Kolinsky Daniel C, Liang Stephen Y
Department of Emergency Medicine, Southeast Louisiana Veterans Health Care System, 2400 Canal Street, New Orleans, LA 70119, USA.
Division of Emergency Medicine, Washington University School of Medicine, 4523 Clayton Avenue, Campus Box 8072, St Louis, MO 63110, USA; Division of Infectious Diseases, Washington University School of Medicine, 4523 Clayton Avenue, Campus Box 8051, St Louis, MO 63110, USA.
Emerg Med Clin North Am. 2018 Nov;36(4):751-766. doi: 10.1016/j.emc.2018.06.006. Epub 2018 Sep 6.
Bone and joint infections are potentially limb-threatening or even life-threatening diseases. Emergency physicians must consider infection when evaluating musculoskeletal complaints, as misdiagnosis can have significant consequences. Patients with bone and joint infections can have heterogeneous presentations with nonspecific signs and symptoms. Staphylococcus aureus is the most commonly implicated microorganism. Although diagnosis may be suggested by physical examination, laboratory testing, and imaging, tissue sampling for Gram stain and microbiologic culture is preferable, as pathogen identification and susceptibility testing help optimize long-term antibiotic therapy. A combination of medical and surgical interventions is often necessary to effectively manage these challenging infections.
骨与关节感染是潜在的肢体威胁甚至危及生命的疾病。急诊医生在评估肌肉骨骼方面的主诉时必须考虑到感染,因为误诊可能会产生严重后果。骨与关节感染患者的表现可能多种多样,症状和体征不具特异性。金黄色葡萄球菌是最常见的致病微生物。虽然体格检查、实验室检测和影像学检查可能提示诊断,但进行组织采样以进行革兰氏染色和微生物培养更佳,因为病原体鉴定和药敏试验有助于优化长期抗生素治疗。通常需要药物和手术干预相结合,才能有效处理这些具有挑战性的感染。