First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
Orthop Surg. 2021 Jun;13(4):1135-1140. doi: 10.1111/os.12912. Epub 2021 May 4.
The aim of this systematic review was to characterize the clinical features of adults with Salmonella osteomyelitis and summarize diagnosis and treatment methods to provide guidance for clinicians. This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We conducted a literature search in the PubMed, EMBASE, and Cochrane Library databases. Article screening and data extraction were performed by two reviewers individually. All the included studies were independently evaluated by two reviewers using the Methodological Index for Non-Randomized Studies (MINORS) criteria. A total of 67 articles published between 1970 and 2019 were selected, which include 69 patients with an average age of 47.5 years (range, 18-79).The majority of cases (47.76%) occurred in immunocompetent adults without common risk factors. Aspiration and biopsy cultures were all positive in Salmonella osteomyelitis patients who underwent aspiration or biopsy. All infections were monomicrobial, and a total of 12 different serotypes were identified. The three most commonly reported Salmonella serotypes were Salmonella typhi (19 cases), Salmonella typhimurium (12 cases), and Salmonella enteritidis (11 cases). Only 12 of the 67 cases in our data (17.91%) had diarrhea symptoms, and 44 of the 67 cases (65.67%) had fever symptoms. Fifty-nine of the 67 cases (88.06%) had local inflammatory manifestations, such as erythema, swelling, and tenderness in the affected area. The commonly reported involved sites were the vertebrae, femur, and tibia. Antibiotic therapy alone was utilized in 30 cases, and 24 patients (80.00%) were eventually cured. In total, 75.68% of patients achieved satisfactory results after treatment with surgery and antibiotics. Third-generation cephalosporins were most commonly utilized, and antibiotic treatment was administered for an average of 11.3 weeks (95% CI, 8.31-14.37 weeks). Salmonella osteomyelitis should be considered in patients without any common risk factors. Aspiration or biopsy can facilitate the identification of pathogens to guide antibiotic choice. Empirical therapy with a third-generation cephalosporin is recommended until the susceptibility of the strain is determined.
本系统评价的目的是描述成人沙门氏菌骨髓炎的临床特征，并总结其诊断和治疗方法，为临床医生提供指导。本系统评价按照 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 指南进行。我们在 PubMed、EMBASE 和 Cochrane Library 数据库中进行了文献检索。由两名评审员分别进行文章筛选和数据提取。所有纳入的研究均由两名评审员使用 Methodological Index for Non-Randomized Studies (MINORS) 标准进行独立评估。共选择了 1970 年至 2019 年期间发表的 67 篇文章，其中包括 69 例平均年龄为 47.5 岁（范围 18-79 岁）的患者。大多数病例（47.76%）发生在无常见危险因素的免疫功能正常的成人中。在接受抽吸或活检的沙门氏菌骨髓炎患者中，抽吸和活检培养均为阳性。所有感染均为单一微生物感染，共鉴定出 12 种不同血清型。报告最多的三种沙门氏菌血清型为伤寒沙门氏菌（19 例）、鼠伤寒沙门氏菌（12 例）和肠炎沙门氏菌（11 例）。我们的数据中只有 12 例（17.91%）有腹泻症状，67 例（65.67%）有发热症状。67 例中有 59 例（88.06%）有局部炎症表现，如受累部位的红斑、肿胀和压痛。常见的受累部位为椎体、股骨和胫骨。单独使用抗生素治疗的有 30 例，最终治愈 24 例（80.00%）。总的来说，手术和抗生素治疗后有 75.68%的患者取得了满意的效果。最常使用的是第三代头孢菌素，抗生素治疗的平均时间为 11.3 周（95%CI：8.31-14.37 周）。在没有任何常见危险因素的患者中应考虑沙门氏菌骨髓炎。抽吸或活检有助于确定病原体，从而指导抗生素的选择。建议在确定菌株敏感性之前，使用第三代头孢菌素进行经验性治疗。
