1Division of Pediatric Orthopaedic Surgery, UCSF Benioff Children's Hospital, University of California San Francisco, Oakland, California.
JBJS Rev. 2020 Jun;8(6):e1900202. doi: 10.2106/JBJS.RVW.19.00202.
The most common causative organism of pediatric osteomyelitis is Staphylococcus aureus, although, more recently, organisms such as Kingella kingae and methicillin-resistant S. aureus have been increasing in prevalence. Magnetic resonance imaging is the best diagnostic imaging modality for pediatric osteomyelitis given its high sensitivity and specificity. Most cases of early osteomyelitis without a drainable abscess can be adequately treated with a short course of intravenous antibiotics followed by at least 3 weeks of oral antibiotics. Surgical management of pediatric osteomyelitis is usually indicated in the presence of an abscess and/or failed treatment with antibiotic therapy. Clinical examination, fever, and C-reactive protein testing should be used to guide the conversion to oral antibiotics, the total antibiotic regimen duration, and the need for an additional debridement surgical procedure.
儿童骨髓炎最常见的病原体是金黄色葡萄球菌，不过近年来，金氏金菌和耐甲氧西林金黄色葡萄球菌等病原体的发病率也在上升。鉴于磁共振成像（MRI）具有较高的灵敏度和特异性，因此它是诊断儿童骨髓炎的最佳影像学方法。大多数无可引流脓肿的早期骨髓炎病例，经短程静脉用抗生素治疗后，再至少用 3 周的口服抗生素即可充分治疗。存在脓肿和/或抗生素治疗失败的情况下，通常需要手术治疗儿童骨髓炎。临床检查、发热和 C 反应蛋白检测可用于指导转为口服抗生素、总抗生素疗程以及是否需要进一步清创手术。
