Culture-negative osteomyelitis.
OBJECTIVE
To examine the natural history, clinical manifestations, laboratory changes and outcomes of children with culture-negative osteomyelitis and to compare findings with cases of culture-positive infection treated during the same time period.


METHODS
Retrospective review of consecutive admissions for osteomyelitis during the 4-year period 1998 through 2001, with a minimum follow-up of 1 year.


METHODS
A single urban children's hospital with a large orthopedic referral service. CLINICAL AND LABORATORY MEASURES: Age, gender, predisposing factors, clinical manifestations, maximum temperature, duration of pain, bone involved, laboratory changes, results of cultures from infected bone and blood and outcome after treatment.


RESULTS
A total of 85 patients fulfilled study criteria, of whom 40 were culture-negative. Compared with culture-positive cases, culture-negative osteomyelitis patients were less likely to have antecedent trauma (P = 0.0357) and overlying skin changes (P = 0.0001), duration of pain and other symptoms was longer (P = 0.0396) and skeletal residua were rare. They were also older, with this difference approaching statistical significance (P = 0.0586).


CONCLUSIONS
Children with culture-negative osteomyelitis present initially differently from culture-positive cases and can be managed as presumed staphylococcal disease with excellent long term results.
Floyed
Rebecca L
RL
Division of Infectious Diseases, Department of Pediatrics, LSU Health Sciences Center, Louisiana State University, New Orleans, LA, USA.
Steele
Russell W
RW
D000293:Adolescent; D017677:Age Distribution; D000900:Anti-Bacterial Agents; D001769:Blood / Q000382:microbiology*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008826:Microbial Sensitivity Tests; D010019:Osteomyelitis / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology*; D011336:Probability; D011379:Prognosis; D012016:Reference Values; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D017678:Sex Distribution; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents