Department of Pediatrics, Faculty of Medicine, University Hospital of Cologne, Kerpenerstr. 62, 50397, Cologne, Germany.
Department of Orthopedics and Trauma Surgery, University Hospital of Cologne, Cologne, Germany.
Infection. 2023 Aug;51(4):831-838. doi: 10.1007/s15010-022-01934-4. Epub 2022 Oct 6.
In recent years an earlier step down to oral antibiotic therapy has been advocated for numerous infections. Trained infectious disease specialists regularly consulting their colleagues may speed up the implementation of such recommendations into clinical practice and thus may improve treatment.
We retrospectively analyzed bone and joint infections in children admitted to the University Hospital of Cologne between 2010 and 2021. We assessed clinical, imaging, and microbiological findings and treatment modalities. Additionally, we assessed both the impact of a newly implemented pediatric infectious diseases consultation service and publications on revised treatment recommendations by comparing antibiotic therapy in two periods (2010-2016 versus 2017 to 2021).
In total, 29 children presented with osteomyelitis, 16 with bacterial arthritis and 7 with discitis. In period 2 (2017-2021) we observed shorter duration of intravenous treatment (p = 0.009) and a higher percentage of oral antibiotic treatment in relation to the total duration of antibiotics (25% versus 59%, p = 0.007) compared to period 1 (2010-2016). Yet, no differences were identified for the total length of antibiotic treatment. Additionally, biopsies or synovial fluid samples were retrieved and cultured in more children in period 2 (p = 0.077). The main pathogen identified in osteomyelitis and bacterial arthritis was Staphylococcus aureus (MSSA), diagnosis was confirmed predominantly with MRI.
Recent guidelines addressing the safety of an earlier step-down (to oral) antibiotic therapy have influenced clinical practice in the treatment of bone and joint infections in our hospital. A newly implemented pediatric infectious diseases consultation service might have accelerated this progress resulting in a faster step down to oral treatment.
近年来，许多感染提倡更早地降阶梯为口服抗生素治疗。接受过培训的传染病专家定期咨询他们的同事，可能会加快将这些建议付诸临床实践，并因此改善治疗效果。
我们回顾性分析了 2010 年至 2021 年期间科隆大学医院收治的儿童骨骼和关节感染病例。我们评估了临床、影像学和微生物学检查结果以及治疗方式。此外，我们通过比较两个时期（2010-2016 年与 2017 年至 2021 年）的抗生素治疗情况，评估了新实施的儿科传染病咨询服务和出版物对修订治疗建议的影响。
共有 29 例儿童患有骨髓炎，16 例患有细菌性关节炎，7 例患有椎间盘炎。在第 2 阶段（2017-2021 年），我们观察到静脉治疗时间缩短（p=0.009），并且口服抗生素治疗的比例相对于抗生素总疗程更高（25%比 59%，p=0.007），与第 1 阶段（2010-2016 年）相比。然而，抗生素总疗程没有差异。此外，第 2 阶段有更多的患儿进行了活检或滑膜液样本采集和培养（p=0.077）。骨髓炎和细菌性关节炎的主要病原体是金黄色葡萄球菌（MSSA），诊断主要通过 MRI 确认。
最近的指南强调了降阶梯（口服）抗生素治疗的安全性，这影响了我们医院骨骼和关节感染治疗的临床实践。新实施的儿科传染病咨询服务可能加速了这一进展，从而更快地降阶梯为口服治疗。
