Effective and Rapid Microbial Identification in Pediatric Osteoarticular Infections Using Blood Culture Bottles

Effectiveness of multidisciplinary interventions to improve blood culture efficiency and optimize antimicrobial utilization

Background

The low positive rate of blood cultures often leads to downstream consequences. We present a summary of multidisciplinary interventions implemented by a tertiary referral hospital to improve blood culture efficiency and optimize antimicrobial usage.

Methods

We evaluated the knowledge, attitude, and practice (KAP) of healthcare workers in a tertiary care hospital before and after intervention using a questionnaire. A multidisciplinary team was formed to implement the intervention, defining roles, standardizing procedures, continually improving education and feedback, and establishing incentive mechanisms. Regular quality control assessments are conducted on the responsible departments.

Results

Following the intervention, the median submission time for blood culture specimens was reduced from 2.2 h to 1.3 h (p < 0.001). Additionally, the intervention group showed significant (p < 0.05) increases in rates of positivity (9.9% vs. 8.6%), correct timing (98.7% vs. 89.6%), correct processing (98.1% vs. 92.3%), reduced contamination rates (0.9% vs. 1.4%), and disqualification rates (1.3% vs. 1.7%). The delivery rate of therapeutic antibacterial increased (16.1% vs. 15.2%), and the consumption of restrictive grade antimicrobial also significantly increased (26.7% vs. 22.9%). The intervention measures led to a substantial improvement in awareness and compliance with KAP of blood culture collection in the hospital. Hospital-wide antimicrobial usage deceased by 10.7% after intervention.

Conclusion

A multidisciplinary collaborative model proves effective in improving blood culture efficiency and optimizing antimicrobial usage.

Clinical Practice Guideline by the Pediatric Infectious Diseases Society (PIDS) and the Infectious Diseases Society of America (IDSA): 2023 Guideline on Diagnosis and Management of Acute Bacterial Arthritis in Pediatrics

This clinical practice guideline for the diagnosis and treatment of acute bacterial arthritis (ABA) in children was developed by a multidisciplinary panel representing the Pediatric Infectious Diseases Society (PIDS) and the Infectious Diseases Society of America (IDSA). This guideline is intended for use by healthcare professionals who care for children with ABA, including specialists in pediatric infectious diseases and orthopedics. The panel's recommendations for the diagnosis and treatment of ABA are based upon evidence derived from topic-specific systematic literature reviews. Summarized below are the recommendations for the diagnosis and treatment of ABA in children. The panel followed a systematic process used in the development of other IDSA and PIDS clinical practice guidelines, which included a standardized methodology for rating the certainty of the evidence and strength of recommendation using the GRADE approach (Grading of Recommendations Assessment, Development and Evaluation) (see Figure 1). A detailed description of background, methods, evidence summary and rationale that support each recommendation, and knowledge gaps can be found online in the full text.

Nanopore 16S amplicon sequencing enables rapid detection of pathogen in knee periprosthetic joint infection

OBJECTIVES

We investigated whether nanopore 16S amplicon sequencing is capable of bacterial identification in patients with knee prosthetic joint infection (PJI), and we compared its efficacy with conventional culture studies.

METHODS

In total, 36 patients who had clinical manifestation suspected of PJI were enrolled in this study. To begin, synovial fluids were aspirated from the affected knee using aseptic technique and tissues specimens were obtained during the surgery. Next, DNA was extracted from the synovial fluid or tissues, and 16S rDNA PCR was performed. In PCR positive cases, nanopore amplicon sequencing was then performed for up to 3 h. The results of amplicon sequencing were compared to those of conventional culture studies.

RESULTS

Of the 36 patients enrolled, 22 were classified as true infections according to the MSIS criteria whereas 14 were considered uninfected. Among the 22 PJI cases, 19 cases were culture positive (CP-PJI) while three cases were culture negative (CN-PJI). In 14 of 19 (73.7 %) CP- PJI cases, 16S sequencing identified concordant bacteria with conventional culture studies with a significantly shorter turnaround time. In some cases, nanopore 16S sequencing was superior to culture studies in the species-level identification of pathogen and detection of polymicrobial infections. Altogether, in the majority of PJI candidate patients (32 of 36, 88.9 %), 16S sequencing achieved identical results to cultures studies with a significantly reduced turnaround time (100.9 ± 32.5 h vs. 10.8 ± 7.7 h, p < 0.001).

CONCLUSIONS

Nanopore 16S sequencing was found to be particularly useful for pathogen identification in knee PJI. Although the sensitivity was not superior to culture studies, the nanopore 16S sequencing was much faster, and species-level identification and detection of polymicrobial infections were superior to culture studies.