title: Microbiological characteristics of acute osteoarticular infections in children.
abstract: This study aimed to describe the microbiological characteristics of acute septic arthritis (SA) and osteomyelitis (OM) in children. Cases of children (0-15 years) with SA/OM were identified through a retrospective search of hospital discharge codes over a six-year period. In addition, a systematic literature search and meta-analysis of studies reporting culture results of children with SA/OM was performed. In our retrospective chart review, we identified 65 cases of OM and 46 cases of SA. The most frequently cultured organisms in both conditions were Gram-positive cocci, primarily Staphylococcus aureus. On admission, most patients had a normal white blood cell count (WCC) but elevated C-reactive protein (CRP) and/or erythrocyte sedimentation rate (ESR). Bacteraemia was associated with a longer mean length of hospitalization for both infections. Considering our results and the meta-analysis, we found low rates of culture-positivity in cases of clinically confirmed infection. In SA, articular fluid was culture-positive in 42.49% [95% confidence interval (CI) 28.39-57.23]. In OM, intra-operative samples were culture-positive in 52.65% (95% CI 30.54-74.22). Bacteraemia was detected in 23.91% (95% CI 8.40-44.24) of children with SA and 21.48% (95% CI 10.89-34.47) with OM. Despite appropriate sampling, a positive microbiological diagnosis is often lacking in paediatric acute osteoarticular infection using standard culture-based methods. This highlights the need for validation and use of more sensitive diagnostic methods, such as PCR.
authors.affiliation: Royal Hospital for Sick Children, 9 Sciennes Road, Edinburgh, EH9 1LF, UK.|Division of Infection and Pathway Medicine, The University of Edinburgh, The Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK.
authors.forename: Clark D
authors.initials: CD
authors.lastname: Russell
authors.affiliation: Royal Hospital for Sick Children, 9 Sciennes Road, Edinburgh, EH9 1LF, UK.
authors.forename: Rishi
authors.initials: R
authors.lastname: Ramaesh
authors.affiliation: Royal Hospital for Sick Children, 9 Sciennes Road, Edinburgh, EH9 1LF, UK.
authors.forename: Pota
authors.initials: P
authors.lastname: Kalima
authors.affiliation: Royal Hospital for Sick Children, 9 Sciennes Road, Edinburgh, EH9 1LF, UK.
authors.forename: Alastair
authors.initials: A
authors.lastname: Murray
authors.affiliation: Royal Hospital for Sick Children, 9 Sciennes Road, Edinburgh, EH9 1LF, UK.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Gaston
mesh_terms: D000293:Adolescent; D001170:Arthritis, Infectious / Q000150:complications / Q000453:epidemiology / Q000382:microbiology* / Q000473:pathology; D016470:Bacteremia / Q000453:epidemiology / Q000382:microbiology / Q000473:pathology; D001419:Bacteria / Q000145:classification / Q000302:isolation & purification*; D001424:Bacterial Infections / Q000453:epidemiology / Q000382:microbiology* / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010019:Osteomyelitis / Q000150:complications / Q000453:epidemiology / Q000382:microbiology* / Q000473:pathology; D012189:Retrospective Studies