Clinical characteristics and outcomes of culture-negative versus culture-positive osteomyelitis in children treated at a tertiary hospital in central Taiwan

Chen, Jiun-An; Lin, Hsiao-Chuan; Wei, Hsiu-Mei; Hsu, Yu-Lung; Lai, Huan-Cheng; Low, Yan Yi; Chiu, Yu‐Ting; Kuo, Ching-Ming; Hwang, Kao-Pin

doi:10.1016/j.jmii.2020.08.005

Cited by 11 publications

(8 citation statements)

References 31 publications

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“…Differential clinical behaviours based on culture status have also been observed in other infectious conditions. Negative cultures in sepsis requiring intensive care unit admission [ 22 ], in pneumonia [ 23 ] and in osteomyelitis [ 24 , 25 ] have been associated with more favourable clinical outcomes (lower complication or mortality rates), possibly due to a lower bacterial load. Whether there is a link between the degree of pleural inflammation and worse clinical outcomes is an area for further research, though such an association has been reported [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Phenotyping empyema by pleural fluid culture results and macroscopic appearance: an 8-year retrospective study

Chan

Ng²,

Ling³

et al. 2023

ERJ Open Res

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BackgroundThe understanding on the clinical impact of phenotyping empyema is limited. The study was designed to evaluate the clinical characteristics and outcomes based on the two readily available parameters, pleural fluid culture status and macroscopic fluid appearance.MethodsA retrospective study was conducted on patients with empyema hospitalised between 2013 and 2020. Empyema was classified into culture-positive empyema (CPE) and culture-negative empyema (CNE); pus-appearing empyema (PAE) and non-pus-appearing empyema (non-PAE) based on the pleural fluid culture status and macroscopic fluid appearance respectively.ResultsAltogether 212 patients had confirmed empyema (CPE: 188, CNE: 24; PAE: 118, non-PAE: 94). The cohort was male predominant (163, 76.9%) with a mean age of 65.0±13.6 years. Most patients (180, 84.9%) had at least one comorbidity. Patients with CPE had higher in-hospital (19.1%versus0.0%, p=0.017), 90-day mortality rates (18.6%versus0.0%, p=0.017) and more extra-pulmonary sources of infection (29.8%versus8.3%, p=0.026) when compared with patients with CNE. No significant difference in mortality rate was found between PAE and non-PAE during the in-hospital stay, 30 days and 90 days. Patients with PAE had less extra-pulmonary source of infection (20.3%versus36.2%, p=0.010) and more anaerobic infection (40.9%versus24.5%, p=0.017) than those with non-PAE. The median RAPID scores were higher in the CPE and non-PAE groups. After adjusting for covariates, culture positivity was not independently associated with mortality on multivariable analysis.ConclusionEmpyema is a heterogeneous disease with different clinical characteristics. Phenotyping empyema into different subclasses based on pleural fluid microbiological results and macroscopic fluid appearance would provide insight on the underlying bacteriology, source of infection and subsequent clinical outcomes.

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Section: Discussionmentioning

confidence: 99%

Phenotyping empyema by pleural fluid culture results and macroscopic appearance: an 8-year retrospective study

Chan

Ng²,

Ling³

et al. 2023

ERJ Open Res

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“…MRSA is an important cause of bloodstream infections (BSI), and in 2009–2017, the MRSA detection rate was 40%–50% among BSI-associated S. aureus ( Zhang et al., 2022 ). Additionally, S. aureus was reported to be the main pathogen (67.5%) in paediatric osteomyelitis, and the proportion of MRSA among the cases due to S. aureus was 44% ( Chen et al., 2021 ). In the present work, the most common clinical sources of MRSA infection were the respiratory tract (62.73%), followed by an abscess (16.78%), a secretion (7.61%), and blood (4.64%), and the constituent proportions isolated from blood, secretions, and urine were higher in neonates compared with those in non-neonates.…”

Section: Discussionmentioning

confidence: 99%

Antimicrobial resistance profile of methicillin-resistant Staphylococcus aureus isolates in children reported from the ISPED surveillance of bacterial resistance, 2016–2021

et al. 2023

Front. Cell. Infect. Microbiol.

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IntroductionMethicillin-resistant Staphylococcus aureus (MRSA) poses a serious threat to public health worldwide. In December 2015, the Infectious Disease Surveillance of Pediatrics (ISPED) program was organized to monitor bacterial epidemiology and resistance trends in children.MethodsThis retrospective study was conducted from January 2016–December 2021 on patients at eleven ISPED-group hospitals.ResultsFrom 2016–2021, a total of 13024 MRSA isolates were obtained from children. The most common age group for patients with MRSA infection was less than 3 years old, and newborns were an important group affected by MRSA infection. MRSA was most commonly isolated from the lower respiratory, an abscess, a secretion, or blood in neonates and from the lower respiratory, an abscess, or the upper respiratory in non-neonates. All isolates were susceptible to vancomycin and linezolid and resistant to penicillin; additionally, 76.88%, 54.97%, 22.30%, 5.67%, 5.14%, 3.63%, and 1.42% were resistant to erythromycin, clindamycin, tetracycline, levofloxacin, sulfamethoxazole-trimethoprim (TMP-SMX), gentamicin, and rifampin, respectively. Between 2016 and 2021, a significant increase was seen in the levofloxacin- and TMP-SMX-resistance rates (from 5.45% to 7.14% and from 4.67% to 6.50%, respectively) among MRSA isolates, along with a significant decrease in the rates of resistance to erythromycin (from 82.61% to 68.08%), clindamycin (from 60.95% to 46.82%), tetracycline (from 25.37% to 17.13%), gentamicin (from 4.53% to 2.82%), and rifampin (from 1.89% to 0.41%).DiscussionThe antibiotic-resistance rates varied among MRSA isolated from different sources. Because of the high antibiotic resistance rate to clindamycin, this antibiotic is not recommended for empirical treatment of MRSA infections, especially in osteomyelitis.

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“…As the infection of osteocytes is hypothesised to represent an important niche of persistence within PJI (10, 30), we sought to test if clinically utilised antibiotics could reduce the abundance of bacteria within a relevant cell model with the predominant causative organism of hip and knee osteomyelitis/PJI, S. aureus . The prevalence and severity of non-culturable infections in PJI and osteomyelitis informed the use of methods that would be sensitive to modification of non-culturable bacterial communities, and which would allow analysis of the effect of the treatment on the culturability of the population (31–33). We found that it is possible for the two antibiotics trialled to, in fact, increase the quantity of intracellular bacteria and that the measurement of bacterial abundance by culture alone would have masked this paradoxical effect.…”

Section: Discussionmentioning

confidence: 99%

Staphylococcus aureusPersistence in Osteocytes: Weathering the Storm of Antibiotics and Autophagy/Xenophagy

Gunn,

Zelmer,

Kidd

et al. 2023

Preprint

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BackgroundStaphylococcus aureusis a major causative pathogen of osteomyelitis. Intracellular infection of osteocytes and other bone cell types have been reported, with the bacteria able to survive and persist for an extended period, despite application of gold-standard clinical interventions. The mechanisms, by which intracellularS. aureuspersists through antibiotic therapy are unknown. In this study we investigated if antibiotic-mediated dysregulation of autophagy is a contributing factor.MethodsHuman osteocyte-like cells were exposed to combinations of rifampicin, vancomycin and modulators of autophagy, in the presence or absence ofS. aureus. Intracellular bacterial growth characteristics were assessed through CFU analysis, viable DNA abundance and the rate of escape into antibiotic-free medium, in parallel with measures of host cell autophagic flux.ResultsRifampicin, alone or in combination with vancomycin, caused a rapid decrease in the culturability of the intracellular bacterial community concomitant with increased absolute bacterial DNA levels. Low dose vancomycin alone increased both measures but this was reversed at higher doses. Both antibiotics significantly inhibited autophagic flux. Whilst the modulation of autophagic flux affected bacterial culturability, this did not affect viable bacterial DNA levels.ConclusionsAutophagy was shown to be a factor in the host-pathogen relationship in this model, as its modulation affected the growth phenotype of intracellularS. aureus. Whilst rifampicin and vancomycin treatments moderately suppressed autophagic flux acutely, this was not explanative of the paradoxical response ofS. aureusto antibiotic treatment. As such, whilst rifampicin and vancomycin had off-target effects on autophagy, similar to those ofS. aureus, these were not causally linked to the antibiotic-mediated pressure towards persistent infection.

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Clinical characteristics and outcomes of culture-negative versus culture-positive osteomyelitis in children treated at a tertiary hospital in central Taiwan

Cited by 11 publications

References 31 publications

Phenotyping empyema by pleural fluid culture results and macroscopic appearance: an 8-year retrospective study

Phenotyping empyema by pleural fluid culture results and macroscopic appearance: an 8-year retrospective study

Antimicrobial resistance profile of methicillin-resistant Staphylococcus aureus isolates in children reported from the ISPED surveillance of bacterial resistance, 2016–2021

Staphylococcus aureusPersistence in Osteocytes: Weathering the Storm of Antibiotics and Autophagy/Xenophagy

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