title: Significance of Negative Cultures in the Treatment of Acute Hematogenous Bone and Joint Infections in Children.
abstract: BACKGROUND
  Synovial fluid and blood cultures often remain negative in acute bone and joint infections of childhood even when characteristic symptoms, signs, and/or radiologic proof are present.
  
  
  METHODS
  We analyzed 345 prospectively documented osteoarticular infections in children at age 3 months to 15 years. In 23% of the cases (N = 80), synovial, bone, and/or blood cultures remained negative. The characteristics of these cases were compared with patients with culture-positive bone and joint infections.
  
  
  RESULTS
  The 2 groups did not differ in age or gender distribution, surgical procedures performed, or outcome. In the culture-negative cases, the initial serum C-reactive protein level was lower (58 vs 87 mg/L, P < .0001) and the hospital stay was shorter (8 vs 11 days, P < .0001).
  
  
  CONCLUSIONS
  Bone and joint infections in which cultures fail to identify the causative agent can be treated similarly as culture-positive cases.
authors.affiliation: Department of Orthopedic Surgery, Turku University Hospital and University of Turku; Departments of Children's Hospital, Helsinki University Central Hospital, Finland.
authors.forename: Markus
authors.initials: M
authors.lastname: Pääkkönen
authors.affiliation: Pediatrics and Children's Hospital, Helsinki University Central Hospital, Finland.
authors.forename: Markku J T
authors.initials: MJ
authors.lastname: Kallio
authors.affiliation: Pediatric Surgery, University of Helsinki Children's Hospital, Helsinki University Central Hospital, Finland.
authors.forename: Pentti E
authors.initials: PE
authors.lastname: Kallio
authors.affiliation: Pediatrics and Children's Hospital, Helsinki University Central Hospital, Finland.
authors.forename: Heikki
authors.initials: H
authors.lastname: Peltola
keywords: Bacteria; Culture; Osteomyelitis; Septic Arthritis