Culture-negative osteomyelitis

Pediatr Infect Dis J. 2003 Aug;22(8):731-6. doi: 10.1097/


Objective: To examine the natural history, clinical manifestations, laboratory changes and outcomes of children with culture-negative osteomyelitis and to compare findings with cases of culture-positive infection treated during the same time period.

Design: Retrospective review of consecutive admissions for osteomyelitis during the 4-year period 1998 through 2001, with a minimum follow-up of 1 year.

Setting: A single urban children's hospital with a large orthopedic referral service. CLINICAL AND LABORATORY MEASURES: Age, gender, predisposing factors, clinical manifestations, maximum temperature, duration of pain, bone involved, laboratory changes, results of cultures from infected bone and blood and outcome after treatment.

Results: A total of 85 patients fulfilled study criteria, of whom 40 were culture-negative. Compared with culture-positive cases, culture-negative osteomyelitis patients were less likely to have antecedent trauma (P = 0.0357) and overlying skin changes (P = 0.0001), duration of pain and other symptoms was longer (P = 0.0396) and skeletal residua were rare. They were also older, with this difference approaching statistical significance (P = 0.0586).

Conclusions: Children with culture-negative osteomyelitis present initially differently from culture-positive cases and can be managed as presumed staphylococcal disease with excellent long term results.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Age Distribution
  • Anti-Bacterial Agents
  • Blood / microbiology*
  • Case-Control Studies
  • Child
  • Child, Preschool
  • Drug Therapy, Combination / therapeutic use
  • Female
  • Humans
  • Incidence
  • Male
  • Microbial Sensitivity Tests
  • Osteomyelitis / drug therapy
  • Osteomyelitis / epidemiology*
  • Osteomyelitis / etiology*
  • Probability
  • Prognosis
  • Reference Values
  • Retrospective Studies
  • Risk Factors
  • Sensitivity and Specificity
  • Severity of Illness Index
  • Sex Distribution
  • Treatment Outcome


  • Anti-Bacterial Agents