Subject(s)
Acridine Orange , Bacteremia/diagnosis , Catheterization, Central Venous/adverse effects , Gentian Violet , Parenteral Nutrition, Total , Phenazines , Staining and Labeling/methods , Adolescent , Adult , Blood/microbiology , Child , Child, Preschool , Culture Media , Humans , Infant , Leukocytes , Sensitivity and SpecificityABSTRACT
AIM: To study the bacterial aetiology of acute osteoarticular infections in children and to analyse the efficiency of culture methods. METHODS: Bacteriological data of 407 cases of clinically suspected osteoarticular infections affecting 406 children hospitalized in an orthopaedic surgery department between 1999 and 2002 were retrospectively reviewed. RESULTS: Bacterial cultures from clinical specimens were positive in 74 cases (18%): 38 cases of septic arthritis and 36 cases of bone infections (osteitis, osteomyelitis or osteoarthritis). The use of liquid medium bottles to grow bacteria from articular fluids increased the rate of positive cultures compared to the use of standard solid media (p = 0.0001). The most commonly recovered pathogen was Staphylococcus aureus (44%) followed by Kingella kingae (14%), Streptococcus pyogenes (10%) and Streptococcus pneumoniae (10%). K. kingae was most frequently isolated among children under 36 mo of age (p = 0.0003), whereas S. aureus was most frequently isolated among children over 36 mo (p = 0.0015). CONCLUSION: By improving our culture method, we observed a recrudescence of isolation of K. kingae, but S. aureus remains the main pathogen isolated from osteoarticular infections in children. This finding is useful for the adaptation of a probabilistic antibiotic treatment of these infections.
Subject(s)
Arthritis, Infectious/microbiology , Bacterial Infections/microbiology , Bone Diseases/microbiology , Bacteriological Techniques , Child , Child, Preschool , Female , Humans , Kingella kingae/isolation & purification , Male , Osteitis/microbiology , Osteoarthritis/microbiology , Osteomyelitis/microbiology , Retrospective Studies , Staphylococcus aureus/isolation & purification , Streptococcus pneumoniae/isolation & purification , Streptococcus pyogenes/isolation & purificationABSTRACT
OBJECTIVES: To describe clinical features, microbiologic characteristics and outcome of bacteremia in the elderly patients hospitalized in a geriatric hospital. PATIENTS AND METHODS: All episodes of bacteremia diagnosed from January 1(st) to December 31(st) 1998 were analysed, excluding false-positive cases due to skin contamination. The hospital comprises 1084 geriatric beds distributed as 111 in acute care (ACF), 333 in rehabilitation and intermediate-care (RICF), and 516 in long-term-care facilities (LTCF). RESULTS: Sixty-six episodes of bacteremia were observed in 65 patients. Among them 59 (89%) were nosocomial bacteremia distributed as 20 in ACF, 29 in RICF and 10 in LTCF (rates of 0.6, 0.35, and 0.05 episodes per 1000 patient-days, respectively.). Escherichia coli and Staphylococcus aureus were the main bacterial species involved in 31% and 28% of the cases, respectively. E. coli strains were 50% resistant to amoxicillin and 41% resistant to co-amoxiclav, and 68% of S. aureus strains were resistant to methicillin. Portals of entry were urinary tract (44%), respiratory tract (14%), digestive tract (11%), and soft tissue (8%). The same bacterial strain as in bacteremia was isolated from a peripheric site in 30 cases (47%), most of them being urines. For 15% cases, portal of entry cannot be determined. Mortality associated to nosocomial bacteremia was 25%, and death was significantly associated to MRSA, urinary or intravascular devices, chronic wounds and inappropriate antibiotic prescription. CONCLUSION: In geriatric hospitals, bacteremia are mainly nosocomial cases. Prevention should focus on indwelling devices and antibiotic resistance.
