The Utilization of Interventional Radiology Procedures in the Microbiologic Diagnosis of Pediatric Acute Hematogenous Osteomyelitis
Year: 2015
Type: article
Study design: Observational Study
Abstract: Background. Acute hematogenous osteomyelitis (AHO) is a severe infection in children. Drainage of purulent collections in bones serves a dual purpose of providing specimens for culture as well as a therapeutic benefit. Interventional radiology (IR)-guided aspiration of bone may serve as a less invasive means of bone culture (BnC) in select patients. We examined the impact of IR obtained BnC in AHO diagnosis and management. Methods. A retrospective review of cases of AHO seen by the infectious diseases consult service at Texas Children's Hospital was performed from 2011 to 2014. Patients with chronic disease (>28 days of symptoms), orthopedic hardware, puncture wounds, or an infected contiguous focus were excluded. Results. Four hundred one cases were reviewed with 250 meeting inclusion criteria. Microbiology data are shown in figure 1. Blood cultures were positive for a pathogen in 107 of 231 cases (46.3%). One hundred fifty patients underwent surgical procedures by orthopedics, 123 (82%) of which had positive BnC. Among these 123 patients, 62 (50.4%) had organisms only identified through BnC; in 53 cases (85.4%), this information led to a change in antibiotic choice. Sixty-six patients had BnC by IR, 34 (51.5%) of which had positive BnC and 15 (22.7%) of which had positive blood cultures. Patients with infection of the pelvis or spine were more likely to have IR procedures performed (P < .001; figure 2). For those with positive IR BnC, 18 (52.9%) had a pathogen identified only by BnC; in 15 of 18 (83.3%) cases, the BnC result led to a change in antibiotic management. A C-reactive protein <3 mg/dL and a lack of fever strongly predicted a negative IR BnC (91.9%; P = .002). The IR procedures were performed with ultrasound (n = 14), fluoroscopy (n = 38), or computed tomography guidance (n = 14). Thirty-five patients required general anesthesia for IR BnC; no adverse events were related to IR procedures. Conclusion. The BnC remains important in the microbiologic diagnosis of osteomyelitis. Although a large number of patients were bacteremic, BnC was the only means of identifying a pathogen in 80 of 216 cases (37%), and this resulted in a change in antibiotic management in >80% of such cases. Interventional radiology can be used safely to obtain bone cultures in children with AHO not requiring open surgical drainage. Further research is needed to better understand the optimal utilization of IR in the management of pediatric AHO. Disclosures. S. L. Kaplan, Forest Laboratories: Grant Investigator, Grant recipient. Pfizer: Grant Investigator, Grant recipient
Source: Open Forum Infectious Diseases
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $4,053
OpenAlex ID: W2346630873