Thakolkaran Nimmy, Shetty Avinash K
Department of Family Medicine, Mount Sinai Hospital, Chicago, IL.
Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC.
Ochsner J. 2019 Summer;19(2):116-122. doi: 10.31486/toj.18.0138.
The epidemiology of acute hematogenous osteomyelitis (AHO) in children has changed. We reviewed the current literature regarding the epidemiology, microbiology, pathogenesis, clinical presentation, diagnosis, and antimicrobial management of AHO in children. is the most common microorganism causing pediatric AHO, followed by group A (GAS). AHO due to community-associated methicillin-resistant (MRSA) can cause severe and complicated disease. Pathogen isolation by culture is key for targeted antibiotic therapy. Polymerase chain reaction assay in tissue sample or joint fluid may enhance the yield of . C-reactive protein is useful in diagnosis and monitoring the course of AHO. Magnetic resonance imaging is the preferred diagnostic imaging study for AHO. Clindamycin or vancomycin (for serious disease) is recommended for empiric therapy of suspected AHO due to MRSA depending on the geographic prevalence. Penicillinase-stable penicillins or first-generation cephalosporins are preferred antibiotics to treat methicillin-sensitive (MSSA) infection. Beta-lactam agents are the drugs of choice for treating AHO due to GAS, or For uncomplicated AHO due to MSSA, a short parenteral antibiotic course followed by oral therapy for a minimum total duration of 3-4 weeks is adequate. Complicated AHO due to MRSA may warrant prolonged therapy with surgical intervention. Given the evolution of pathogens, the variability in clinical presentations and course ranging from simple to complex disease, and response to treatment, the management of AHO continues to evolve and warrants an individualized, multidisciplinary approach.
儿童急性血源性骨髓炎（AHO）的流行病学已发生变化。我们回顾了有关儿童AHO的流行病学、微生物学、发病机制、临床表现、诊断及抗菌治疗的当前文献。金黄色葡萄球菌是引起儿童AHO最常见的微生物，其次是A组链球菌（GAS）。社区相关性耐甲氧西林金黄色葡萄球菌（MRSA）所致的AHO可引起严重和复杂的疾病。通过培养进行病原体分离是靶向抗生素治疗的关键。组织样本或关节液中的聚合酶链反应检测可能会提高金黄色葡萄球菌的检出率。C反应蛋白对AHO的诊断和病程监测有用。磁共振成像（MRI）是AHO首选的诊断性影像学检查。根据地理流行情况，对于疑似由MRSA引起的AHO经验性治疗，推荐使用克林霉素或万古霉素（用于重症疾病）。对甲氧西林敏感金黄色葡萄球菌（MSSA）感染，青霉素酶稳定的青霉素或第一代头孢菌素是首选抗生素。β-内酰胺类药物是治疗由GAS或其他细菌引起的AHO的首选药物。对于MSSA所致的非复杂性AHO，短期肠外抗生素疗程后口服治疗，总疗程至少3 - 4周即可。MRSA所致的复杂性AHO可能需要延长治疗并进行手术干预。鉴于病原体的演变、临床表现和病程从简单到复杂疾病的变异性以及对治疗的反应，AHO的治疗仍在不断发展，需要个体化、多学科的方法。
