Comparison of Clinical Features and Serum Parameters of Culture-Positive Children with Culture-Negative Children in Septic Arthritis and Acute Osteomyelitis

Abstract

PURPOSE OF THE STUDYThe aim of this study was to investigate the culture results of children undergoing debridement for suspected septic arthritis or acute osteomyelitis and to compare the laboratory parameters and clinical characteristics of culture-positive and culture-negative patients. MATERIAL AND METHODSPatients who underwent surgery in our hospital for septic arthritis and acute osteomyelitis between 2011 and 2019 were retrospectively analyzed. Seventy-two of 96 patients were included in the study. The patients had documented joint swelling, redness, pain with joint movement and weight-bearing failure. Fever was assessed preoperatively. Sedimentation rate, C-reactive protein level, white blood cell count and the leukocyte count in aspiration material as well as complications were evaluated preoperatively and 3 months postoperatively. RESULTSTwenty patients underwent surgery of the hip; 39 of the knee; 7 of the foot, ankle and distal tibia; 1 of the elbow; and 1 of the distal radius. Additionally, 4 patients had septic arthritis and acute osteomyelitis of the femur. The mean age of the patients was 7.8 years (1-16). The mean follow-up period was 16.2 months (3-42). Preoperative aspiration was performed in 44 of 72 patients. Thirty of 72 patients had positive cultures. No statistically significant difference in age, preoperative duration, C-reactive protein, sedimentation, white blood cell count, preoperative fever or complications was found when compared between patients with culture growth and those without reproduction (p > 0.05). There was a significant difference between the leukocyte count in the aspiration material (p < 0.05). CONCLUSIONSPrediagnosis of septic arthritis or acute osteomyelitis in pediatric patients is important in terms of future joint health and sepsis. According to our findings an inability to obtain bacteria does not exclude septic arthritis as a diagnosis. Empirical antibiotic therapy with a wide postoperative spectrum is important for joint health in these patients. Preoperative serum parameters cannot predict the agent needed for treatment.

Ultrasound-Guided Needle Aspiration of Subperiosteal Abscess in a Child with Acute Osteomyelitis of the Fibula

“…When osteomyelitis is suspected based on history and physical examination, blood investigations such as white blood cell count (WCC), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) along with imaging studies are performed; however, a definitive diagnosis usually requires culture of the pathogen from tissue samples 3,6,7 . The usefulness of imaging studies such as radiography, magnetic resonance imaging (MRI), computed tomography, bone scintigraphy, and ultrasound has been reported, but there is limited evidence for the requirement of imaging studies in the diagnosis and treatment of acute osteomyelitis 1,3 .…”