Iliadis Alexios D, Ramachandran Manoj
Centre for Orthopaedics, The Royal London and Barts and The London Children's Hospitals, Barts Health NHS Trust, London, UK.
EFORT Open Rev. 2017 Mar 13;2(1):7-12. doi: 10.1302/2058-5241.2.160027. eCollection 2017 Jan.
Despite advances in understanding and management, paediatric osteoarticular infections continue to pose diagnostic difficulties for clinicians. Delays in diagnosis can lead to potentially devastating morbidity.No single investigation, including joint aspiration, is sufficiently reliable to diagnose conclusively paediatric bone and joint infection. Diagnosis should be based on a combination of clinical signs, imaging and laboratory investigations. Algorithms should supplement, and not replace, clinical decision making in all cases.The roles of aspiration, arthrotomy and arthroscopy in the treatment of septic arthritis are not clearly defined. There is a very limited role for surgery in the management of acute haematogenous osteomyelitis.The ideal duration and mode of administration of antibiotic therapy for osteoarticular paediatric infection is not yet fully defined but there is increasing evidence that shorter courses (three weeks) and early conversion (day four) to oral administration is safe and effective in appropriate cases. Clear and concise antibiotic guidelines should be available based on local population characteristics, pathogens and their sensitivities. is increasingly identified through polymerase chain reaction and is now recognised as the commonest pathogen in children aged under four years. Methicillin-resistant and Panton-Valentine leukocidin-producing strains of are being increasingly reported.A multidisciplinary integrated evidence-based approach is required to optimise outcomes.Further large-scale, multicentre studies are needed to delineate the optimal management of paediatric osteoarticular infection. Cite this article: 2017;1:7-12. DOI: 10.1302/2058-5241.2.160027.
尽管在认识和管理方面取得了进展，但儿童骨关节炎感染仍然给临床医生带来诊断难题。诊断延迟可能导致潜在的严重发病率。没有任何一项检查，包括关节穿刺，能够足够可靠地确诊儿童骨和关节感染。诊断应基于临床体征、影像学和实验室检查的综合结果。在所有情况下，诊断算法应辅助而不是取代临床决策。关节穿刺、关节切开术和关节镜检查在化脓性关节炎治疗中的作用尚未明确界定。手术在急性血源性骨髓炎的管理中作用非常有限。儿童骨关节炎感染抗生素治疗的理想疗程和给药方式尚未完全确定，但越来越多的证据表明，在适当情况下，较短疗程（三周）和早期（第四天）改为口服给药是安全有效的。应根据当地人群特征、病原体及其敏感性制定清晰简洁的抗生素指南。通过聚合酶链反应越来越多地检测到，现在被认为是4岁以下儿童中最常见的病原体。耐甲氧西林和产生杀白细胞素的菌株的报告越来越多。需要采取多学科综合循证方法来优化治疗效果。需要进一步开展大规模、多中心研究来确定儿童骨关节炎感染的最佳管理方法。引用本文：2017；1：7 - 12。DOI：10.1302/2058 - 5241.2.160027。
