Thingsaker Elise Evja, Urbane Urzula Nora, Pavare Jana
Faculty of Medicine, Riga Stradins University, LV-1007 Riga, Latvia.
Sørlandet Sykehus Helseforetak, 4604 Kristiansand, Norway.
Medicina (Kaunas). 2021 Jan 4;57(1):36. doi: 10.3390/medicina57010036.
: Paediatric acute osteomyelitis (AO) may result in major life-threatening and limb-threatening complications if not recognized and treated early. The management of AO may depend on local microbial prevalence and virulence factors. This study compares the approach to paediatric AO in hospitals in two countries-Latvia and Norway. The study includes patients with AO hospitalized in the paediatric department in the Norwegian hospital Sørlandet Sykehus Kristiansand (SSK), in the period between the 1st of January 2012 and the 31st of December 2019. The results from SSK are compared to the results of a published study of AO in patients hospitalized at the Children's Clinical University Hospital (CCUH) in Riga, Latvia. The most isolated pathogen from cultures in both hospitals was (methicillin-sensitive). The lower extremity was the most affected body part (75% in CCUH, 95% in SSK), the main clinical symptom was pain (CCUH 92%, SSK 96.6%). Deep culture aspiration was most often taken intraoperatively in CCUH (76.6%) and percutaneously in SSK (44.8%). Oxacillin was the most applied antibiotic in CCUH (89.4%), and Cloxacillin in SSK (84.6%). Combined treatment with anti-Staphylococcal penicillins and Clindamycin was administered in 25.5% and 33.8% of CCUH and SSK patients, respectively. The median duration of the intravenous antibacterial treatment in CCUH and SSK was 15 and 10 days, respectively, and a switch to oral therapy was mainly made at discharge in both hospitals. The median total duration of antibiotic treatment was 25 days in CCUH and 35 days in SSK. 75% of CCUH and 10.3% of SSK patients were treated surgically. Complications were seen in 47% of patients in CCUH and in 38% in SSK. The transition to oral antibacterial treatment in both hospitals was delayed, which suggests a lack of criteria for discontinuation of intravenous therapy and could potentially contribute to longer hospitalization, higher cost of treatment and risk of complications. The use of more invasive techniques for deep culturing and significantly more common surgical interventions could possibly be linked to a higher complication rate in AO patients treated at the Latvian hospital.
小儿急性骨髓炎（AO）若不及早识别与治疗，可能导致危及生命和肢体的严重并发症。AO的治疗可能取决于当地微生物的流行情况和毒力因子。本研究比较了拉脱维亚和挪威两国医院对小儿AO的治疗方法。该研究纳入了2012年1月1日至2019年12月31日期间在挪威克里斯蒂安桑南海岸医院（SSK）儿科住院的AO患者。将SSK的结果与拉脱维亚里加儿童临床大学医院（CCUH）已发表的AO患者研究结果进行比较。两家医院培养物中最常分离出的病原体是（甲氧西林敏感菌）。下肢是受影响最严重的身体部位（CCUH为75%，SSK为95%），主要临床症状为疼痛（CCUH为92%，SSK为96.6%）。在CCUH，深部培养抽吸术最常在术中进行（76.6%），而在SSK则经皮进行（44.8%）。在CCUH，苯唑西林是最常用的抗生素（89.4%），在SSK则是氯唑西林（84.6%）。CCUH和SSK分别有25.5%和33.8%的患者接受了抗葡萄球菌青霉素与克林霉素的联合治疗。CCUH和SSK静脉抗菌治疗的中位持续时间分别为15天和10天，且两家医院主要在出院时转为口服治疗。抗生素治疗的中位总持续时间在CCUH为25天，在SSK为35天。CCUH有75%的患者和SSK有10.3%的患者接受了手术治疗。CCUH有47%的患者出现并发症，SSK有38%的患者出现并发症。两家医院向口服抗菌治疗的过渡均延迟，这表明缺乏停止静脉治疗的标准，可能会导致住院时间延长、治疗成本增加以及并发症风险上升。在拉脱维亚医院接受治疗的AO患者中，使用更具侵入性的深部培养技术以及明显更常见的手术干预可能与更高的并发症发生率有关。
