From the Department of Pediatrics, Section of Infectious Diseases, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas.
Pediatr Infect Dis J. 2019 Aug;38(8):808-811. doi: 10.1097/INF.0000000000002349.
Staphylococcus aureus is a significant cause of implant-associated infections (IAIs). Data detailing the optimal treatment of IAIs are lacking in children. We describe the clinical features and outcomes of pediatric patients with S. aureus IAIs seen at Texas Children's Hospital.
Patients and their isolates were identified from a S. aureus surveillance database from 2008 to 2016 in Houston, TX. Demographic and clinical data were collected retrospectively. Fisher's exact was used for statistical analysis.
Forty-five patients with 47 IAIs were identified. Most patients had an infected orthopedic implant: 22 (47%) spinal rods and 19 (40%) with other orthopedic hardware. Thirty (64%) IAIs developed within 90 days of implant placement. Six patients had polymicrobial infections and 3 patients were bacteremic. Of the 47 IAI isolates, 34 (72%) were methicillin-susceptible S. aureus (MSSA) and 13 (28%) were methicillin-resistant S. aureus. All children underwent surgical irrigation, debridement and antibiotic therapy. Of the 47 IAI episodes, 22 of the implants were removed at time of initial presentation, 7 implants had delayed removal, and 18 implants remained in place. Successful treatment was achieved in all patients with immediate implant removal (22/22) and in 83% of patients with implant retention (15/18), including 10 patients with early postoperative infections (<3 months) and 5 patients with late postoperative infections (>3 months). Four patients had recurrence of infection.
The majority of S. aureus IAIs were methicillin-susceptible S. aureus. All children with immediate implant removal and most children with retained implants were treated successfully with surgery and antibiotic therapy.
金黄色葡萄球菌是导致植入物相关感染（IAI）的重要原因。目前缺乏详细的儿童 IAI 最佳治疗数据。我们描述了在德克萨斯儿童医院就诊的金黄色葡萄球菌 IAI 儿科患者的临床特征和结局。
从 2008 年至 2016 年休斯顿的金黄色葡萄球菌监测数据库中确定了患者及其分离株。回顾性收集人口统计学和临床数据。Fisher 确切检验用于统计分析。
共确定了 45 例 47 例 IAI 患者。大多数患者的感染植入物为骨科植入物：22 例（47%）脊柱棒和 19 例（40%）其他骨科植入物。30 例（64%）IAI 在植入后 90 天内发生。6 例患者发生混合感染，3 例菌血症。在 47 株 IAI 分离株中，34 株（72%）为甲氧西林敏感金黄色葡萄球菌（MSSA），13 株（28%）为耐甲氧西林金黄色葡萄球菌。所有患儿均接受手术冲洗、清创和抗生素治疗。在 47 例 IAI 发作中，22 例植入物在初次就诊时被移除，7 例植入物延迟移除，18 例植入物保留在原位。立即移除植入物的所有患者（22/22）和 83%保留植入物的患者（15/18）均获得成功治疗，包括 10 例术后早期感染（<3 个月）和 5 例术后晚期感染（>3 个月）。4 例患者出现感染复发。
金黄色葡萄球菌 IAI 大多数为甲氧西林敏感金黄色葡萄球菌。所有立即移除植入物的患儿和大多数保留植入物的患儿均通过手术和抗生素治疗成功治愈。
