Pediatric musculoskeletal infection—be it in the form of an abscess, osteomyelitis, pyomyositis, or septic arthritis—remains a challenge for orthopaedic surgeons. The orthopaedic response to the diagnosis of infection spans the gamut from little to no hospitalization with a brief course of antibiotics to a prolonged hospital stay with multiple surgical interventions and extended intravenous antibiotics. Potential complications include subsequent growth abnormality, venous thrombosis, pathologic fracture, osteonecrosis, chronic infection, or even death1. Organism identification in pediatric musculoskeletal infection remains central to patient care, as it informs antibiotic selection and the duration of antibiotic treatment.

The current study explores the diagnostic practices of health-care providers, including orthopaedic surgeons, in the isolation of bacteria from a musculoskeletal infection. This retrospective, single-institution study of 869 children with musculoskeletal infection over a 5.5-year study period investigated the positive yield of blood cultures and cultures (aerobic, anaerobic, fungal, and acid-fast bacteria [AFB]) of infection-site material. In total, 4537 cultures were processed. Of specimens sent during initial work-up, positive results were noted for 64.5% of the aerobic infection-site cultures and 18.3% of the blood cultures, with ≤2.5% of the anaerobic, fungal, or AFB infection-site cultures returning a positive result. A valuable additional analysis was performed by the authors that suggested that no deleterious effect on culture yields occurred when patients were administered antibiotics prior to the acquisition of culture material from the infection site.

The article’s inherent strengths include the large number of patients, an organized categorization of infection types, and the overall completeness of data. The key conclusions of the article are worthy of repetition, as they will influence the current practice of culture-sample acquisition for the orthopaedic surgeon managing pediatric musculoskeletal infection: (1) aerobic culture of synovial fluid or tissue from the site of a musculoskeletal infection provides the highest yield of bacterial organisms; fungal, anaerobic, and AFB culture should not be routinely performed during initial evaluation; (2) fungal and AFB culture of synovial fluid or tissue should be performed in addition to aerobic culture in the setting of a penetrating injury or patient immunocompromise; (3) antibiotics given prior to synovial-fluid or tissue culture do not deleteriously impact the ability to identify an organism but can impact blood-culture results; and (4) blood cultures in cases of superficial infection (skin or abscess) have a low yield and should not be performed except in the setting of systemic sepsis.