A Call for Additional Study on IR-Guided Bone Culture for Pediatric AHO Patients

SAN DIEGO — Bone culture was the only means of identifying a pathogen in  80 of 216 cases of pediatric acute hematogenous osteomyelitis (AHO), according to results of a retrospective study presented at ID Week.

“Identifying these pathogens through IR guided bone culture was important to treatment, since properly identification often times led to a change in the type of antibiotic the patient was prescribed,” Jonathon McNeil, MD, of Baylor College of Medicine and Texas Children’s Hospital said during his presentation of the abstract.

“The study looked at pediatric cases of AHO seen by the infectious  diseases consult service at Texas Children’s Hospital from Jan. 2013 through June 2014. In 46.3% of reviewed cases, blood cultures were positive for a pathogen.

The researchers noted that their orthopedic surgeons operated on 150 patients and 82% had a positive bone culture. Among those, half had organisms identified only through bone culture.  This led to a change in antibiotic choice for 53 patients.

Sixty-six patients had an interventional radiology-guided bone culture. 

Just over half of those patients,  51.5 percent, had a positive bone  culture and 15 patients had positive blood cultures.

Patients with infection in the pelvis or spine were more likely to have IR-guided procedures, the researchers noted. For those with a positive IR bone culture, 18 patients had a pathogen identified only though the bone culture. In 15 of those 18 cases, the bone culture result led to a change in antibiotic management.

A CRP less than three mg/dl and a lack of fever strongly predicted a negative IR bone culture, according to the researchers. Thirty-five patients required general anesthesia for the IR bone culture.

Dr McNeil said that their findings suggest that IR-guided bone culture “can be performed to obtain culture material  safely and effectively particularly in patients with sites of disease that are difficult to access surgically,” however, he said, more data are needed.

Reference

1. McNeil, Jonathon, MD, Vallejo, Jesus, MD, Forbes, Andrea, RN, et al. The Utilization of Interventional Radiology Procedures in the Microbiologic Diagnosis of Pediatric Acute Hematogenous Osteomyelitis. Abstract #75, Presented at Infectious Disease Week, Oct. 7–12, 2015, San Diego.