儿科骨髓炎和化脓性关节炎的病原菌分布和耐药性分析：单中心 15 年回顾性分析。
Paediatric Osteomyelitis and Septic Arthritis Pathogen Distribution and Antimicrobial Resistance in a Single Centre: A 15-Year Retrospective Analysis.
机构信息
Department of Orthopaedics, the Affiliated Hospital of Guizhou Medical University, Guiyang 550000, China.
Department of Pediatric Orthopaedics, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, China.
出版信息
J Trop Pediatr. 2022 Apr 5;68(3). doi: 10.1093/tropej/fmac038.
BACKGROUND
The epidemiological characteristics of the common pathogens underlying acute haematogenous osteoarticular infection (AHOI) and their resistance to drugs have temporal and regional differences.
AIMS
To determine the antimicrobial treatment most effective for culture-negative AHOI patients and those without bacterial cultures.
METHODS
Retrospective analysis of clinical data of children with AHOI who were culture positive from January 2007 to December 2021. And the distribution of the main pathogens and the drug resistance Staphylococcus aureus were analysed in different time periods, age groups and infection types.
RESULTS
A total of 188 cases met the inclusion criteria, including 97 cases of acute haematogenous osteomyelitis (AHO), 75 cases of septic arthritis (SA) and 16 cases of AHO concomitant with SA. The commonest causative pathogen in local children was S. aureus of Gram-positive cocci, followed by Streptococcus, and occasionally Gram-negative bacilli. The distribution of S. aureus had no significant correlation with age or infection type. Staphylococcus aureus accounted for 81.82%, 90.91% and 96.15% of all pathogens, and methicillin-resistant S. aureus (MRSA) accounted for 24.22%, 53.33% and 76.00% of S. aureus in 2007-11, 2012-16 and 2017-21, respectively. The frequency of MRSA infection showed an increasing trend over time.
CONCLUSION
Staphylococcus aureus is still the main pathogen of AHOI in local children. The proportion of MRSA in S. aureus has also increased over time to 76% in the last 5 years, and the increased proportion of MRSA can affect the choice of initial empirical medication.
背景
引起急性血源性骨髓炎和关节感染（AHOI）的常见病原体的流行病学特征及其耐药性具有时间和地域差异。
目的
确定对培养阴性 AHOI 患者和未进行细菌培养患者最有效的抗菌治疗方法。
方法
回顾性分析 2007 年 1 月至 2021 年 12 月期间培养阳性的儿童 AHOI 患者的临床资料。分析不同时期、年龄组和感染类型的主要病原体分布和金黄色葡萄球菌耐药情况。
结果
共纳入 188 例符合条件的病例，其中急性血源性骨髓炎（AHO）97 例，化脓性关节炎（SA）75 例，AHO 合并 SA16 例。本地儿童常见的致病病原体是革兰阳性球菌中的金黄色葡萄球菌，其次是链球菌，偶尔也有革兰阴性杆菌。金黄色葡萄球菌的分布与年龄或感染类型无显著相关性。金黄色葡萄球菌占所有病原体的 81.82%、90.91%和 96.15%，甲氧西林耐药金黄色葡萄球菌（MRSA）分别占 2007-11 年、2012-16 年和 2017-21 年金黄色葡萄球菌的 24.22%、53.33%和 76.00%。MRSA 感染的频率呈上升趋势。
结论
金黄色葡萄球菌仍是本地儿童 AHOI 的主要病原体。MRSA 在金黄色葡萄球菌中的比例也随时间推移而增加，在过去 5 年中增加到 76%，MRSA 比例的增加会影响初始经验性用药的选择。
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