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Since 1980, 64 children with pelvic osteomyelitis (40 boys) were treated at a major pediatric referral center. The average age was 11 years and 6 months. The presenting complaints included pain in 61 children, fever in 30, and altered weight-bearing in 31. The erythrocyte sedimentation rate was elevated in 56 and there was leukocytosis in 19. The most commonly affected sites were the ilium in 21 and the acetabulum in 20, followed by the pubis in 11 and the ischium in 10. Culture results were negative in 32 and positive for Staphylococcus aureus in 26. Treatment consisted of intravenous antibiotics in 62 and irrigation and debridement in five children, all of whom presented since 1990. The infection resolved in 62 children and persisted in two. Three developed complications, including fusion of the sacroiliac joint in one, deformity of the acetabulum in one, and one child with an underlying protein C deficiency developed thromboembolism. Recent patients have demonstrated increased severity, likely due to increased virulence of the organism.