Russell Clark D, Ramaesh Rishi, Kalima Pota, Murray Alastair, Gaston Mark S
Royal Hospital for Sick Children, 9 Sciennes Road, Edinburgh, EH9 1LF, UK.
Division of Infection and Pathway Medicine, The University of Edinburgh, The Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK.
J Med Microbiol. 2015 Apr;64(Pt 4):446-453. doi: 10.1099/jmm.0.000026. Epub 2015 Jan 16.
This study aimed to describe the microbiological characteristics of acute septic arthritis (SA) and osteomyelitis (OM) in children. Cases of children (0-15 years) with SA/OM were identified through a retrospective search of hospital discharge codes over a six-year period. In addition, a systematic literature search and meta-analysis of studies reporting culture results of children with SA/OM was performed. In our retrospective chart review, we identified 65 cases of OM and 46 cases of SA. The most frequently cultured organisms in both conditions were Gram-positive cocci, primarily Staphylococcus aureus. On admission, most patients had a normal white blood cell count (WCC) but elevated C-reactive protein (CRP) and/or erythrocyte sedimentation rate (ESR). Bacteraemia was associated with a longer mean length of hospitalization for both infections. Considering our results and the meta-analysis, we found low rates of culture-positivity in cases of clinically confirmed infection. In SA, articular fluid was culture-positive in 42.49% [95% confidence interval (CI) 28.39-57.23]. In OM, intra-operative samples were culture-positive in 52.65% (95% CI 30.54-74.22). Bacteraemia was detected in 23.91% (95% CI 8.40-44.24) of children with SA and 21.48% (95% CI 10.89-34.47) with OM. Despite appropriate sampling, a positive microbiological diagnosis is often lacking in paediatric acute osteoarticular infection using standard culture-based methods. This highlights the need for validation and use of more sensitive diagnostic methods, such as PCR.
本研究旨在描述儿童急性化脓性关节炎（SA）和骨髓炎（OM）的微生物学特征。通过回顾性检索六年期间的医院出院编码，确定了患有SA/OM的儿童（0至15岁）病例。此外，还对报告SA/OM儿童培养结果的研究进行了系统文献检索和荟萃分析。在我们的回顾性病历审查中，我们确定了65例OM病例和46例SA病例。两种情况下最常培养出的微生物是革兰氏阳性球菌，主要是金黄色葡萄球菌。入院时，大多数患者白细胞计数（WCC）正常，但C反应蛋白（CRP）和/或红细胞沉降率（ESR）升高。菌血症与两种感染的平均住院时间延长有关。考虑到我们的结果和荟萃分析，我们发现临床确诊感染病例的培养阳性率较低。在SA中，关节液培养阳性率为42.49%[95%置信区间（CI）28.39 - 57.23]。在OM中，术中样本培养阳性率为52.65%（95%CI 30.54 - 74.22）。SA患儿中23.91%（95%CI 8.40 - 44.24）检测到菌血症，OM患儿中21.48%（95%CI 10.89 - 34.47）检测到菌血症。尽管进行了适当的采样，但使用基于标准培养的方法在儿科急性骨关节炎感染中往往缺乏阳性微生物学诊断。这凸显了验证和使用更敏感诊断方法（如PCR）的必要性。
