When a child has the signs and symptoms of possible acute hematogenous osteomyelitis, we often hope that a simple blood culture will help us make the diagnosis rather than need to move forward with more aggressive biopsy to confirm the diagnostic organism through operative or interventional radiology (IR) biopsy.
Yet how sensitive is a blood culture for finding the pathogen causing the bone infection without that biopsy? McNeil et al. (10.1542/peds.2015-4616) report on their retrospective review of 250 pediatric cases seen at Texas Children’s Hospital and find that blood cultures were positive only 46% of the time. 80 patients had positive cultures obtained by operative or IR biopsy with negative blood cultures and as a result, therapy changed after biopsy in 85% of these blood-culture negative patients.
Thus when suspecting a bone infection, bone culture remains the gold standard for diagnosis in at least a third of the patients in this study. Now whether IR is better than open surgical biopsy and drainage remains a question still to be studied given that there was no difference in positive bone biopsy cultures obtained using either method. Do you have a preference in which modality for biopsy and drainage you use? What influences that decision? We’d be interested in learning about your practice strategy for osteomyelitis by responding to this blog, posting a comment to this study online or on our Facebook page or Twitter handle.