Núñez Cuadros Esmeralda, Calvo Rey Cristina, Saavedra-Lozano Jesús
Hospitalización Pediátrica, Unidad de Reumatología Pediátrica, Unidad Asistencial de Pediatría, Hospital Regional Universitario de Málaga, Málaga, España.
Servicio de Pediatría y Enfermedades Infecciosas, Hospital Universitario La Paz, Fundación IdiPaz. TEDDY Network (European Network of Excellence for Pediatric Clinical Research), Madrid, España; Red de Investigación Traslacional en Infectología Pediátrica (RITIP), España.
An Pediatr (Engl Ed). 2020 Nov;93(5):289-296. doi: 10.1016/j.anpedi.2019.11.008. Epub 2020 Jan 21.
In 2014 the Consensus Document produced by the Spanish Paediatric Societies (SEIP-SERPE-SEOP) was published to help in the diagnosis and treatment of osteoarticular infections (OAI). In 2015 the RIOPed was considered as a multidisciplinary national network for the investigation into OAI. The aim of this study was to assess the level of adaption to the recommendations established in the Consensus during one year of follow-up.
A prospective, national multicentre study was carried out in 37 hospitals between September 2015 and September 2016. The study included patients >16years-old with a diagnosis of OAI, confirmed by microbiological isolation, or probable: septic arthritis (SA) with >40,000 white cells in synovial fluid, or osteomyelitis (OM)/spondylodiscitis (SD) with a compatible imaging test. The results were compared with those obtained in a retrospective study conducted between 2008 and 2012.
A total of 235 cases were included, of which 131 were OM, 79 SA, 30 OA, and 15 SD. As regards the complementary tests that the Consensus considered mandatory to perform, radiography was carried out on 87.8% of the cases, a blood culture on 91.6%, and culture of the synovial fluid in 99% of SA. A magnetic resonance (MR) was performed on 71% of the OM cases. The choice of intravenous empirical antibiotic treatment was adapted to the recommendations in 65.1% of cases, and in 62.3% for the oral treatment. Surgery was performed in 36.8% of SA cases (85.7% arthrotomy), with a significant decrease compared to the retrospective study (P=.014). Only 58.5% of cases followed the recommendations on the duration of the treatment; however, a lower duration of intravenous treatment was observed.
In general, the level of adaptation to the recommendations that were set by the Expert Group, is good for the complementary tests, and acceptable as regards the choice of antibiotic treatment, although inadequate in almost 40% of cases. A decrease in hospital stay was achieved.
2014年，西班牙儿科学会（SEIP - SERPE - SEOP）发布了共识文件，以协助骨关节炎感染（OAI）的诊断和治疗。2015年，RIOPed被视为一个用于OAI调查的多学科国家网络。本研究的目的是评估在一年随访期间对共识中确立的建议的适应程度。
2015年9月至2016年9月期间，在37家医院开展了一项前瞻性全国多中心研究。该研究纳入了年龄大于16岁、诊断为OAI的患者，诊断经微生物分离确诊或疑似：滑液中白细胞计数>40000的化脓性关节炎（SA），或经影像学检查符合骨髓炎（OM）/脊椎间盘炎（SD）。将结果与2008年至2012年进行的一项回顾性研究结果进行比较。
共纳入235例病例，其中131例为OM，79例为SA，30例为OA，15例为SD。关于共识认为必须进行的补充检查，87.8%的病例进行了X线摄影，91.6%进行了血培养，99%的SA病例进行了滑液培养。71%的OM病例进行了磁共振（MR）检查。静脉经验性抗生素治疗的选择在65.1%的病例中符合建议，口服治疗在62.3%的病例中符合建议。36.8%的SA病例接受了手术（85.7%为关节切开术），与回顾性研究相比有显著下降（P = 0.014）。只有58.5%的病例遵循了治疗持续时间的建议；然而，观察到静脉治疗的持续时间较短。
总体而言，对专家组制定的建议的适应程度在补充检查方面良好，在抗生素治疗选择方面尚可接受，尽管近40%的病例存在不足。住院时间有所缩短。
