Characteristics of Children With Culture Negative Acute Hematogenous Musculoskeletal Infections. Issue 2 (February 2022)

• Record Type: Journal Article
• Authors: Searns, Justin B.; DeVine, Mackenzie N.; MacBrayne, Christine E.; Williams, Manon C.; Pearce, Kelly; Donaldson, Nathan; Parker, Sarah K.
• Is Part Of: Journal of pediatric orthopaedics. Volume 42:Issue 2(2022)
• Publication Date: 2022-02
• Subjects: pediatric -- musculoskeletal infection -- microbiology -- diagnostics; Pediatric orthopedics -- Periodicals; 618.927
• DOI: 10.1097/BPO.0000000000002033
• Languages: English
• ISSNs: 0271-6798

Abstract

Abstract : Background: Identifying the causative pathogen for acute hematogenous musculoskeletal infections (MSKIs) allows for directed antimicrobial therapy and diagnostic confidence. However, 20% to 50% of children with acute MSKIs remain culture negative. The objective of this study was to compare characteristics of culture negative MSKI patients to those where a pathogen is identified. Methods: Electronic medical records of children admitted between July 2014 to September 2018 to a single quaternary care pediatric hospital with acute MSKIs were retrospectively reviewed. Clinical and demographic characteristics were compared between culture positive and culture negative MSKIs. Results: A total of 170 patients were included of whom 43 (25%) were culture negative. All culture negative patients had at least 1 culture type obtained, and the majority (84%) had both blood and source cultures performed. When compared with patients with a causative pathogen identified, culture negative patients were younger (2.3 vs. 9.8 y), smaller (13.5 vs. 31.6 kg), less likely to be febrile on arrival (56% vs. 77%), less likely to have an abscess on imaging (23% vs. 48%), and were more likely to have uncomplicated septic arthritis (35% vs. 8%). No critically ill patient was culture negative. Seven culture negative patients had additional Kingella kingae testing performed, none of which were positive. Conclusions: Despite targeted and standardized efforts to identify causative bacteria, 25% of children with acute MSKIs never have a pathogen identified. Culture negative patients are younger, less febrile, are less likely to have an abscess, and more likely to have isolated septic arthritis. Level of Evidence: This is a retrospective cohort study interested in identifying patient characteristics that predict rate of culture positivity for acute MSKIs. This study meets criteria for Level II evidence. Abstract : Supplemental Digital Content is available in the text.