Acute osteomyelitis and septic arthritis in the neonate, risk factors and outcome

Abstract Background Osteoarticular infections are often encountered in the pediatric population. Therapy is guided by isolation of a putative organism, however, operative cultures are often negative. Next generation sequencing (NGS) allows for more sensitive sampling of body compartments generally considered sterile. We sought to evaluate the utility of NGS in comparison to culture in detecting a pathogenic organism in acute osteomyelitis and septic arthritis in children. Methods This was a single-site study to evaluate the utility of NGS in comparison to culture in detecting a pathogenic organism in acute osteomyelitis and septic arthritis in children. Eligible patients were all patients with osteomyelitis or septic arthritis admitted to Rady Children’s Hospital from July 2019 through July 2020. We excluded any patients with bone or joint surgery within 30 days prior to admission. Operative samples were chosen at the surgeon’s discretion (joint aspirate, synovium, or bone) based on operative findings. We compared NGS testing to standard care culture from the same site. Results We enrolled 41 subjects. NGS of the operative samples identified a pathogen in 26 (63.4%) patients versus 18 (43.9%) by culture. Operative culture missed the diagnosis in 10 cases, though PCR identified the organism in 6 of those cases (5 were cases in which Kingella kingae was identified). In 4 subjects, NGS identified a putative organism where standard care testing (either PCR or culture) was negative. NGS was falsely positive in 1 subject and falsely negative for one other subject. Sensitivity was 96.3% (CI 95%, 81.0–99.9%) and Specificity was 92.9% (CI 95%, 66.1–99.8) for NGS versus 64.3% (CI 95%, 44.1–81.4) and 84.6% (CI 95%, 54.6–99.9%) for culture respectively. Conclusion In this single site prospective study of pediatric osteoarticular infections, we demonstrate improved sensitivity and specificity of NGS testing when compared to standard culture. Disclosures All Authors: No reported disclosures

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64-year-old male with septic arthritis of the pubic symphysis

Clinics and Practice ◽

10.4081/cp.2011.e76 ◽

2011 ◽

Vol 1 (3) ◽

pp. 76 ◽

Cited By ~ 3

Author(s):

Ewa Konik ◽

Brent Bauer ◽

Mark Lee

Keyword(s):

Risk Factors ◽

Staphylococcus Aureus ◽

Pseudomonas Aeruginosa ◽

Septic Arthritis ◽

Groin Pain ◽

Pubic Symphysis ◽

Pelvic Malignancy ◽

Incontinence Surgery ◽

Streptococcus Anginosus ◽

Hip Motion

Septic arthritis of the pubic symphysis is a rare disease. Typical clinical features include fever, pubic or groin pain, pain with hip motion, and painful or waddling gait. Identified predisposing factors to develop an infection in pubic joint include female incontinence surgery or postpartum period; sports, especially soccer; pelvic malignancy; and intravenous drug abuse. The most often identified microorganisms were Staphylococcus aureus and Pseudomonas aeruginosa. Osteomyelitis complicates the majority of cases, and about half of the patients require surgical debridement along with a prolonged antibiotic treatment. We report a case of Streptococcus anginosus septic arthritis of the pubic symphysis. The patient did not have any of the above risk factors.

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Acute osteomyelitis and septic arthritis in children

Journal of Paediatrics and Child Health ◽

10.1111/j.1440-1754.2005.00538.x ◽

2005 ◽

Vol 41 (1-2) ◽

pp. 59-62 ◽

Cited By ~ 156

Author(s):

ED Goergens ◽

A McEvoy ◽

M Watson ◽

IR Barrett

Keyword(s):

Septic Arthritis ◽

Acute Osteomyelitis

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393. Changing Trends, Risk Factors, and Treatment Challenges in Staphylococcus aureus Septic Arthritis

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.466 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S202-S202

Author(s):

Valerie Gobao ◽

Mostafa Alfishawy ◽

Neel Shah ◽

Karin Byers ◽

Mohamed Yassin ◽

...

Keyword(s):

Risk Factors ◽

Staphylococcus Aureus ◽

Drug Use ◽

Positive Result ◽

Septic Arthritis ◽

Intravenous Drug ◽

Intravenous Drug Use ◽

Retrospective Case ◽

Factors Associated ◽

Rule Out

Abstract Background Staphylococcus aureus is a common organism in native septic arthritis. It is traditionally believed to be self-limited with rapid and aggressive debridement and appropriate antibiotic selection. The incidence of S. aureus septic arthritis is increasing, and further characterization is needed to improve diagnosis and treatment. For patients presenting with native S. aureus septic arthritis, we evaluated the reliability of methicillin-resistant S. aureus (MRSA) screening as a predictor to rule out MRSA septic arthritis, the risk factors associated with this disease, and the treatment and surgical outcomes. Methods A retrospective case–control study of patients diagnosed with septic arthritis in the UPMC health system (Pittsburgh, PA) between 2012 and 2016 was completed. The primary outcomes of interest were surgical intervention and the need to alter antibiotic treatment. Patient demographics, characteristics, and outcomes were recorded. Results A total of 215 cases of septic arthritis were identified, and 64% (n = 138) had S. aureus cultured. In this set, 36% (50/138) of these patients were identified with MRSA. Of the patients diagnosed with MRSA septic arthritis, 50% screened prior to admission had a positive result (8/16) and 48% screened during admission had a positive result (14/29). Compared with septic arthritis with other organisms, risk factors associated with S. aureus included history of intravenous drug use (OR: 4.3, CI: 1.7 to 10.8, P = 0.002) and being immunocompetent (OR: 0.3, CI: 0.1 to 0.6, P = 0.002). These infections were associated with concurrent infections of the spine (OR: 5.7, CI: 2.1 to 15.1, P = 0.0005). As compared with other organisms, there was a high probability of switching antibiotics during treatment (OR: 3.7, CI: 1.1 to 13.0, P = 0.04) and relapse of infection (OR: 4.2, CI: 1.2 to 14.6, P = 0.02). Conclusion S. aureus septic arthritis is associated with intravenous drug use, and not with immunosuppression. A negative MRSA screen does not rule out this organism. Concurrent spine infections are common. There is a high likelihood of infection relapse and that antibiotics will need to be altered during treatment. With the opioid epidemic, the incidence is likely to increase further. More work is needed to improve diagnosis and overcome treatment challenges. Disclosures All authors: No reported disclosures.

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