Santa Casa de São Paulo, Departamento de Pediatria, São Paulo, SP, Brazil.
Santa Casa de São Paulo, Departamento de Pediatria, Setor de Infectologia Pediátrica, São Paulo, SP, Brazil; Faculdade de Ciências Médicas da Santa Casa de São Paulo, Departamento de Ciências Patológicas, Disciplina de Microbiologia, São Paulo, SP, Brazil.
J Pediatr (Rio J). 2020 Mar-Apr;96 Suppl 1(Suppl 1):58-64. doi: 10.1016/j.jped.2019.10.005. Epub 2019 Nov 26.
To collect the most up-to-date information regarding pediatric osteoarticular infections, including the epidemiological and microbiological profiles, diagnosis, and treatment.
A non-systematic review was performed on the search engines PubMed, SciELO, LILACS, and Google Scholar, using the keywords "bone and joint infection", "children", "pediatric", "osteomyelitis", "septic arthritis" and "spondylodiscitis" over the last ten years. The most relevant articles were selected by the authors to constitute the database.
Osteoarticular infections are still a major cause of morbidity in pediatrics. Their main etiology is Staphylococcus aureus, but there has been an increase in the detection of Kingella kingae, especially through molecular methods. Microbiological identification allows treatment direction, while evidence of inflammatory activity assists in treatment follow-up. Imaging tests are especially useful in the initial diagnosis of infections. Empirical treatment should include coverage for the main microorganisms according to the age and clinical conditions of the patient, while considering the local resistance profile. Surgical procedures can be indicated for diagnosis, focus control, and function preservation. Acute complications include sepsis, deep venous thrombosis, and pulmonary embolism. Deaths are rare. Late complications are uncommon but may lead to deformities that compromise motor development.
A correct and early diagnosis, prompt implementation of adequate antimicrobial therapy, and focus control, when indicated, are critical to a better prognosis.
收集最新的儿科骨与关节感染信息，包括流行病学和微生物特征、诊断和治疗。
通过在 PubMed、SciELO、LILACS 和 Google Scholar 搜索引擎上使用“骨与关节感染”、“儿童”、“儿科”、“骨髓炎”、“化脓性关节炎”和“脊椎炎”等关键词，对过去十年的文献进行了非系统性回顾。作者选择了最相关的文章来构成数据库。
骨与关节感染仍然是儿科发病率的主要原因。其主要病因是金黄色葡萄球菌，但通过分子方法检测到金氏金氏菌的检出率有所增加。微生物鉴定有助于确定治疗方向，而炎症活动的证据有助于治疗随访。影像学检查在感染的初始诊断中特别有用。经验性治疗应根据患者的年龄和临床状况覆盖主要微生物，同时考虑当地的耐药谱。手术可用于诊断、控制病灶和保存功能。急性并发症包括败血症、深静脉血栓形成和肺栓塞。死亡率罕见。晚期并发症虽不常见，但可能导致影响运动发育的畸形。
正确和早期的诊断、及时实施适当的抗菌治疗以及在有指征时控制病灶，对改善预后至关重要。
