Tien Irene
Boston Medical Center, Division of Pediatric Emergency Medicine, Boston, Massachusetts 02118, USA.
Curr Opin Pediatr. 2006 Jun;18(3):254-9. doi: 10.1097/01.mop.0000193308.45333.11.
To provide an update on the diagnosis and management of skin, soft-tissue, and osteoarticular infections in children.
Our understanding of the epidemiology of skin and soft-tissue infections and osteoarticular infections is changing rapidly. Community-associated methicillin-resistant Staphylococcus aureus has become a predominant cause of childhood skin and soft-tissue infections. Kingella kingae is also increasingly identified as a cause of osteoarticular infections. Challenges in Staphylococcus aureus treatment and Kingella kingae identification are changing the approach to skin and soft-tissue infections and osteoarticular infections.
Community-associated methicillin-resistant Staphylococcus aureus should be considered a cause of skin and soft-tissue infections. Empiric antimicrobial choices should be modified in areas in which there is a more than 10% prevalence of community-associated methicillin-resistant Staphylococcus aureus infection. Decontamination of shared sports equipment should be undertaken to minimize person-to-person spread. No established guideline for eradication of carriage of community-associated methicillin-resistant Staphylococcus aureus exists. Kingella kingae is a more prevalent cause of osteoarticular infections than previously recognized and can cause outbreaks of invasive infection via person-to-person transmission. Modification of culturing procedures for osteoarticular infections including inoculation of infected joint fluid and bone in blood-culture bottles should be considered.
提供儿童皮肤、软组织及骨与关节感染诊断和管理的最新情况。
我们对皮肤和软组织感染以及骨与关节感染流行病学的认识正在迅速变化。社区获得性耐甲氧西林金黄色葡萄球菌已成为儿童皮肤和软组织感染的主要原因。金氏金杆菌也越来越多地被确认为骨与关节感染的病因。金黄色葡萄球菌治疗和金氏金杆菌鉴定方面的挑战正在改变皮肤和软组织感染以及骨与关节感染的处理方法。
应将社区获得性耐甲氧西林金黄色葡萄球菌视为皮肤和软组织感染的病因。在社区获得性耐甲氧西林金黄色葡萄球菌感染患病率超过10%的地区，经验性抗菌药物选择应予以调整。应进行共享运动器材的消毒，以尽量减少人际传播。目前尚无根除社区获得性耐甲氧西林金黄色葡萄球菌携带的既定指南。金氏金杆菌是骨与关节感染比以往认识到的更常见的病因，可通过人际传播导致侵袭性感染暴发。应考虑修改骨与关节感染的培养程序，包括将感染的关节液和骨接种到血培养瓶中。
