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Aspirations of the ilium and proximal femur increase the likelihood of culturing an organism in patients with presumed septic arthritis of the hip.

Schmale GA, Bompadre V - J Child Orthop (2015)

Bottom Line: Culture results from aspirates of synovial fluid and bone and tissue from capsule were compared to determine the sensitivities and specificities of a synovial aspirate alone versus synovial aspirate plus aspirates of the ilium and proximal femur to detect infection.The sensitivity of hip synovial fluid aspirates to detect infection via positive culture was only 63 %, though this increased significantly to 100 % when the results of cultures of aspirates of the ilium and proximal femur were included.Positive cultures from a child with a septic hip or peri-articular hip infection help to efficiently and effectively guide antibiotic treatment.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedics and Sports Medicine, Seattle Children's Hospital, 4800 Sand Point Way NE, M/S OA.9.120, Seattle, WA, 98105, USA, gschmale@uw.edu.

ABSTRACT

Purpose: To test the hypothesis that collecting material for culture from metaphyseal bone of the ilium and proximal femur at the time of a hip aspiration will increase the sensitivity to detect an infectious organism in patients with presumed septic arthritis of the hip.

Methods: We retrospectively reviewed a series of 36 patients with presumed septic arthritis of the hip, based on clinical exam and serum inflammatory markers, who underwent aspirations of hip synovial fluid as well as blood from the ilium and proximal femur. Culture results from aspirates of synovial fluid and bone and tissue from capsule were compared to determine the sensitivities and specificities of a synovial aspirate alone versus synovial aspirate plus aspirates of the ilium and proximal femur to detect infection.

Results: The sensitivity of hip synovial fluid aspirates to detect infection via positive culture was only 63 %, though this increased significantly to 100 % when the results of cultures of aspirates of the ilium and proximal femur were included. The specificities were equivalent in both modalities (≥90 %). We conclude that obtaining aspirates of the ilium and proximal femur at the time of hip synovial fluid aspiration increases the likelihood that the procedure will return an infectious organism.

Conclusion: Positive cultures from a child with a septic hip or peri-articular hip infection help to efficiently and effectively guide antibiotic treatment. The child with a septic hip or peri-articular hip infection and positive cultures is likely to receive more narrow-spectrum therapy, potentially decreasing the overuse of broad-spectrum antibiotics.

Level of evidence: DIAGNOSTIC STUDY LEVEL III: Development of diagnostic criteria on the basis of a series of non-consecutive patients (with universally applied reference "gold standard").

No MeSH data available.


Related in: MedlinePlus

a Fluoroscopic image of the position of the 18-gauge spinal needle for a hip joint aspiration via a sub-adductor approach. b Fluoroscopic image of the hip arthrogram using a mixture of radio-opaque dye and saline. c Fluoroscopic image of needle position for aspiration of medullary blood from the proximal femur. d Fluoroscopic image of needle position for aspiration of medullary blood from the ilium
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Fig1: a Fluoroscopic image of the position of the 18-gauge spinal needle for a hip joint aspiration via a sub-adductor approach. b Fluoroscopic image of the hip arthrogram using a mixture of radio-opaque dye and saline. c Fluoroscopic image of needle position for aspiration of medullary blood from the proximal femur. d Fluoroscopic image of needle position for aspiration of medullary blood from the ilium

Mentions: This is a retrospective review of all patients (84) treated surgically by one surgeon at one children’s hospital for a diagnosis of probable septic arthritis of the hip between 2001 and 2012. Of these 84 patients, a subset of 36 patients aged 4–21 years with 37 treated hips was identified and included as they were treated not only by hip aspiration, but aspiration of peri-articular bone (Fig. 1) and open wash-out of the hip because of purulence of the joint aspirate. All aspirates and specimens from the hip joint capsules were then sent for culture. This subset of patients with suspected septic arthritis of the hip included all those that had the most extensive culturing of tissues, i.e. including cultures from aspirates of synovial fluid, blood from the ilium to proximal femur and a hip joint capsule, so that the added value of aspirations of bone about the hip could best be determined.Fig. 1


Aspirations of the ilium and proximal femur increase the likelihood of culturing an organism in patients with presumed septic arthritis of the hip.

Schmale GA, Bompadre V - J Child Orthop (2015)

a Fluoroscopic image of the position of the 18-gauge spinal needle for a hip joint aspiration via a sub-adductor approach. b Fluoroscopic image of the hip arthrogram using a mixture of radio-opaque dye and saline. c Fluoroscopic image of needle position for aspiration of medullary blood from the proximal femur. d Fluoroscopic image of needle position for aspiration of medullary blood from the ilium
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4549341&req=5

Fig1: a Fluoroscopic image of the position of the 18-gauge spinal needle for a hip joint aspiration via a sub-adductor approach. b Fluoroscopic image of the hip arthrogram using a mixture of radio-opaque dye and saline. c Fluoroscopic image of needle position for aspiration of medullary blood from the proximal femur. d Fluoroscopic image of needle position for aspiration of medullary blood from the ilium
Mentions: This is a retrospective review of all patients (84) treated surgically by one surgeon at one children’s hospital for a diagnosis of probable septic arthritis of the hip between 2001 and 2012. Of these 84 patients, a subset of 36 patients aged 4–21 years with 37 treated hips was identified and included as they were treated not only by hip aspiration, but aspiration of peri-articular bone (Fig. 1) and open wash-out of the hip because of purulence of the joint aspirate. All aspirates and specimens from the hip joint capsules were then sent for culture. This subset of patients with suspected septic arthritis of the hip included all those that had the most extensive culturing of tissues, i.e. including cultures from aspirates of synovial fluid, blood from the ilium to proximal femur and a hip joint capsule, so that the added value of aspirations of bone about the hip could best be determined.Fig. 1

Bottom Line: Culture results from aspirates of synovial fluid and bone and tissue from capsule were compared to determine the sensitivities and specificities of a synovial aspirate alone versus synovial aspirate plus aspirates of the ilium and proximal femur to detect infection.The sensitivity of hip synovial fluid aspirates to detect infection via positive culture was only 63 %, though this increased significantly to 100 % when the results of cultures of aspirates of the ilium and proximal femur were included.Positive cultures from a child with a septic hip or peri-articular hip infection help to efficiently and effectively guide antibiotic treatment.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedics and Sports Medicine, Seattle Children's Hospital, 4800 Sand Point Way NE, M/S OA.9.120, Seattle, WA, 98105, USA, gschmale@uw.edu.

ABSTRACT

Purpose: To test the hypothesis that collecting material for culture from metaphyseal bone of the ilium and proximal femur at the time of a hip aspiration will increase the sensitivity to detect an infectious organism in patients with presumed septic arthritis of the hip.

Methods: We retrospectively reviewed a series of 36 patients with presumed septic arthritis of the hip, based on clinical exam and serum inflammatory markers, who underwent aspirations of hip synovial fluid as well as blood from the ilium and proximal femur. Culture results from aspirates of synovial fluid and bone and tissue from capsule were compared to determine the sensitivities and specificities of a synovial aspirate alone versus synovial aspirate plus aspirates of the ilium and proximal femur to detect infection.

Results: The sensitivity of hip synovial fluid aspirates to detect infection via positive culture was only 63 %, though this increased significantly to 100 % when the results of cultures of aspirates of the ilium and proximal femur were included. The specificities were equivalent in both modalities (≥90 %). We conclude that obtaining aspirates of the ilium and proximal femur at the time of hip synovial fluid aspiration increases the likelihood that the procedure will return an infectious organism.

Conclusion: Positive cultures from a child with a septic hip or peri-articular hip infection help to efficiently and effectively guide antibiotic treatment. The child with a septic hip or peri-articular hip infection and positive cultures is likely to receive more narrow-spectrum therapy, potentially decreasing the overuse of broad-spectrum antibiotics.

Level of evidence: DIAGNOSTIC STUDY LEVEL III: Development of diagnostic criteria on the basis of a series of non-consecutive patients (with universally applied reference "gold standard").

No MeSH data available.


Related in: MedlinePlus