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Published on: November 1, 2018
The effect of antibiotic timing on culture yield in paediatric osteoarticular infection
M van der Merwe1, K Rooks1, H Crawford1
1Department of Paediatric Orthopaedics, Starship Children's Hospital, Auckland, New Zealand.
Insights
Administering antibiotics before surgery does not reduce surgical culture yield in children with bone or joint infections. Prompt antibiotic treatment is recommended for suspected osteoarticular infections after blood cultures are drawn.
Area of Science:
- Pediatric Infectious Diseases
- Orthopedic Surgery
- Microbiology
Background:
- Hematogenous osteoarticular infections are serious conditions in children.
- Optimal timing of antibiotic administration for maximizing diagnostic yield is crucial.
Purpose of the Study:
- To evaluate the impact of pre-surgical antibiotic timing on surgical culture yield in pediatric patients.
- To determine if early antibiotic treatment affects the ability to identify causative pathogens in osteoarticular infections.
Main Methods:
- Retrospective case-control study of 131 pediatric patients (0-15 years) with acute osteoarticular infections.
- Patients were categorized into pre-treatment and post-treatment groups based on antibiotic administration relative to surgical cultures.
- Surgical culture yield was the primary outcome, with baseline variables also analyzed.
Main Results:
- No significant differences in baseline characteristics (age, WBC, ethnicity, multi-focality) between groups.
- The rate of positive surgical cultures was 85% in the pre-treatment group versus 54.2% in the post-treatment group (p=0.002).
- Duration of pre-surgical antibiotics did not impact culture yield within the pre-treatment group.
Conclusions:
- Antibiotic administration prior to surgical cultures does not decrease yield in pediatric osteoarticular infections.
- Prompt systemic antibiotic administration is recommended for pediatric patients with suspected osteoarticular infections after blood cultures are obtained.
Purpose:
To assess the influence of antibiotic timing on surgical culture yield in paediatric patients with haematogenous osteoarticular infection.
Methods:
All patients aged 0 to 15 years admitted to a National Children's Hospital with the diagnosis of acute, haematogenous, osteoarticular infection (osteomyelitis and/or septic arthritis) between June 1997 and December 2016 were retrospectively analyzed. Only patients with positive blood cultures undergoing surgery for culture and debridement were included. Patients were allocated into pre-treatment and post-treatment groups, according to whether they received antibiotics before or after surgical cultures were obtained. Outcomes measured included baseline variables, treatment characteristics and surgical culture yield.
Results:
A total of 131 patients were included; 107 patients in the pre-treatment group and 24 patients in the post-treatment group. There was no significant difference with respect to patient age (p = 0.870), white blood cell count (p = 0.197), ethnicity (p = 0.203) or infection multi-focality (p = 0.883) between the two groups.The administration of systemic antibiotics prior to obtaining surgical cultures had no clinically significant effect on surgical culture yield (rate of positive surgical cultures, 85% (pre-treatment) versus 54.2% (post-treatment); p = 0.002). Within the pre-treatment group, there was no significant difference in duration of pre-surgical antibiotic treatment between patients who had positive or negative surgical cultures (mean duration, 45.9 hours (positive cultures) versus 47.9 hours (negative cultures); p = 0.743).
Conclusion:
In paediatric patients with acute, haematogenous, osteoarticular infection, antibiotic administration before surgery does not decrease surgical culture yield. Our results suggest that paediatric patients presenting with suspected osteoarticular infection should receive appropriate systemic antibiotics promptly after blood cultures are obtained.
Level Of Evidence:
Level III - retrospective case-control study.
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