Gafur Omar A, Copley Lawson A B, Hollmig S Tyler, Browne Richard H, Thornton Lori A, Crawford Shellye E
University of Texas Southwestern, Dallas, TX, USA.
J Pediatr Orthop. 2008 Oct-Nov;28(7):777-85. doi: 10.1097/BPO.0b013e318186eb4b.
Methicillin-resistant Staphylococcus aureus is thought to have led to an increase in the incidence of severe musculoskeletal infection in children. Our purpose was (1) to compare the current epidemiology of musculoskeletal infection with historical data at the same institution 20 years prior and (2) to evaluate the spectrum of the severity of this disease process within the current epidemiology.
Children with musculoskeletal infection, treated between January 2002 and December 2004, were studied retrospectively. Diagnoses of osteomyelitis, septic arthritis, pyomyositis, and abscess were established for each child based on overall clinical impression, laboratory indices, culture results, radiology studies, and intraoperative findings. Comparison was made with the experience reported at the same institution in 1982. Children within each diagnostic category were compared with respect to mean values of C-reactive protein and erythrocyte sedimentation rate at admission, number of surgical procedures, intensive care unit admissions, identification of deep venous thrombosis, and length of hospitalization.
Five hundred fifty-four children were studied (osteomyelitis, n = 212; septic arthritis, n = 118; pyomyositis, n = 20; and deep abscess, n = 204). The annualized per capita incidence of osteomyelitis increased 2.8-fold, whereas that of septic arthritis was unchanged when compared with historical data from 20 years prior. Methicillin-resistant Staphylococcus aureus was isolated as the causative organism in 30% of the children. We identified increasing severity of illness according to a hierarchy of tissue involvement (osteomyelitis > septic arthritis > pyomyositis > abscess) and according to the identification of contiguous infections within in each primary diagnostic category.
The incidence of musculoskeletal infection appears to have increased within our community. We found that a more comprehensive diagnostic classification of this disease is useful in understanding the spectrum of the severity of illness and identifying those who require the greatest amount of resources. Magnetic resonance imaging is useful early in the diagnostic process to enable a more detailed disease classification and to expedite surgical decisions. The recognition of the incidence of methicillin-resistant Staphylococcus aureus within our community has also led to a change in empirical antibiotic selection.
耐甲氧西林金黄色葡萄球菌被认为导致了儿童严重肌肉骨骼感染发病率的上升。我们的目的是：（1）将当前肌肉骨骼感染的流行病学情况与20年前同一机构的历史数据进行比较；（2）在当前流行病学范围内评估该疾病过程的严重程度谱。
对2002年1月至2004年12月期间接受治疗的肌肉骨骼感染儿童进行回顾性研究。根据总体临床印象、实验室指标、培养结果、放射学检查和术中发现，为每个儿童确立骨髓炎、化脓性关节炎、脓性肌炎和脓肿的诊断。与1982年同一机构报告的经验进行比较。对每个诊断类别中的儿童，就入院时C反应蛋白和红细胞沉降率的平均值、手术次数、重症监护病房入院情况、深静脉血栓形成的识别以及住院时间进行比较。
共研究了554名儿童（骨髓炎212例；化脓性关节炎118例；脓性肌炎20例；深部脓肿204例）。与20年前的历史数据相比，骨髓炎的年化人均发病率增加了2.8倍，而化脓性关节炎的发病率未变。30%的儿童分离出耐甲氧西林金黄色葡萄球菌作为致病微生物。我们根据组织受累层次（骨髓炎>化脓性关节炎>脓性肌炎>脓肿）以及每个主要诊断类别中连续感染的识别情况，确定疾病严重程度在增加。
我们社区内肌肉骨骼感染的发病率似乎有所上升。我们发现，对这种疾病进行更全面的诊断分类有助于理解疾病严重程度谱，并识别出需要最多资源的患者。磁共振成像在诊断过程早期很有用，可实现更详细的疾病分类并加快手术决策。认识到我们社区内耐甲氧西林金黄色葡萄球菌的发病率也导致了经验性抗生素选择的改变。
