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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

Comparison of the sensitivities of culture of joint aspirates (Modality 1) and culture of joint plus bone aspirates (Modality 2). Receiver operating characteristic (ROC) curves with area under the curve (AUC) values
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Fig2: Comparison of the sensitivities of culture of joint aspirates (Modality 1) and culture of joint plus bone aspirates (Modality 2). Receiver operating characteristic (ROC) curves with area under the curve (AUC) values

Mentions: We compared the sensitivities of both modalities (Modality 1: using joint aspirates alone; Modality 2: using joint aspirates plus aspirates of the ilium and femur) with ROC curves. ROC analysis showed that the AUC for Modality 2 was larger than that of Modality 1 (Mod 1 AUC = 0.744; Mod 2 AUC = 1). The Chi-square test yielded a significance probability of 0.003, suggesting that the overall performance of using positive joint aspirates plus aspirates of the ilium and femur was significantly better than using joint aspirates alone for detecting the infectious organism for a peri-articular hip infection (Fig. 2).Fig. 2


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)

Comparison of the sensitivities of culture of joint aspirates (Modality 1) and culture of joint plus bone aspirates (Modality 2). Receiver operating characteristic (ROC) curves with area under the curve (AUC) values
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig2: Comparison of the sensitivities of culture of joint aspirates (Modality 1) and culture of joint plus bone aspirates (Modality 2). Receiver operating characteristic (ROC) curves with area under the curve (AUC) values
Mentions: We compared the sensitivities of both modalities (Modality 1: using joint aspirates alone; Modality 2: using joint aspirates plus aspirates of the ilium and femur) with ROC curves. ROC analysis showed that the AUC for Modality 2 was larger than that of Modality 1 (Mod 1 AUC = 0.744; Mod 2 AUC = 1). The Chi-square test yielded a significance probability of 0.003, suggesting that the overall performance of using positive joint aspirates plus aspirates of the ilium and femur was significantly better than using joint aspirates alone for detecting the infectious organism for a peri-articular hip infection (Fig. 2).Fig. 2

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