respond to antibiotic treatment, then surgery may be needed. This can delay hospital discharge. Is the infection caused by MRSA— methicillin-resistive staphylococcus aureus? MRSA is a staph infection that has become resistant to all but one antibiotic. And there’s evidence that the bacteria is continuing to mutate (change) with at least one strain now resistant to all antibiotics.

Children who are infected with MRSA are more likely to develop blood clots that can travel to the lungs, a potential cause of death. This reason alone may require a longer period of hospitalization and close monitoring. Blood tests help reveal the presence and type of infection and show which children are at risk for blood clot formation.

One study has shown that children nine years old and older who have MRSA-related osteomyelitis have a 40 per cent incidence of blood clots when the C-reactive protein (CRP) level is more than 6 mg/dL. CRP is a protein found in the blood. CRP levels rise in response to inflammation. Once the CRP level has dropped to 2.0 or less, discharge is more likely. But again, this depends on the child’s symptoms and blood cultures.

When the blood is no longer positive for infection on two separate tests (repeated over time), then the child is switched from intravenous antibiotics to an oral (pill) form. This is when discharge plans can be formulated. Children are hospitalized on average anywhere from three days up to 11 days. Longer hospitalization (several weeks) may be required when multiple surgeries are done and/or when the infection is slow to resolve. The medical staff should be able to provide you with a reasonable estimate of how much time might be needed. Of course, things can change (hopefully for the better!) altering the predicted timeline.