Saavedra-Lozano Jesús, Mejías Asunción, Ahmad Naveed, Peromingo Estrella, Ardura Monica I, Guillen Sara, Syed Ali, Cavuoti Dominick, Ramilo Octavio
Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA.
J Pediatr Orthop. 2008 Jul-Aug;28(5):569-75. doi: 10.1097/BPO.0b013e31817bb816.
Staphylococcus aureus remains the most common etiologic agent of acute osteomyelitis in children. Recently, methicillin-resistant S. aureus (MRSA) has emerged as a major pathogen.
Records of all children admitted with acute osteomyelitis from January 1999 to December 2003 were reviewed. For the comparative analysis, the study population was evenly distributed in 2 periods: period A, January 1999 to June 2001; n = 113; and period B, July 2001 to December 2003; n = 177. In addition, clinical findings of MRSA osteomyelitis were compared with non-MRSA osteomyelitis, including methicillin-sensitive S. aureus infections.
Two hundred ninety children (60% male subjects) with acute osteomyelitis were identified. Median (25th-75th percentile) age at diagnosis was 6 years (range, 2-11 years). Significant clinical findings included the following: localized pain (84%), fever (67%), and swelling (62%). Affected bones included the following: foot (23%), femur (20%), tibia (16%), and pelvis (7%). Thirty-seven percent of blood cultures were positive, and a bacterial isolate was obtained in 55% of cases. Bacteria most frequently isolated included the following: methicillin-sensitive S. aureus (45%) (57% in period Avs 40% in period B), MRSA (23%) (6% in A vs 31% in B; P < 0.001), Streptococcus pyogenes (6%), and Pseudomonas aeruginosa (5%). Children with MRSA compared with those with non-MRSA osteomyelitis had significantly greater erythrocyte sedimentation rate and C-reactive protein values on admission and increased length of hospital stay, antibiotic therapy, and overall rate of complications. We observed significant changes in antibiotic therapy related to increased use of agents with activity against MRSA.
Methicillin-resistant S. aureus was isolated more frequently in the second study period and was associated with worse clinical outcomes.
金黄色葡萄球菌仍然是儿童急性骨髓炎最常见的病原体。最近，耐甲氧西林金黄色葡萄球菌（MRSA）已成为主要病原体。
回顾了1999年1月至2003年12月期间所有因急性骨髓炎入院儿童的记录。为进行比较分析，研究人群平均分为两个时期：A期，1999年1月至2001年6月；n = 113；B期，2001年7月至2003年12月；n = 177。此外，还比较了MRSA骨髓炎与非MRSA骨髓炎（包括甲氧西林敏感金黄色葡萄球菌感染）的临床特征。
共确定290例急性骨髓炎儿童（60%为男性）。诊断时的中位年龄（第25-75百分位数）为6岁（范围2-11岁）。主要临床特征如下：局部疼痛（84%）、发热（67%）和肿胀（62%）。受累骨骼包括：足部（23%）、股骨（20%）、胫骨（16%）和骨盆（7%）。37%的血培养呈阳性，55%的病例获得了细菌分离株。最常分离出的细菌如下：甲氧西林敏感金黄色葡萄球菌（45%）（A期为57%，B期为40%）、MRSA（23%）（A期为6%，B期为31%；P < 0.001）、化脓性链球菌（6%）和铜绿假单胞菌（5%）。与非MRSA骨髓炎儿童相比，MRSA骨髓炎儿童入院时红细胞沉降率和C反应蛋白值显著更高，住院时间、抗生素治疗时间和总体并发症发生率增加。我们观察到抗生素治疗发生了显著变化，这与针对MRSA的活性药物使用增加有关。
在第二个研究时期，耐甲氧西林金黄色葡萄球菌的分离频率更高，且与更差的临床结果相关。
