小儿急性血源性骨髓炎
Pediatric Acute Hematogenous Osteomyelitis.
作者信息
Street Matthew, Puna Rupesh, Huang Mark, Crawford Haemish
机构信息
*Starship Children's Hospital †Department of Medicine, University of Auckland, Auckland, New Zealand.
出版信息
J Pediatr Orthop. 2015 Sep;35(6):634-9. doi: 10.1097/BPO.0000000000000332.
BACKGROUND
Osteomyelitis continues to be a significant problem among the New Zealand pediatric population. We present a large series of acute hematogenous osteomyelitis (AHO) cases, with the aim to identify any changing trends and guide successful management of the disease.
METHODS
A 10-year retrospective review was performed of clinical records of children with AHO at the 2 children's orthopaedic departments in the Auckland region. Cases were identified from Starship Children's Hospital between 1997 and 2007 and Middlemore's Kidz First Hospital between 1998 and 2008.
RESULTS
A total of 813 cases of pediatric AHO were identified. The incidence was 1:4000, which was decreasing over the 10-year period. There was a male predominance and New Zealand (NZ) Maori and Pacific Islanders were overrepresented. The diagnosis was made clinically in 27%, radiographically in 66%, and surgically in 7%. The most common pathogen was Staphylococcus aureus and the incidence of methicillin-resistant S. aureus was low (2%). The average length of antibiotic treatment was 44 days and 44% required surgery. This produced a recurrence rate of only 7% and a 15% treatment-related complication rate.
CONCLUSIONS
In the New Zealand population, the incidence of AHO remains high with NZ Maori and Pacific Islanders overrepresented. The predominant pathogen remains S. aureus and our population has a very low incidence of methicillin-resistant S. aureus; flucloxacillin remains a good choice for empiric treatment in our population. Our rate of relapse and subsequent chronic osteomyelitis is low. This could be explained by traditionally longer antibiotic courses; however, this may also lead to increased treatment-related complications. Through prompt and accurate diagnosis with the aid of laboratory and radiologic tests and effective treatment with appropriate antibiotics (guided by local pathogen sensitivities) and surgical treatment when indicated, AHO can be well managed with minimal severe complications.
LEVEL OF EVIDENCE
Level IV-retrospective case series.
背景
骨髓炎在新西兰儿科人群中仍然是一个重要问题。我们呈现了一系列大量的急性血源性骨髓炎（AHO）病例，旨在确定任何变化趋势并指导该疾病的成功管理。
方法
对奥克兰地区两家儿童骨科部门中患有AHO的儿童的临床记录进行了为期10年的回顾性研究。病例来自1997年至2007年的星舰儿童医院以及1998年至2008年的米德尔莫尔儿童第一医院。
结果
共确定了813例儿科AHO病例。发病率为1:4000，在这10年期间呈下降趋势。男性占主导，新西兰（NZ）毛利人和太平洋岛民的比例过高。27%的病例通过临床诊断，66%通过影像学诊断，7%通过手术诊断。最常见的病原体是金黄色葡萄球菌，耐甲氧西林金黄色葡萄球菌的发病率较低（2%）。抗生素治疗的平均时长为44天，44%的病例需要手术。这导致复发率仅为7%，治疗相关并发症率为15%。
结论
在新西兰人群中，AHO的发病率仍然很高，NZ毛利人和太平洋岛民的比例过高。主要病原体仍然是金黄色葡萄球菌，且我们人群中耐甲氧西林金黄色葡萄球菌的发病率非常低；氟氯西林仍然是我们人群经验性治疗的良好选择。我们的复发率和随后慢性骨髓炎的发生率较低。这可能是由于传统上较长的抗生素疗程；然而，这也可能导致治疗相关并发症增加。通过借助实验室和放射学检查进行及时准确的诊断，并使用适当的抗生素（根据当地病原体敏感性指导）进行有效治疗以及在必要时进行手术治疗，AHO可以得到很好的管理，严重并发症最少。
证据水平
IV级——回顾性病例系列。
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