Advertisement

The role of real-time PCR testing in the investigation of paediatric patients with community-onset osteomyelitis and septic arthritis

  • Sadhbh O’RourkeEmail author
  • Mary Meehan
  • Désirée Bennett
  • Nicola O’Sullivan
  • Robert Cunney
  • Patrick Gavin
  • Roisin McNamara
  • Noelle Cassidy
  • Stephanie Ryan
  • Kathryn Harris
  • Richard Drew
Original Article
  • 17 Downloads

Abstract

Background

Culture yield in osteomyelitis and septic arthritis is low, emphasising the role for molecular techniques.

Aims

The purpose of this study was to review the laboratory investigation of childhood osteomyelitis and septic arthritis.

Methods

A retrospective review was undertaken in an acute tertiary referral paediatric hospital from January 2010 to December 2016. Cases were only included if they had a positive culture or bacterial PCR result from a bone/joint specimen or blood culture, or had radiographic evidence of osteomyelitis.

Results

Seventy-eight patients met the case definition; 52 (66%) were male. The median age was 4.8 years. Blood cultures were positive in 16 of 56 cases (29%), with 11 deemed clinically significant (Staphylococcus aureus = 8, group A Streptococcus = 3). Thirty-seven of 78 (47%) bone/joint samples were positive by culture with S. aureus (n = 16), coagulase-negative Staphylococcus (n = 9) and group A Streptococcus (n = 4), being the most common organisms. Sixteen culture-negative samples were sent for bacterial PCR, and four were positive (Kingella kingae = 2, Streptococcus pneumoniae = 1, group A Streptococcus = 1).

Conclusions

Sequential culture and PCR testing can improve the detection rate of causative organisms in paediatric bone and joint infections, particularly for fastidious microorganisms such as K. kingae. PCR testing can be reserved for cases where culture is negative after 48 h. These results have been used to develop a standardised diagnostic test panel for bone and joint infections at our institution.

Keywords

Osteomyelitis Paediatric Polymerase chain reaction Septic arthritis 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the TSCUH Research and Ethics Committee as a retrospective review (Reference 16.052). For this type of study, formal consent is not required. This article does not contain any studies with animals performed by any of the authors.

References

  1. 1.
    Cohen E, Lifshitz K, Fruchtman Y, Eidelman M, Leibovitz E (2016) Current data on acute haematogenous osteomyelitis in children in southern Israel: epidemiology, microbiology, clinics and therapeutic consequences. Int Orthop 40(9):1987–1994.  https://doi.org/10.1007/s00264-016-3211-6 CrossRefGoogle Scholar
  2. 2.
    Martin AC, Anderson D, Lucey J, Guttinger R, Jacoby PA, Mok TJ, Whitmore TJ, Whitewood CN, Burgner DP, Blyth CC (2016) Predictors of outcome in pediatric osteomyelitis: five years experience in a single tertiary center. Pediatr Infect Dis J 35(4):387–391.  https://doi.org/10.1097/INF.0000000000001031 CrossRefGoogle Scholar
  3. 3.
    Chiappini E, Camposampiero C, Lazzeri S, et al. (2017) Epidemiology and management of acute haematogenous osteomyelitis in a tertiary paediatric center. Int J Environ Res Public Health 14(5).  https://doi.org/10.3390/ijerph14050477
  4. 4.
    Grote V, Silier CC, Voit AM et al (2017) Bacterial osteomyelitis or nonbacterial osteitis in children: a study involving the German surveillance unit for rare diseases in childhood. Pediatr Infect Dis J 36(5):451–456.  https://doi.org/10.1097/INF.0000000000001469 CrossRefGoogle Scholar
  5. 5.
    Kerr DL, Loraas EK, Links AC et al (2017) Toxic shock in children with bone and joint infections: a review of seven years of patients admitted to one intensive care unit. J Child Orthop 11(5):387–392.  https://doi.org/10.1302/1863-2548.11.170058 CrossRefGoogle Scholar
  6. 6.
    Osei L, El Houmami N, Minodier P et al (2017) Paediatric bone and joint infections in French Guiana: a 6 year retrospective review. J Trop Pediatr 63(5):380–388.  https://doi.org/10.1093/tropej/fmw102 CrossRefGoogle Scholar
  7. 7.
    Al-Qwbani M, Jiang N, Yu B (2016) Kingella kingae-associated pediatric osteoarticular infections: an overview of 566 reported cases. Clin Pediatr (Phila) 55(14):1328–1337.  https://doi.org/10.1177/0009922816629620 CrossRefGoogle Scholar
  8. 8.
    Gravel J, Ceroni D, Lacroix L, Renaud C, Grimard G, Samara E, Cherkaoui A, Renzi G, Schrenzel J, Manzano S (2017) Association between oropharyngeal carriage of Kingella kingae and osteoarticular infection in young children: a case-control study. CMAJ 189(35):E1107–E1e11.  https://doi.org/10.1503/cmaj.170127 CrossRefGoogle Scholar
  9. 9.
    Saavedra-Lozano J, Falup-Pecurariu O, Faust SN, Girschick H, Hartwig N, Kaplan S, Lorrot M, Mantadakis E, Peltola H, Rojo P, Zaoutis T, LeMair A (2017) Bone and joint infections. Pediatr Infect Dis J 36(8):788–799.  https://doi.org/10.1097/INF.0000000000001635 CrossRefGoogle Scholar
  10. 10.
    Harris KA, Hartley JC (2003) Development of broad-range 16S rDNA PCR for use in the routine diagnostic clinical microbiology service. J Med Microbiol 52(Pt 8):685–691CrossRefGoogle Scholar
  11. 11.
    Tann CJ, Nkurunziza P, Nakakeeto M, Oweka J, Kurinczuk JJ, Were J, Nyombi N, Hughes P, Willey BA, Elliott AM, Robertson NJ, Klein N, Harris KA (2014) Prevalence of bloodstream pathogens is higher in neonatal encephalopathy cases vs. controls using a novel panel of real-time PCR assays. PLoS One 9(5):e97259.  https://doi.org/10.1371/journal.pone.0097259 CrossRefGoogle Scholar
  12. 12.
    Harris KA, Yam T, Jalili S, Williams OM, Alshafi K, Gouliouris T, Munthali P, NiRiain U, Hartley JC (2014) Service evaluation to establish the sensitivity, specificity and additional value of broad-range 16S rDNA PCR for the diagnosis of infective endocarditis from resected endocardial material in patients from eight UK and Ireland hospitals. Eur J Clin Microbiol Infect Dis 33(11):2061–2066.  https://doi.org/10.1007/s10096-014-2145-4 CrossRefGoogle Scholar
  13. 13.
    Lehours P, Freydiere AM, Richer O, Burucoa C, Boisset S, Lanotte P, Prere MF, Ferroni A, Lafuente C, Vandenesch F, Megraud F, Menard A (2011) The rtxA toxin gene of Kingella kingae: a pertinent target for molecular diagnosis of osteoarticular infections. J Clin Microbiol 49(4):1245–1250.  https://doi.org/10.1128/JCM.01657-10 CrossRefGoogle Scholar
  14. 14.
    Harris KA, Turner P, Green EA, Hartley JC (2008) Duplex real-time PCR assay for detection of Streptococcus pneumoniae in clinical samples and determination of penicillin susceptibility. J Clin Microbiol 46(8):2751–2758.  https://doi.org/10.1128/JCM.02462-07 CrossRefGoogle Scholar
  15. 15.
    Chometon S, Benito Y, Chaker M, Boisset S, Ploton C, Bérard J, Vandenesch F, Freydiere AM (2007) Specific real-time polymerase chain reaction places Kingella kingae as the most common cause of osteoarticular infections in young children. Pediatr Infect Dis J 26(5):377–381CrossRefGoogle Scholar
  16. 16.
    Doyle R, Gondwe A, Fan YM, Maleta K, Ashorn P, Klein N, Harris K (2018) Lactobacillus-deficient vaginal microbiota dominate post-partum women in rural Malawi. Appl Environ Microbiol 84:e02150–e02117.  https://doi.org/10.1128/AEM.02150-17 CrossRefGoogle Scholar

Copyright information

© Royal Academy of Medicine in Ireland 2019

Authors and Affiliations

  • Sadhbh O’Rourke
    • 1
    Email author
  • Mary Meehan
    • 2
  • Désirée Bennett
    • 2
  • Nicola O’Sullivan
    • 2
  • Robert Cunney
    • 2
    • 3
  • Patrick Gavin
    • 4
  • Roisin McNamara
    • 5
  • Noelle Cassidy
    • 6
  • Stephanie Ryan
    • 7
  • Kathryn Harris
    • 8
  • Richard Drew
    • 2
    • 9
    • 10
  1. 1.Department of Clinical MicrobiologyTemple Street Children’s University HospitalDublin 1Ireland
  2. 2.Irish Meningitis and Sepsis Reference LaboratoryTemple Street Children’s University HospitalDublin 1Ireland
  3. 3.Health Protection Surveillance CentreDublin 1Ireland
  4. 4.Department of Infectious DiseasesTemple Street Children’s University HospitalDublin 1Ireland
  5. 5.Emergency DepartmentTemple Street Children’s University HospitalDublin 1Ireland
  6. 6.Department of OrthopaedicsTemple Street Children’s University HospitalDublin 1Ireland
  7. 7.Department of RadiologyTemple Street Children’s University HospitalDublin 1Ireland
  8. 8.Department of Microbiology, Virology and Infection Prevention and ControlGreat Ormond Street NHS Foundation TrustLondonUK
  9. 9.Department of Clinical MicrobiologyRoyal College of SurgeonsDublin 2Ireland
  10. 10.Clinical Innovation UnitRotunda HospitalDublin 1Ireland

Personalised recommendations