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Ir J Med Sci. 2019 Jan 31. doi: 10.1007/s11845-019-01973-1. [Epub ahead of print]

The role of real-time PCR testing in the investigation of paediatric patients with community-onset osteomyelitis and septic arthritis.

Author information

1
Department of Clinical Microbiology, Temple Street Children's University Hospital, Dublin 1, Ireland. orourkemicro@gmail.com.
2
Irish Meningitis and Sepsis Reference Laboratory, Temple Street Children's University Hospital, Dublin 1, Ireland.
3
Health Protection Surveillance Centre, Dublin 1, Ireland.
4
Department of Infectious Diseases, Temple Street Children's University Hospital, Dublin 1, Ireland.
5
Emergency Department, Temple Street Children's University Hospital, Dublin 1, Ireland.
6
Department of Orthopaedics, Temple Street Children's University Hospital, Dublin 1, Ireland.
7
Department of Radiology, Temple Street Children's University Hospital, Dublin 1, Ireland.
8
Department of Microbiology, Virology and Infection Prevention and Control, Great Ormond Street NHS Foundation Trust, London, UK.
9
Department of Clinical Microbiology, Royal College of Surgeons, Dublin 2, Ireland.
10
Clinical Innovation Unit, Rotunda Hospital, Dublin 1, Ireland.

Abstract

BACKGROUND:

Culture yield in osteomyelitis and septic arthritis is low, emphasising the role for molecular techniques.

AIMS:

The purpose of this study was to review the laboratory investigation of childhood osteomyelitis and septic arthritis.

METHODS:

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.

RESULTS:

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).

CONCLUSIONS:

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.

KEYWORDS:

Osteomyelitis; Paediatric; Polymerase chain reaction; Septic arthritis

PMID:
30706296
DOI:
10.1007/s11845-019-01973-1

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