The Contemporary Microbiology and Rates of Concomitant Osteomyelitis in Acute Septic Arthritis.

BACKGROUND: Septic arthritis (SA) and acute osteomyelitis (AO) are among the most common serious bacterial infections of childhood. Knowledge of the microbiology of SA is critical to treatment. Awareness of the presence of attendant AO is also important to guide clinical management. We sought to describe the current microbiology of SA in children and clinical features associated with coexisting AO. MATERIALS AND METHODS: Patients with SA were identified from the infectious diseases consult service records from 2010 to 2014. Patients with penetrating/open trauma and orthopedic hardware in situ were excluded. RESULTS: A total of 168 patients with SA were included. The most common causative organism was Staphylococcus aureus accounting for 47.7% of cases (29.1% were methicillin-susceptible S. aureus and 18.5% were methicillin-resistant S. aureus), followed by group A streptococcus (GAS, 8.9%). The proportion of cases due to GAS increased from 2011 to 2014 (3.3%-16.7%; P = 0.1). One hundred eight (64.3%) patients had concurrent AO. The presence of osteomyelitis was associated with older median age (5.9 vs. 2.4 years; P = 0.04), a longer duration of symptoms (5 vs. 2.5 days; P < 0.001), S. aureus (62.1% vs. 21.7%; P < 0.001), bacteremia (46.2% vs. 20.3%; P = 0.001), a longer duration of fever after admission (5 vs. 2 days; P < 0.001) and a longer length of stay (10 vs. 6 days; P < 0.001). CONCLUSIONS: Methicillin-resistant S. aureus continues to be an important cause of SA though GAS may be increasing in frequency. The presence of concomitant osteomyelitis is higher than previously reported and associated with older age, a longer duration of symptoms and fever, bacteremia and S. aureus.

Part 1. Undergraduate nursing evidence-based practice education: envisioning the role of students.

Nursing educators have embraced the integration of evidence-based practice (EBP) into the nursing education curriculum in numerous ways. As this review of the nursing pedagogy literature demonstrates, most of these approaches built upon long-standing commitments to helping students understand the scientific research process, think critically, and develop the information literacy skills that will enable them to find the evidence that can inform their practice. Many reports in the nursing pedagogy literature recounted various strategies used to teach EBP to nursing students. Another category of nursing pedagogy articles discussed ways that EBP education can be suffused throughout the nursing school curriculum. Few educators, however, have envisioned students as having a role beyond that of the mere recipients of EBP education. Nonetheless, a small but growing number of nurse educators have begun to envision students as enablers of practice change in clinical settings. These innovators advocate a pedagogical paradigm that places students into socially meaningful partnerships with practicing nurses as a means to promote the uptake of EBP in clinical settings.