Potential Clinical Effects of a Novel Rapid Diagnostic Panel for Pediatric Musculoskeletal Infections

Abstract

A direct-from-source rapid musculoskeletal diagnostic panel (MDP) was validated recently. We compared clinical measures to theoretical time points had MDP results been available. The MDP would have significantly decreased the time to pathogen identification (7 hours), time to definitive antimicrobial therapy (22 hours), and hospital length of stay (26.4 hours).

Characteristics of Children With Culture Negative Acute Hematogenous Musculoskeletal Infections

“…1,[5][6][7] Causative bacterial pathogens are identified primarily through bacterial cultures of blood and infected musculoskeletal sources, and less commonly through serologic studies or polymerase chain reaction (PCR)-based testing. [8][9][10][11][12][13] Routine collection of blood cultures is widely accepted for MSKIs, however, blood cultures identify a pathogen in <50% of patients. 3,[14][15][16][17][18] Concurrent collection of source samples from infected tissues increases the chance of identifying a causative bacterial pathogen.…”

“…Causative bacterial pathogens are identified primarily through bacterial cultures of blood and infected musculoskeletal sources, and less commonly through serologic studies or polymerase chain reaction (PCR)-based testing 8–13. Routine collection of blood cultures is widely accepted for MSKIs, however, blood cultures identify a pathogen in <50% of patients 3,14–18.…”

Use of Metagenomic Next-Generation Sequencing to Identify Pathogens in Pediatric Osteoarticular Infections

“…Both blood cultures and cultures obtained operatively may be negative in up to 50% of cases [ 2 , 4 , 5 , 20–23 ]. Pathogen-specific PCR testing may be useful as an adjunct, but commercial clinical PCR assays for the evaluation of osteomyelitis are not widely available (PCR assays for K kingae and for B burgdorferi for joint aspirate specifically are commercially available) [ 24 , 25 ]. Identification of a pathogen may be important in guiding therapeutic decision making, and positive culture data may result in a change in management in up to 85% of cases [ 4 ].…”

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

“…For bone and joint specimens, the Cepheid ® MRSA/SA SSTI PCR was recently found to reliably identify both MSSA and MRSA from musculoskeletal specimens in children ( 32 , 33 ). In addition, targeted PCRs for Kingella kingae are now available for bone and joint specimens ( 15 , 32 ).…”