Divisions of Pediatric Orthopaedics (C.H.S., T.-J.C., I.H.C., and W.J.Y.), and Pediatrics (E.H.C.), Seoul National University Children's Hospital, Seoul, Republic of Korea.
Department of Orthopaedic Surgery, Jeju National University Hospital, Jeju, Republic of Korea.
J Bone Joint Surg Am. 2020 Oct 21;102(20):1792-1798. doi: 10.2106/JBJS.20.00219.
The detection and identification of pathogenic microorganisms are essential for the treatment of osteoarticular infection. However, obtaining a sufficient amount of specimen from pediatric patients is often difficult. Herein, we aimed to demonstrate the effectiveness of the blood culture bottle (BCB) system in pediatric osteoarticular infections. We hypothesized that our BCB culture method is superior to the conventional swab and tissue culture methods in terms of required specimen size, incubation time, and microbial identification rate.
We analyzed the prospectively collected data of pediatric patients who underwent surgical treatment for osteoarticular infections between August 2016 and October 2019. Four needles were dipped in the infected fluid or tissue during the surgical procedure as soon as the infected area was exposed and were used to inoculate 2 aerobic pediatric BCBs and 2 anaerobic general BCBs. We also collected 2 conventional swab samples and 2 tissue samples from the identical area. The microbial identification rate and the time required for identification were compared between BCB, swab, and tissue cultures.
Forty patients constituted the study group; 13 patients had osteomyelitis, 17 patients had septic arthritis, and 10 patients had both. Of these 40 patients, the microbial identification rate was higher with BCB cultures (27 [68%]) than with swab cultures (18 [45%]; p = 0.004) or tissue cultures (15 [38%]; p < 0.001). Nine samples (9 patients [23%]) were only positive in the BCB culture. Positive microbial growth was not detected with conventional culture methods when microorganisms did not grow on the BCB culture. Compared with swab culture (4.3 ± 1.1 days; p < 0.001) or tissue culture (4.4 ± 1.1 days; p < 0.001), the BCB culture reduced the time required for microbial identification (3.5 ± 0.9 days).
In pediatric osteoarticular infections, the BCB culture system improved the microbial identification rate, reduced the time to identification, and permitted a smaller-volume specimen, compared with traditional culture systems.
Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.
检测和鉴定病原体对于骨关节感染的治疗至关重要。然而，从儿科患者中获取足够量的标本通常较为困难。在此，我们旨在展示血培养瓶（BCB）系统在儿科骨关节感染中的有效性。我们假设，与传统的拭子和组织培养方法相比，我们的 BCB 培养方法在所需标本量、孵育时间和微生物鉴定率方面具有优势。
我们分析了 2016 年 8 月至 2019 年 10 月期间接受骨关节感染手术治疗的儿科患者的前瞻性数据。一旦暴露感染区域，就会用 4 根针从感染的液体或组织中蘸取标本，并将其接种到 2 个需氧儿科 BCB 和 2 个厌氧普通 BCB 中。我们还从相同区域采集了 2 个传统拭子样本和 2 个组织样本。比较了 BCB、拭子和组织培养物的微生物鉴定率和鉴定所需的时间。
40 名患者构成了研究组；13 名患者患有骨髓炎，17 名患者患有脓毒性关节炎，10 名患者同时患有这两种疾病。在这 40 名患者中，BCB 培养物的微生物鉴定率（27 [68%]）高于拭子培养物（18 [45%]；p = 0.004）或组织培养物（15 [38%]；p < 0.001）。在仅 9 个样本（9 名患者[23%]）中 BCB 培养物为阳性。当 BCB 培养物上未生长微生物时，传统培养方法未检测到阳性微生物生长。与拭子培养物（4.3 ± 1.1 天；p < 0.001）或组织培养物（4.4 ± 1.1 天；p < 0.001）相比，BCB 培养物缩短了微生物鉴定所需的时间（3.5 ± 0.9 天）。
在儿科骨关节感染中，与传统培养系统相比，BCB 培养系统提高了微生物鉴定率，缩短了鉴定时间，并且可以使用更小体积的标本。
诊断 II 级。有关证据水平的完整描述，请参阅作者指南。
