Dayer R, Alzahrani M M, Saran N, Ouellet J A, Journeau P, Tabard-Fougère A, Martinez-Álvarez S, Ceroni D
Division of Paediatric Orthopaedics, University Hospitals of Geneva, 6 Rue Willy Donzé, 1211 Geneva 14, Switzerland.
Division of Orthopaedics, McGill University and Imam Abdulrahman Bin Faisal University, 845 Rue Sherbrooke O, Montréal, QC H3A 0G4, Canada.
Bone Joint J. 2018 Apr 1;100-B(4):542-548. doi: 10.1302/0301-620X.100B4.BJJ-2017-1080.R1.
This multicentre, retrospective study aimed to improve our knowledge of primary pyogenic spinal infections in children by analyzing a large consecutive case series.
The medical records of children with such an infection, treated at four tertiary institutions between 2004 and 2014, were analyzed retrospectively. Epidemiological, clinical, paraclinical, radiological, and microbiological data were evaluated. There were 103 children, of whom 79 (76.7%) were aged between six months and four years.
We confirmed a significant male predominance in the incidence of primary pyogenic spinal infections in children (65%). The lumbar spine was the most commonly affected region, and 27 infections (26.2%) occurred at L4/5. The white blood cell count was normal in 61 children (59%), and the CRP level was normal in 43 (42%). Blood cultures were performed in 95 children, and were positive in eight (8%). A total of 20 children underwent culture of biopsy or aspiration material, which was positive in eight (40%). Methicillin-sensitive Staphylococcus aureus (MSSA) and Kingella ( K.) kingae were the most frequently isolated pathogens.
MSSA remains the most frequently isolated pathogen in children with primary pyogenic infection of the spine, but K. kingae should be considered as an important pathogen in children aged between six months and four years. Therefore, an empirical protocol for antibiotic treatment should be used, with consideration being made for the triphasic age distribution and specific bacteriological aetiology. In the near future, the results of polymerase chain reaction assay on throat swabs may allow the indirect identification of K. kingae spondylodiscitis in young children and thus aid early treatment. However, these preliminary results require validation by other prospective multicentre studies. Cite this article: Bone Joint J 2018;100-B:542-8.
本多中心回顾性研究旨在通过分析大量连续病例系列，增进我们对儿童原发性化脓性脊柱感染的认识。
对2004年至2014年间在四家三级医疗机构接受治疗的此类感染儿童的病历进行回顾性分析。评估了流行病学、临床、辅助临床、放射学和微生物学数据。共有103名儿童，其中79名（76.7%）年龄在6个月至4岁之间。
我们证实儿童原发性化脓性脊柱感染的发病率男性显著占优（65%）。腰椎是最常受累的部位，27例感染（26.2%）发生在L4/5。61名儿童（59%）白细胞计数正常，43名（42%）C反应蛋白水平正常。95名儿童进行了血培养，8名（8%）呈阳性。共有20名儿童接受了活检或穿刺材料培养，其中8名（40%）呈阳性。甲氧西林敏感金黄色葡萄球菌（MSSA）和金氏金氏杆菌是最常分离出的病原体。
MSSA仍然是儿童原发性化脓性脊柱感染最常分离出的病原体，但金氏金氏杆菌应被视为6个月至4岁儿童的重要病原体。因此，应采用经验性抗生素治疗方案，并考虑年龄的三相分布和特定的细菌学病因。在不久的将来，咽喉拭子聚合酶链反应检测结果可能有助于间接识别幼儿的金氏金氏杆菌性脊椎间盘炎，从而有助于早期治疗。然而，这些初步结果需要其他前瞻性多中心研究进行验证。引用本文：《骨关节杂志》2018年；100-B：542-548。
