Identifying predictors for source culture positivity in children with acute musculoskeletal infections

Area of Science:

• Pediatric Infectious Diseases
• Musculoskeletal Infections
• Bacterial Pathogen Identification

Background:

• Accurate identification of bacterial pathogens in pediatric acute hematogenous musculoskeletal infections (MSKIs) is crucial for effective treatment.
• Current diagnostic approaches often involve invasive operative procedures, necessitating optimization for yield.

Purpose of the Study:

• To determine if clinical markers can predict which pediatric MSKI patients are most likely to yield a causative pathogen from source cultures alone.
• To identify patients who would benefit most from operative diagnostic procedures.

Main Methods:

• A retrospective cohort study of 170 pediatric patients (6 months to 18 years) with acute osteomyelitis, septic arthritis, or pyomyositis.
• Patients were stratified based on blood and source culture results.
• Clinical predictors were analyzed using univariable and multivariate statistical models.

Main Results:

• No clinical predictors were significantly associated with an increased likelihood of identifying a causative pathogen on source culture alone.
• Elevated C-reactive protein and a history of fever were paradoxically associated with decreased odds of positive source cultures.

Conclusions:

• Predictive modeling was unsuccessful in identifying pediatric MSKI patients with high yield for source culture positivity.
• It remains difficult to predict which patients will benefit most from operative diagnostic procedures based on current clinical markers.