From the Division of Pediatric Orthopaedic Surgery, Nemours Children's Hospital, Orlando, FL (Erkilinc), the Division of Pediatric Orthopaedic Surgery, Rainbow Babies and Children's Hospital, University Hospitals Cleveland Medical Center, Cleveland, OH (Gilmore, Weber, and Mistovich), Case Western Reserve University School of Medicine, Cleveland, OH (Gilmore, Weber, and Mistovich).
J Am Acad Orthop Surg. 2021 Mar 1;29(5):196-206. doi: 10.5435/JAAOS-D-20-00835.
Septic arthritis continues to present challenges regarding the clinical diagnosis, workup, and definitive management. Urgent management is essential, so treating surgeons must efficiently work through differential diagnoses, identify concomitant infections, and do a timely irrigation and débridement. The incidence of methicillin-resistant Staphylococcus aureus is increasing, typically resulting in a more rapid progression of symptoms with more severe clinical presentation. The diagnostic utility of MRI has resulted in improved detection of concomitant septic arthritis and osteomyelitis, although MRI must not substantially delay definitive management. Early diagnosis followed by urgent irrigation and débridement and antibiotic therapy are essential for satisfactory long-term outcomes. Antibiotics should not be administered until blood cultures and arthrocentesis fluid are obtained, except in rare cases of a septic or toxic patient. Once cultures are obtained, empiric antibiotic therapy should commence and provide coverage for the most likely pathogens, given the patient's age. Laboratory markers, especially C-reactive protein, should be followed until normalization and correlate with resolution of clinical symptoms. Definitive antibiotic selection should be shared with a pediatric infectious disease specialist, who can help guide the duration of treatment.
脓毒性关节炎在临床诊断、检查和明确治疗方面仍然存在挑战。紧急处理至关重要，因此治疗外科医生必须有效地处理鉴别诊断，确定伴随感染，并及时进行灌洗和清创。耐甲氧西林金黄色葡萄球菌的发病率正在增加，通常导致症状更快进展，临床表现更严重。MRI 的诊断效用已导致对伴随的脓毒性关节炎和骨髓炎的检测得到改善，尽管 MRI 不能明显延迟明确的治疗。早期诊断后，紧急灌洗和清创以及抗生素治疗对获得满意的长期结果至关重要。在极少数脓毒症或中毒患者的情况下，在获得血液培养和关节穿刺液之前，不应给予抗生素。一旦获得培养物，应根据患者的年龄开始经验性抗生素治疗，并提供最可能病原体的覆盖范围。应跟踪实验室标志物，尤其是 C 反应蛋白，直到其正常化并与临床症状的缓解相关。应与儿科传染病专家共同确定明确的抗生素选择，以帮助指导治疗时间。
