title: Microbiological culture methods for pediatric musculoskeletal infection: a guideline for optimal use.
abstract: BACKGROUND
  Culture results affect the diagnosis and treatment of children with musculoskeletal infection. To our knowledge, no previous large-scale study has assessed the relative value of culture methods employed during the evaluation of these conditions. The purpose of this study was to identify an optimal culture strategy for pediatric musculoskeletal infection.
  
  
  METHODS
  Children with musculoskeletal infection were retrospectively studied to assess culture results from the infection site or blood; culture type, including aerobic, anaerobic, fungal, and acid-fast bacteria (AFB); antibiotic exposure history; and clinical history of children with positive culture results.
  
  
  RESULTS
  We studied 869 children, including 353 with osteomyelitis, 199 with septic arthritis, forty-two with pyomyositis, and 275 with abscess. The 4537 cultures processed included 1303 aerobic, 903 anaerobic, 340 fungal, 289 AFB, and 1702 blood. Of 3004 specimens sent during initial work-up, positive results occurred in 677 of 1049 aerobic cultures (64.5%), 140 of 763 blood cultures (18.3%), eighteen of 722 anaerobic cultures (2.5%), five of 251 fungal cultures (2.0%), and two of 219 AFB cultures (0.9%). Staphylococcus aureus was the most common pathogen isolated, from 428 (50.7%) of 844 children for whom blood or infection-site culture material was sent (methicillin-resistant S. aureus, 252; and oxacillin-sensitive S. aureus, 176). Cultures were negative in 206 (29.0%) of the 710 children for whom culture material from the site of infection was sent. Children with true-positive anaerobic, fungal, or AFB cultures had a history of immunocompromise, penetrating inoculation, or failed primary treatment. Antibiotic exposure prior to culture-sample acquisition did not interfere with aerobic culture results from the site of infection.
  
  
  CONCLUSIONS
  Our findings suggest that anaerobic, fungal, and AFB cultures should not be routinely performed during the initial evaluation of children with hematogenous musculoskeletal infection. These cultures should be performed for children with immunocompromise, clinical suspicion of penetrating inoculation, or failed primary treatment.
authors: University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, Dallas, TX 75390-9113. E-mail address for J. Section: jarren.section@utsouthwestern.edu. E-mail address for S.D. Gibbons: steven.gibbons@utsouthwestern.edu. E-mail address for D.E. Greenberg: david.greenberg@utsouthwestern.edu.
authors: Jarren
authors: J
authors: Section
authors: University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, Dallas, TX 75390-9113. E-mail address for J. Section: jarren.section@utsouthwestern.edu. E-mail address for S.D. Gibbons: steven.gibbons@utsouthwestern.edu. E-mail address for D.E. Greenberg: david.greenberg@utsouthwestern.edu.
authors: Steven D
authors: SD
authors: Gibbons
authors: Baylor College of Medicine, Texas Children's Hospital, 1102 Bates Avenue, C.0630.56, Houston, TX 77030. E-mail address: theresa.barton@bcm.edu.
authors: Theresa
authors: T
authors: Barton
authors: University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, Dallas, TX 75390-9113. E-mail address for J. Section: jarren.section@utsouthwestern.edu. E-mail address for S.D. Gibbons: steven.gibbons@utsouthwestern.edu. E-mail address for D.E. Greenberg: david.greenberg@utsouthwestern.edu.
authors: David E
authors: DE
authors: Greenberg
authors: Texas Scottish Rite Hospital for Children, 2222 Welborn Street, Dallas, TX 75219. E-mail address: Chanhee.Jo@tsrh.org.
authors: Chan-Hee
authors: CH
authors: Jo
authors: Children's Medical Center Dallas, 1935 Medical District Drive, Dallas, TX 75235. E-mail address: Lawson.copley@childrens.com.
authors: Lawson A B
authors: LA
authors: Copley
mesh_terms: D000038:Abscess / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001170:Arthritis, Infectious / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008828:Microbiological Techniques; D010019:Osteomyelitis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D010372:Pediatrics; D017410:Practice Guidelines as Topic; D052880:Pyomyositis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents