Characteristics of Children With Culture Negative Acute Hematogenous Musculoskeletal Infections

Searns, Justin; DeVine, Mackenzie N.; Miyagami, Taiju; Williams, Manon; Pearce, Kelly; Donaldson, Nathan; Parker, Sarah K.

doi:10.1097/bpo.0000000000002033

Cited by 6 publications

(11 citation statements)

References 30 publications

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“…Molecular diagnostics were not used uniformly in this cohort which may have led to an under-recognition of fastidious organisms, particularly K. kingae , which were misclassified into the no organism identified category. However, the rate of nonmicrobiologically confirmed disease is consistent with prior literature 10,30 and is, in fact, lower than that reported in some studies. 31…”

Section: Discussionsupporting

confidence: 91%

Predictive Factors to Guide Empiric Antimicrobial Therapy of Acute Hematogenous Osteomyelitis in Children

Hoyer

Joseph

Kaplan

et al. 2023

Pediatric Infectious Disease Journal

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Background: Acute hematogenous osteomyelitis (AHO) is a serious infection in children. Pediatric Infectious Diseases Society guidelines recommend empiric methicillin-resistant Staphylococcus aureus (MRSA) therapy in regions where MRSA accounts for more than 10–20% of all staphylococcal osteomyelitis. We sought to examine factors present at the time of admission which may predict etiology and guide empiric treatment for pediatric AHO in a region with endemic MRSA. Methods: We reviewed admissions with International Classification of Diseases 9/10 codes for AHO from 2011 to 2020 in otherwise healthy children. Medical records were reviewed for clinical and laboratory parameters present on the day of admission. Logistic regression was used to determine clinical variables independently associated with (1) MRSA infection and (2) non-Staphylococcus aureus infection. Results: A total of 545 cases were included. An organism was identified in 77.1% of cases and S. aureus was the most common (66.2%); 18.9% of all AHO cases were MRSA. Organisms besides S. aureus were identified in 10.8% of cases. CRP >7 mg/dL, subperiosteal abscess, history of any prior skin or soft tissue infection (SSTI) and need for intensive care unit admission were independently associated with MRSA infection. Vancomycin was used as an empiric treatment in 57.6% of cases. If the above criteria were relied upon to predict MRSA AHO, empiric vancomycin use could have been reduced by 25%. Conclusions: Critical illness, CRP >7 mg/dL at the time of presentation, subperiosteal abscess and history of SSTI are suggestive of MRSA AHO, and could be considered when planning empiric therapy. Further work is needed to validate these findings before wider implementation.

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Section: Discussionsupporting

confidence: 91%

Predictive Factors to Guide Empiric Antimicrobial Therapy of Acute Hematogenous Osteomyelitis in Children

Hoyer

Joseph

Kaplan

et al. 2023

Pediatric Infectious Disease Journal

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“…Among the 76 patients, 37 (48.7%) had positive bacterial cultures and 39 (51.3%) had negative pus or blood culture results. This is consistent with the reported positive rates for routine bacterial cultures in the literature, which range from 30 to 82% [31][32][33][34][35][36][37]. [3,[31][32][33][34][35][36][37].…”

Section: Discussionsupporting

confidence: 91%

“…Among the 76 patients, 37 (48.7%) had positive bacterial cultures and 39 (51.3%) had negative pus or blood culture results. This is consistent with the reported positive rates for routine bacterial cultures in the literature, which range from 30 to 82% [31–37]. Staphylococcus aureus was the most common pathogen in septic arthritis, accounting for 70.3% (26 patients) of the positive bacterial cultures, including methicillin-sensitive Staphylococcus aureus in 18 (48.6%) and methicillin-resistant Staphylococcus aureus in 8 (21.6%).…”

Section: Discussionsupporting

confidence: 89%

“…This is consistent with the reported positive rates for routine bacterial cultures in the literature, which range from 30 to 82% [31][32][33][34][35][36][37]. [3,[31][32][33][34][35][36][37]. As a result of the limited repertoire of bacterial species detected in positive cultures, any comparative analysis of prognosis across distinct bacterial classifications was precluded.…”

Section: Discussionsupporting

confidence: 82%

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Analysis of poor prognostic factors for septic arthritis of the hip in children: a case series of 76 patients

Feng,

Wang,

Yao

et al. 2023

Journal of Pediatric Orthopaedics B

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The clinical characteristics, treatment and outcomes of children with septic arthritis of the hip in our hospital were analyzed to identify the risk factors for a poor prognosis. The clinical data of 76 children with septic arthritis of the hip who were treated at our hospital from January 2010 to December 2020 were retrospectively analyzed. According to the most recent follow-up data, the patients were classified as good prognosis or poor prognosis. The differences between the two groups were analyzed. From January 2010 to December 2020, a total of 76 children with septic arthritis of the hip were admitted to our hospital, comprising 52 (68.4%) with a good prognosis and 24 (31.6%) with a poor prognosis. The risk of a poor prognosis was significantly higher in the group with time from onset to surgery >22 days than in the group with time from onset to surgery <11 days. The risk of poor prognosis in the group with C-reactive protein (CRP) > 100 mg/L was significantly higher than that in the group with CRP < 20 mg/L. Time from onset to surgery >14 days and CRP > 93 mg/L were the cutoff values for a poor prognosis. Significant elevation of CRP and prolonged time from onset to surgery in children with septic arthritis of the hip are risk factors for a poor prognosis. Early diagnosis and effective treatment are very important because delays in these factors can lead to a poor prognosis. Level of Evidence: Level II, retrospective study.

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“…Antimicrobial delays of greater than 3 h increase mortality nearly 5-fold among septic children ( 24 ). In addition, among critically ill children with OAIs at our institution, we found 100% had a pathogen found via blood cultures, decreasing the diagnostic benefit of source cultures in septic patients ( 25 ). Therefore, OAI-associated sepsis requires immediate antimicrobial therapy as the consequences of withholding life-saving antimicrobials far outweigh the marginal diagnostic benefit.…”

Section: Introductionmentioning

confidence: 90%

Characteristics of Children With Culture Negative Acute Hematogenous Musculoskeletal Infections

Cited by 6 publications

References 30 publications

Predictive Factors to Guide Empiric Antimicrobial Therapy of Acute Hematogenous Osteomyelitis in Children

Predictive Factors to Guide Empiric Antimicrobial Therapy of Acute Hematogenous Osteomyelitis in Children

Analysis of poor prognostic factors for septic arthritis of the hip in children: a case series of 76 patients

Delaying antimicrobials for pediatric bone and joint infections: Balancing clinical risks with diagnostic benefits

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