Clinical characteristics and prognosis of children with culture-negative osteoarticular infections: a meta-analysis based on cohort studies.

Purpose: Pediatric osteoarticular infections (OAIs) are an orthopedic emergency that can lead to severe sequelae if not treated appropriately. Approximately half of the patients with OAIs in clinical practice fail to obtain microbiological results even after undergoing aspiration or surgery, which presents a significant challenge in clinical practice. The inability to identify pathogens can lead to incorrect antibiotic usage or under-treatment, increasing the risk of adverse outcomes. This study aims to investigate the clinical characteristics and prognosis of culture-negative OAIs compared to culture-positive OAIs through a meta-analysis, providing insights to optimize treatment strategies. Methods: A systematic search was conducted to identify cohort studies comparing the clinical characteristics and prognosis of children with culture-negative OAIs to those with culture-positive OAIs. The search encompassed the databases of Wanfang Data, China National Knowledge Infrastructure, China Biology Medicine disc, Excerpta Medica Database, PubMed and the Cochrane Library, with the literature review extending up to March 2024. Data were extracted from eligible articles and assessed using the Newcastle-Ottawa scale, and the articles were selected based on predefined inclusion and exclusion criteria. Results: Twelve literature reports covering 1630 patients were included in this meta-analysis. Publication bias did not significantly affect the results. The incidence of long-term sequelae, temperature before admission, baseline laboratory indicators and possibility of surgery in the culture-negative group of patients were significantly lower than those in the culture-positive group. In addition, there were no significant differences in gender, age, race, trauma history, patient delay, antibiotic usage before admission or clinical symptoms between the two groups. Conclusions: Children diagnosed with culture-negative OAIs generally demonstrated less severe systemic inflammatory responses, required shorter treatment durations, exhibited a reduced likelihood of requiring surgical intervention and were less prone to experience long-term functional impairments compared to children with culture-positive OAIs. However, no differences in patient characteristics and clinical symptoms were found between the two groups. Further large-scale studies are still required to validate these findings. Type of study: Meta-analysis. Level of evidence: Level III.