O'Rourke Sadhbh, Meehan Mary, Bennett Désirée, O'Sullivan Nicola, Cunney Robert, Gavin Patrick, McNamara Roisin, Cassidy Noelle, Ryan Stephanie, Harris Kathryn, Drew Richard
Department of Clinical Microbiology, Temple Street Children's University Hospital, Dublin 1, Ireland.
Irish Meningitis and Sepsis Reference Laboratory, Temple Street Children's University Hospital, Dublin 1, Ireland.
Ir J Med Sci. 2019 Nov;188(4):1289-1295. doi: 10.1007/s11845-019-01973-1. Epub 2019 Jan 31.
Culture yield in osteomyelitis and septic arthritis is low, emphasising the role for molecular techniques.
The purpose of this study was to review the laboratory investigation of childhood osteomyelitis and septic arthritis.
A retrospective review was undertaken in an acute tertiary referral paediatric hospital from January 2010 to December 2016. Cases were only included if they had a positive culture or bacterial PCR result from a bone/joint specimen or blood culture, or had radiographic evidence of osteomyelitis.
Seventy-eight patients met the case definition; 52 (66%) were male. The median age was 4.8 years. Blood cultures were positive in 16 of 56 cases (29%), with 11 deemed clinically significant (Staphylococcus aureus = 8, group A Streptococcus = 3). Thirty-seven of 78 (47%) bone/joint samples were positive by culture with S. aureus (n = 16), coagulase-negative Staphylococcus (n = 9) and group A Streptococcus (n = 4), being the most common organisms. Sixteen culture-negative samples were sent for bacterial PCR, and four were positive (Kingella kingae = 2, Streptococcus pneumoniae = 1, group A Streptococcus = 1).
Sequential culture and PCR testing can improve the detection rate of causative organisms in paediatric bone and joint infections, particularly for fastidious microorganisms such as K. kingae. PCR testing can be reserved for cases where culture is negative after 48 h. These results have been used to develop a standardised diagnostic test panel for bone and joint infections at our institution.
骨髓炎和脓毒性关节炎的培养阳性率较低，这凸显了分子技术的作用。
本研究旨在回顾儿童骨髓炎和脓毒性关节炎的实验室检查情况。
对一家急性三级转诊儿科医院2010年1月至2016年12月期间的病例进行回顾性研究。仅纳入那些骨/关节标本或血培养的培养结果或细菌PCR结果为阳性，或有骨髓炎影像学证据的病例。
78例患者符合病例定义；52例（66%）为男性。中位年龄为4.8岁。56例中的16例（29%）血培养呈阳性，其中11例被认为具有临床意义（金黄色葡萄球菌=8例，A组链球菌=3例）。78例中的37例（47%）骨/关节样本培养呈阳性，金黄色葡萄球菌（n = 16）、凝固酶阴性葡萄球菌（n = 9）和A组链球菌（n = 4）是最常见的病原体。16例培养阴性的样本送去进行细菌PCR检测，4例呈阳性（金氏金杆菌=2例，肺炎链球菌=1例，A组链球菌=1例）。
序贯培养和PCR检测可提高儿童骨和关节感染中致病病原体的检出率，特别是对于像金氏金杆菌这样的苛养微生物。PCR检测可保留用于培养48小时后仍为阴性的病例。这些结果已被用于制定我们机构骨和关节感染的标准化诊断检测方案。
