Feng Wei, Yao Ziming, Liu Haonan, Zhu Danjiang, Song Baojian, Wang Qiang
Department of Orthopedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56, Nalishi Road, Beijing 100045, PR China.
Department of Orthopedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56, Nalishi Road, Beijing 100045, PR China.
J Orthop Sci. 2024 Sep;29(5):1294-1299. doi: 10.1016/j.jos.2023.08.009. Epub 2023 Aug 17.
Septic arthritis of the hip is a serious infection in children. However, blood and joint fluid cultures are often negative, which makes the diagnosis and treatment challenging. We analyzed the clinical features of children with septic arthritis of the hip with negative bacterial cultures and identified the risk factors for poor outcomes.
The clinical data of children with septic arthritis of the hip with negative bacterial cultures who were treated at our hospital from January 2010 to December 2020 were retrospectively analyzed. The clinical characteristics and outcomes of the culture-negative cohort were compared with those of children with positive bacterial cultures treated during the same period. Culture-negative patients were divided into a group with good outcomes and a group with poor outcomes. The differences between the two groups were compared.
Thirty-nine children with culture-negative septic arthritis of the hip were compared with 37 children with culture-positive sepsis. Compared with the culture-positive group, the culture-negative group had a significantly younger mean age and a significantly lower mean serum C-reactive protein concentration. Logistic regression analysis of culture-negative patients with good versus poor outcomes revealed that the independent risk factors for poor outcomes were an increased serum C-reactive protein concentration and prolonged time from onset to surgery. The cut-off values for predicting a poor outcome in the culture-negative group were a time from onset to surgery of greater than 21 days and a C-reactive protein concentration of greater than 23 mg/L.
Culture-negative septic arthritis of the hip has similar clinical features to culture-positive septic arthritis of the hip and can result in sequelae of varying severity. Therefore, active anti-infective and hip drainage therapy should be performed when children present with clinical symptoms, inflammatory marker concentrations, and imaging findings that are clinically diagnostic for septic arthritis of the hip.
Level II, retrospective study.
儿童髋关节化脓性关节炎是一种严重感染。然而，血液和关节液培养结果常为阴性，这给诊断和治疗带来挑战。我们分析了细菌培养阴性的儿童髋关节化脓性关节炎的临床特征，并确定了预后不良的危险因素。
回顾性分析2010年1月至2020年12月在我院接受治疗的细菌培养阴性的儿童髋关节化脓性关节炎的临床资料。将培养阴性队列的临床特征和预后与同期接受治疗的细菌培养阳性儿童的临床特征和预后进行比较。培养阴性的患者分为预后良好组和预后不良组。比较两组之间的差异。
将39例细菌培养阴性的儿童髋关节化脓性关节炎患者与37例细菌培养阳性的脓毒症患儿进行比较。与培养阳性组相比，培养阴性组的平均年龄显著更小，平均血清C反应蛋白浓度显著更低。对培养阴性患者预后良好与不良情况进行逻辑回归分析显示，预后不良的独立危险因素是血清C反应蛋白浓度升高和从发病到手术的时间延长。预测培养阴性组预后不良的临界值为从发病到手术的时间大于21天以及C反应蛋白浓度大于23mg/L。
细菌培养阴性的儿童髋关节化脓性关节炎与细菌培养阳性的儿童髋关节化脓性关节炎具有相似的临床特征，可导致不同严重程度的后遗症。因此，当儿童出现临床症状、炎症标志物浓度及影像学表现符合儿童髋关节化脓性关节炎的临床诊断时，应积极进行抗感染及髋关节引流治疗。
二级，回顾性研究。
