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Role of Operative or Interventional Radiology-Guided Cultures for Osteomyelitis
J Chase McNeil1, Andrea R Forbes2, Jesus G Vallejo2
1Section of Infectious Diseases, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas jm140109@bcm.tmc.edu.
Background And Objective:
Acute hematogenous osteomyelitis (AHO) is a severe infection in children. Drainage of purulent collections in bones provides specimens for culture as well as therapeutic benefit. Interventional radiology (IR)-guided procedures may serve as a less invasive means of culture in select patients. We examined the impact of IR and surgically obtained cultures in the diagnosis and management of AHO.
Methods:
A retrospective review of cases of AHO was performed from 2011 to 2014. Patients with chronic disease, orthopedic hardware, puncture wounds, or an infected contiguous focus were excluded.
Results:
A total of 250 cases met inclusion criteria. Blood cultures were positive in 107 of 231 cases (46.3%), and 123 of 150 patients had positive cultures (82%) obtained by orthopedic surgery. Of these 123 patients, 62 (50.4%) had organisms identified only through operating room (OR) cultures. Of the 66 patients who had cultures obtained by IR, 34 (51.5%) had positive IR cultures. For those with positive IR cultures, 18 (52.9%) had negative blood cultures. Among the 80 patients with negative blood culture and positive OR/IR culture, the results changed antibiotic therapy in 68 (85%) patients.
Conclusions:
IR or OR culture was the only means of identifying a pathogen in 80 of 216 cases (37%), and in >80% changed medical management. IR can be used effectively to obtain bone cultures in children with AHO not requiring open surgical drainage. Further research is needed to better understand the optimal utilization of IR and OR culture in pediatric AHO.
Insights
Interventional radiology (IR) and orthopedic surgery cultures are vital for diagnosing pediatric acute hematogenous osteomyelitis (AHO). These methods significantly impact treatment decisions when blood cultures are negative.
Area of Science:
- Pediatric Infectious Diseases
- Musculoskeletal Infections
- Diagnostic Microbiology
Background:
- Acute hematogenous osteomyelitis (AHO) is a serious pediatric infection.
- Bone cultures are crucial for diagnosis and treatment.
- Interventional radiology (IR) offers a less invasive approach for obtaining cultures.
Purpose of the Study:
- To evaluate the diagnostic and management impact of IR-guided and surgically obtained cultures in pediatric AHO.
- To compare the yield of IR cultures versus traditional methods.
Main Methods:
- Retrospective review of 250 pediatric AHO cases (2011-2014).
- Exclusion of patients with chronic disease, hardware, or contiguous infections.
- Analysis of blood, IR-guided, and orthopedic surgery cultures.
Main Results:
- Orthopedic surgery cultures yielded positive results in 82% of patients, with 50.4% identified exclusively in the operating room.
- IR cultures were positive in 51.5% of cases, identifying pathogens in 52.9% of patients with negative blood cultures.
- Positive IR or orthopedic surgery cultures changed antibiotic therapy in 85% of patients with negative blood cultures.
Conclusions:
- IR and orthopedic surgery cultures are essential for pathogen identification in pediatric AHO, especially when blood cultures are negative.
- IR-guided procedures are effective for bone cultures in select AHO cases not requiring surgery.
- Further research is needed to optimize the use of IR and surgical cultures in pediatric AHO management.
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