Background: 

The detection and identification of pathogenic microorganisms are essential for the treatment of osteoarticular infection. However, obtaining a sufficient amount of specimen from pediatric patients is often difficult. Herein, we aimed to demonstrate the effectiveness of the blood culture bottle (BCB) system in pediatric osteoarticular infections. We hypothesized that our BCB culture method is superior to the conventional swab and tissue culture methods in terms of required specimen size, incubation time, and microbial identification rate.

Methods: 

We analyzed the prospectively collected data of pediatric patients who underwent surgical treatment for osteoarticular infections between August 2016 and October 2019. Four needles were dipped in the infected fluid or tissue during the surgical procedure as soon as the infected area was exposed and were used to inoculate 2 aerobic pediatric BCBs and 2 anaerobic general BCBs. We also collected 2 conventional swab samples and 2 tissue samples from the identical area. The microbial identification rate and the time required for identification were compared between BCB, swab, and tissue cultures.

Results: 

Forty patients constituted the study group; 13 patients had osteomyelitis, 17 patients had septic arthritis, and 10 patients had both. Of these 40 patients, the microbial identification rate was higher with BCB cultures (27 [68%]) than with swab cultures (18 [45%]; p = 0.004) or tissue cultures (15 [38%]; p < 0.001). Nine samples (9 patients [23%]) were only positive in the BCB culture. Positive microbial growth was not detected with conventional culture methods when microorganisms did not grow on the BCB culture. Compared with swab culture (4.3 ± 1.1 days; p < 0.001) or tissue culture (4.4 ± 1.1 days; p < 0.001), the BCB culture reduced the time required for microbial identification (3.5 ± 0.9 days).

Conclusions: 

In pediatric osteoarticular infections, the BCB culture system improved the microbial identification rate, reduced the time to identification, and permitted a smaller-volume specimen, compared with traditional culture systems.

Level of Evidence: 

Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

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使用血液培养瓶对小儿骨关节炎感染进行有效，快速的微生物鉴定

背景： 

病原微生物的检测和鉴定对于治疗骨关节感染至关重要。但是，从儿科患者获得足够数量的标本通常很困难。在此，我们旨在证明血液培养瓶（BCB）系统在小儿骨关节感染中的有效性。我们假设我们的BCB培养方法在所需标本大小，孵育时间和微生物鉴定率方面优于传统的拭子和组织培养方法。

方法： 

我们分析了2016年8月至2019年10月间接受手术治疗的骨关节感染的儿科患者的前瞻性数据。在感染区域暴露后，在手术过程中将四根针头浸入感染的液体或组织中，并用于接种2个有氧儿科BCB和2个无氧普通BCB。我们还从同一区域收集了2个常规拭子样本和2个组织样本。比较了BCB，拭子和组织培养物的微生物鉴定率和鉴定所需时间。

结果： 

40名患者组成了研究组。骨髓炎13例，脓毒性关节炎17例，两者均10例。在这40例患者中，BCB培养物（27 [68％]）的微生物识别率高于拭子培养物（18 [45％]； p = 0.004）或组织培养物（15 [38％]； p <0.001） 。9个样本（9例患者[23％]）仅在BCB培养中呈阳性。当微生物未在BCB培养上生长时，常规培养方法未检测到阳性微生物生长。与拭子培养（4.3±1.1天； p <0.001）或组织培养（4.4±1.1天； p <0.001）相比，BCB培养减少了微生物鉴定所需的时间（3.5±0.9天）。

结论： 

与传统的培养系统相比，在小儿骨关节感染中，BCB培养系统提高了微生物鉴定率，减少了鉴定时间，并允许体积较小的标本。

证据级别： 

诊断级别II。有关证据水平的完整说明，请参见《作者说明》。