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 2011-2014. Patients with chronic disease (>28 days of symptoms), orthopedic hardware, puncture wounds or an infected contiguous focus were excluded.
Results: 401 cases were reviewed with 250 meeting inclusion criteria. Microbiology data are shown in Figure 1. Blood cultures were positive for a pathogen in 107/231 cases (46.3%). 150 patients underwent surgical procedures by orthopedics of which 123 had positive BnC (82%). Among these 123 patients, 62 (50.4%) had organisms only identified through BnC; in 53 cases this information led to a change in antibiotic choice (85.4%). 66 patients had BnC by IR of which 34 (51.5%) had positive BnC and 15 (22.7%) had positive blood cultures Patients with infection of the pelvis or spine were more likely to have IR procedures performed (p<0.001, Figure 2). For those with positive IR BnC, 18 (52.9%) had a pathogen identified only by BnC; in 15/18 (83.3%) the BnC result led to a change in antibiotic management. A CRP < 3 mg/dl and a lack of fever strongly predicted a negative IR BnC (91.9%, p=0.002). IR procedures were performed with ultrasound (n=14), fluoroscopy (n=38) or CT-guidance (n=14). 35 patients required general anesthesia for IR BnC; no adverse events were related to IR procedures.
Conclusion: BnC remains important in the microbiologic diagnosis of osteomyelitis. While a large number of patients were bacteremic, BnC was the only means of identifying a pathogen in 80/216 cases (37%) and this resulted in a change in antibiotic management in >80% of such cases. IR can be utilized 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.
A. Forbes, None
K. Hulten, None
E. O. Mason Jr., None
S. L. Kaplan, Forest Labs: Grant Investigator , Grant recipient
Pfizer: Grant Investigator , Grant recipient