Impact of antibiotic pretreatment on cultures in children with osteomyelitis and septic arthritis

1. In a cohort of hospitalized children, culture positivity was not associated with antibiotic pretreatment.

Evidence Rating Level: 2 (Good)

Osteomyelitis and septic arthritis require prompt diagnosis, long-term antimicrobial therapy, and sometimes surgical debridement to prevent significant morbidity and mortality in pediatric patients. Although empiric antibiotics are the mainstay of treatment, there is no consensus on timing of administration. Early initiation may decrease pathogen isolation and thus prevent targeted antimicrobial treatment, whereas delay in treatment may lead to increased complications. Therefore, this retrospective review sought to identify the effect of early antibiotics on culture yield. Of 584 included participants, 263 (45.0%) had osteomyelitis, 176 (30.1%) had septic arthritis, and 145 (24.8%) participants had both. The median age of the group was 6.1 years and 60.6% were male. The primary outcome measured was culture positivity.  Patients were treated with antibiotics prior to culture in 125 of 525 (23.8%) blood cultures, 51 of 90 (56.7%) bone cultures, 92 of 265 (34.7%) joint cultures, and 140 of 197 (71%) “other” (wound, abscess, or fluid other than joint fluid) cultures. 221 of 525 blood cultures were positive, from which 55 were pretreated and 166 were not (P = 0.62). 63 of 90 bone cultures were positive, from which 38 were pretreated and 25 did not receive treatment prior to antibiotics (P = 0.29). 103 of 265 joint cultures were found to be positive, from which 36 were treated with antibiotics while 67 were not (P = 0.95). Finally, 138 of 197 “other” cultures were found to be positive where 103 received antibiotics before culture and 35 did not (P = 0.09). Overall, the study concluded that there were no significant differences in culture positivity between patients pretreated with antibiotics and those that were not pretreated. This study was the largest study to examine the effect and timing of antibiotics on culture results in this population. Therefore, future studies, preferably prospective studies, are needed to further validate these results.

Click to read the study in BMC Pediatrics

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