Motwani Girish, Mehta Rujuta, Aroojis Alaric, Vaidya Sandeep
Department of Paediatric Orthopaedics, B.J. Wadia Hospital for Childrens, Mumbai, India.
J Clin Orthop Trauma. 2017 Jan-Mar;8(1):89-92. doi: 10.1016/j.jcot.2016.09.001. Epub 2016 Sep 28.
Early treatment of septic arthritis is essential before irreversible damage to the articular cartilage occurs. Clinicians often start empirical antibiotic therapy for symptomatic relief while awaiting a definitive culture report. In present day parlance with variations in different centres in the private and public sector and rampant antibiotic abuse, a lot of resistance is being seen in the flora and their sensitivity patterns. Hence it is imperative to document and analyze these changing trends.
The authors conducted a retrospective analysis of prospectively gathered data of 60 patients under 14 years of age. Joint arthrotomy was performed as a standard therapeutic protocol and the drained pus or synovial fluid was sent for gram stain and culture by 2 different methods: conventional agar plate method and BACTEC Peds Plus/F bottle method. Antibiotic susceptibility tests were done by the disc diffusion method of Clinical Laboratory Standards Institute (CLSI).
The commonest presenting age group was below 1 year (80% patients) including 24 neonates. There were 19 hospital and 41 community acquired cases of septic arthritis. The hip (56%) was the commonest affected joint followed by knee (28%), shoulder joint (11%) and elbow (5%). Microorganism was isolated in 53% isolates of joint fluid only (36 culture positive patients). Conventional agar methods of culture showed positive report in only 42% patients (15/36 patients) while with the BACTEC method the yield was 71%. In the Community acquired septic arthritis, methicillin sensitive was isolated as commonest microbe while resistant variety of gram negative bacilli including and were found as predominant organism causing hospital acquired nosocomial infection of joints. The results strikingly differ in terms of response to treatment as most patients (11/19 patients) showed significant resistance to the most commonly practiced empirical antibiotic regimen of ampicillin-cloxacillin group in routine practice. When cefazolin was used as empirical antibiotic, it has shown good response and better sensitivity in 82% patients (27/33 patients).
is still the most common organism in septic arthritis. The BACTEC system was found to improve the yield of clinically significant isolates. Though a significant resistance to common antibiotic regimen is noticed, the strain is susceptible to cephalosporin group of antibiotics. We recommend the use of cephalosporine antibiotics as an empirical therapy till culture and sensitivity report are available.
在关节软骨发生不可逆损伤之前，早期治疗化脓性关节炎至关重要。临床医生在等待明确的培养报告时，常开始经验性抗生素治疗以缓解症状。在当今不同私立和公立部门中心存在差异且抗生素滥用猖獗的情况下，在菌群及其敏感性模式中出现了大量耐药性。因此，记录和分析这些变化趋势势在必行。
作者对前瞻性收集的60例14岁以下患者的数据进行了回顾性分析。作为标准治疗方案进行关节切开术，并将引流的脓液或滑液通过两种不同方法送去进行革兰氏染色和培养：传统琼脂平板法和BACTEC Peds Plus/F瓶法。抗生素敏感性试验采用临床实验室标准协会（CLSI）的纸片扩散法进行。
最常见的发病年龄组为1岁以下（80%的患者），包括24例新生儿。有19例医院获得性和41例社区获得性化脓性关节炎病例。髋关节（56%）是最常受累的关节，其次是膝关节（28%）、肩关节（11%）和肘关节（5%）。仅在53%的关节液分离物中分离出微生物（36例培养阳性患者）。传统琼脂培养方法仅在42%的患者（15/36例患者）中显示阳性报告，而采用BACTEC方法阳性率为71%。在社区获得性化脓性关节炎中，分离出的最常见微生物是对甲氧西林敏感的，而包括[具体菌名缺失]和[具体菌名缺失]在内的革兰氏阴性杆菌耐药品种是导致医院获得性关节医院感染的主要病原体。在治疗反应方面结果显著不同，因为大多数患者（11/19例患者）对常规实践中最常用的氨苄西林 - 氯唑西林组经验性抗生素方案表现出显著耐药性。当使用头孢唑林作为经验性抗生素时，82%的患者（27/33例患者）显示出良好的反应和更高的敏感性。
[具体菌名缺失]仍然是化脓性关节炎中最常见的病原体。发现BACTEC系统可提高具有临床意义的分离物的检出率。尽管注意到对常见抗生素方案有显著耐药性，但该菌株对头孢菌素类抗生素敏感。我们建议在获得培养和敏感性报告之前，使用头孢菌素类抗生素作为经验性治疗。
