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Microbiological culture methods for pediatric musculoskeletal infection: a guideline for optimal use
Jarren Section1, Steven D Gibbons1, Theresa Barton2
1University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, Dallas, TX 75390-9113. E-mail address for J. Section: jarren.section@utsouthwestern.edu. E-mail address for S.D. Gibbons: steven.gibbons@utsouthwestern.edu. E-mail address for D.E. Greenberg: david.greenberg@utsouthwestern.edu.
Background:
Culture results affect the diagnosis and treatment of children with musculoskeletal infection. To our knowledge, no previous large-scale study has assessed the relative value of culture methods employed during the evaluation of these conditions. The purpose of this study was to identify an optimal culture strategy for pediatric musculoskeletal infection.
Methods:
Children with musculoskeletal infection were retrospectively studied to assess culture results from the infection site or blood; culture type, including aerobic, anaerobic, fungal, and acid-fast bacteria (AFB); antibiotic exposure history; and clinical history of children with positive culture results.
Results:
We studied 869 children, including 353 with osteomyelitis, 199 with septic arthritis, forty-two with pyomyositis, and 275 with abscess. The 4537 cultures processed included 1303 aerobic, 903 anaerobic, 340 fungal, 289 AFB, and 1702 blood. Of 3004 specimens sent during initial work-up, positive results occurred in 677 of 1049 aerobic cultures (64.5%), 140 of 763 blood cultures (18.3%), eighteen of 722 anaerobic cultures (2.5%), five of 251 fungal cultures (2.0%), and two of 219 AFB cultures (0.9%). Staphylococcus aureus was the most common pathogen isolated, from 428 (50.7%) of 844 children for whom blood or infection-site culture material was sent (methicillin-resistant S. aureus, 252; and oxacillin-sensitive S. aureus, 176). Cultures were negative in 206 (29.0%) of the 710 children for whom culture material from the site of infection was sent. Children with true-positive anaerobic, fungal, or AFB cultures had a history of immunocompromise, penetrating inoculation, or failed primary treatment. Antibiotic exposure prior to culture-sample acquisition did not interfere with aerobic culture results from the site of infection.
Conclusions:
Our findings suggest that anaerobic, fungal, and AFB cultures should not be routinely performed during the initial evaluation of children with hematogenous musculoskeletal infection. These cultures should be performed for children with immunocompromise, clinical suspicion of penetrating inoculation, or failed primary treatment.
Insights
For pediatric musculoskeletal infections, aerobic and blood cultures are most effective. Routine anaerobic, fungal, and acid-fast bacteria (AFB) cultures are not recommended initially, unless specific risk factors are present.
Area of Science:
- Pediatric Infectious Diseases
- Musculoskeletal Infections
- Microbiology
Background:
- Accurate diagnosis and treatment of pediatric musculoskeletal infections rely on culture results.
- Previous large-scale studies evaluating optimal culture strategies are lacking.
- This study aimed to determine the most effective culture approach for pediatric musculoskeletal infections.
Purpose of the Study:
- To identify the optimal culture strategy for diagnosing pediatric musculoskeletal infections.
- To assess the diagnostic yield of various culture methods in children.
- To guide the selection of appropriate cultures for initial evaluation.
Main Methods:
- Retrospective analysis of 869 children with musculoskeletal infections.
- Evaluation of culture results from infection sites and blood.
- Assessment of different culture types: aerobic, anaerobic, fungal, and acid-fast bacteria (AFB), alongside antibiotic exposure and clinical history.
Main Results:
- Aerobic cultures yielded the highest positive results (64.5%), followed by blood cultures (18.3%).
- Staphylococcus aureus was the most common pathogen identified.
- Anaerobic, fungal, and AFB cultures showed low positive rates and were associated with specific patient factors like immunocompromise or penetrating injuries.
Conclusions:
- Routine anaerobic, fungal, and AFB cultures are not cost-effective for initial evaluation of hematogenous pediatric musculoskeletal infections.
- These specialized cultures should be reserved for cases with immunocompromise, suspected penetrating inoculation, or treatment failure.
- Optimizing culture strategies can improve diagnostic accuracy and resource allocation.
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