Identifying predictors for source culture positivity in children with acute musculoskeletal infections

Christine E. MacBrayne; Mackenzie N. DeVine; Kelly Pearce; Nathan Donaldson; Sarah K. Parker; Justin B. Searns

doi:10.1515/dx-2021-0155

Article

Identifying predictors for source culture positivity in children with acute musculoskeletal infections

Christine E. MacBrayne , Mackenzie N. DeVine , Kelly Pearce , Nathan Donaldson , Sarah K. Parker and Justin B. Searns

Published/Copyright: May 30, 2022

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From the journal Diagnosis Volume 9 Issue 3

Abstract

Objectives

Identifying the causative bacterial pathogen for children with acute hematogenous musculoskeletal infections (MSKIs) allows for improved care. The purpose of our study was to determine if clinical markers could predict which patients will have a causative pathogen found on source culture alone, thus being highest yield to undergo operative diagnostic procedures.

Methods

A single-center, retrospective cohort study was performed. Medical records for patients between 6 months and 18 years of age admitted between July 2014 and September 2018 with a discharge diagnosis of acute osteomyelitis, septic arthritis, or pyomyositis were reviewed. Patients were stratified based on results of blood and source cultures. Predictors of interest were screened on a univariable basis with significant predictors retained in a multivariate analysis.

Results

There were 170 patients included. No predictors were significantly associated with increased odds of having a causative pathogen found on source culture alone. Degree of C-reactive protein elevation and history of fever were associated with decreased odds of being source culture positive, OR (95% CI); 0.92 (0.87, 0.98) and 0.39 (0.19, 0.81), respectively.

Conclusions

Predictive modeling failed to identify children with MSKIs whose causative pathogen was found by source culture alone. It is difficult to predict which MSKI patients will be highest yield for operative diagnostic procedures.

Keywords: bacterial culture; biomarker; infection; musculoskeletal; operative; pediatrics

Corresponding author: Christine E. MacBrayne, PharmD, MSCS, Department of Pharmacy, Children’s Hospital Colorado, 13123 E. 16th Ave. B375, Aurora, CO 80045, USA, E-mail: Christine.MacBrayne@childrenscolorado.org

Research funding: None declared.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: Authors state no conflict of interest.
Informed consent: Informed consent was not required for this retrospective review.
Ethical approval: This study was approved by the Institutional Review Board.

References

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Received: 2021-12-27

Accepted: 2022-05-10

Published Online: 2022-05-30

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Articles in the same Issue

https://doi.org/10.1515/dx-2021-0155

Keywords for this article

bacterial culture; biomarker; infection; musculoskeletal; operative; pediatrics