دورية أكاديمية
أعرض في EDS

Age and CRP Associated With Improved Tissue Pathogen Identification in Children With Blood Culture Negative Osteomyelitis: Results From the CORTICES Multicenter Database.

التفاصيل البيبلوغرافية
العنوان: Age and CRP Associated With Improved Tissue Pathogen Identification in Children With Blood Culture Negative Osteomyelitis: Results From the CORTICES Multicenter Database.
المؤلفون: Burns JD; Phoenix Children's Hospital, Phoenix, AZ., Upasani VV; Rady Children's Hospital, San Diego, CA., Bastrom TP; Rady Children's Hospital, San Diego, CA., Baldwin KD; Children's Hospital of Philadelphia, Philadelphia, PA., Schoenecker JG; Vanderbilt Children's Orthopedics, Nashville, TN., Shore BJ; Boston Children's Hospital, Boston, MA., Brighton BK; OrthoCarolina, Concord, NC., Goldstein RY; Children's Hospital, Los Angeles, CA., Heyworth BE; Boston Children's Hospital, Boston, MA., Miller ML; Washington University, St. Louis, MO., Sanders JS; Children's Hospital Colorado, Aurora, CO., Truong WH; Gillette Children's, St. Paul, MN.
مؤلفون مشاركون: Childrens ORthopedic Trauma and Infection Consortium for Evidence-Based Study
المصدر: Journal of pediatric orthopedics [J Pediatr Orthop] 2023 Sep 01; Vol. 43 (8), pp. e603-e607. Date of Electronic Publication: 2023 Jun 05.
نوع المنشور: Multicenter Study; Journal Article
اللغة: English
بيانات الدورية: Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 8109053 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1539-2570 (Electronic) Linking ISSN: 02716798 NLM ISO Abbreviation: J Pediatr Orthop Subsets: MEDLINE
أسماء مطبوعة: Publication: 2000- : Philadelphia : Lippincott Williams & Wilkins
Original Publication: New York Ny : Raven Press
مواضيع طبية MeSH: Methicillin-Resistant Staphylococcus aureus* , Osteomyelitis*/diagnosis , Osteomyelitis*/drug therapy , Osteomyelitis*/complications, Child ; Humans ; Child, Preschool ; C-Reactive Protein/analysis ; Blood Culture ; Retrospective Studies ; Anti-Bacterial Agents/therapeutic use ; Acute Disease
مستخلص: Background: Acute hematogenous osteomyelitis (AHO) is a relatively common condition in children, and identifying the offending pathogen with blood or tissue cultures aids in diagnosis and medical management while reducing treatment failure. Recent 2021 AHO clinical practice guidelines from the Pediatric Infectious Disease Society recommend obtaining routine tissue cultures, particularly in cases with negative blood cultures. The purpose of this study was to identify variables associated with positive tissue cultures when blood cultures are negative.
Methods: Children with AHO from 18 pediatric medical centers throughout the United States through the Children's ORthopaedic Trauma and Infection Consortium for Evidence-based Study were evaluated for predictors of positive tissue cultures when blood cultures were negative. Cutoffs of predictors were determined with associated sensitivity and specificity.
Results: One thousand three children with AHO were included, and in 688/1003 (68.6%) patients, both blood cultures and tissue cultures were obtained. In patients with negative blood cultures (n=385), tissue was positive in 267/385 (69.4%). In multivariate analysis, age ( P <0.001) and C-reactive protein (CRP) ( P =0.004) were independent predictors. With age >3.1 years and CRP >4.1 mg/dL as factors, the sensitivity of obtaining a positive tissue culture when blood cultures were negative was 87.3% (80.9-92.2%) compared with 7.1% (4.4-10.9%) if neither of these factors was present. There was a lower ratio of methicillin-resistant Staphylococcus aureus in blood culture-negative patients who had a positive tissue culture 48/188 (25.5%), compared with patients who had both positive blood and tissue cultures 108/220 (49.1%).
Conclusion: AHO patients with CRP ≤ 4.1 mg/dL and age under 3.1 years are unlikely to have clinical value from tissue biopsy that exceeds the morbidity associated with this intervention. In patients with CRP > 4.1 mg/dL and age over 3.1 years, obtaining a tissue specimen may add value; however, it is important to note that effective empiric antibiotic coverage may limit the utility of positive tissue cultures in AHO.
Level of Evidence: Level III-Retrospective comparative study.
(Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
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فهرسة مساهمة: Investigator: JA Janicki; DJ Hedequist; CJ May; JS Murphy; JR Denning; JC Laine; DD Spence; AC Beebe; KD Rickert; AW Lindberg; TJ Blumberg; SB Rosenfeld; JF Hill; LA Copley; ME Johnson; BA Ramo; AI Riccio; GY Li; SN Moore-Lotridge; RJ Koehler; M Stepanovich; D McLaughlin; N Fletcher; J Owen; A Arkader; W Ramalingam; S De; B Sheffer; J Larson; A Kadado; N Lempert; Z Meyer; I Swarup
المشرفين على المادة: 9007-41-4 (C-Reactive Protein)
0 (Anti-Bacterial Agents)
تواريخ الأحداث: Date Created: 20230606 Date Completed: 20230808 Latest Revision: 20230808
رمز التحديث: 20230808
DOI: 10.1097/BPO.0000000000002448
PMID: 37278086
قاعدة البيانات: MEDLINE
الوصف
تدمد:1539-2570
DOI:10.1097/BPO.0000000000002448