Yildirim Arslan Sema, Sahbudak Bal Zumrut, Guner Ozenen Gizem, Bilen Nimet Melis, Avcu Gulhadiye, Erci Ece, Kurugol Zafer, Gunay Huseyin, Tamsel İpek, Ozkinay Ferda
Medical School of Ege University, Division of Infectious Disease, Department of Pediatrics, Izmir, Turkey.
Medical School of Ege University, Department of Orthopaedics and Traumatology, Izmir, Turkey.
World Allergy Organ J. 2024 Feb 7;17(2):100850. doi: 10.1016/j.waojou.2023.100850. eCollection 2024 Feb.
Bone and joint infections are common in children, particularly those under 10 years of age. While antimicrobial therapy can often successfully treat these infections, surgical drainage may also be necessary. It is important to note that prolonged courses of treatment have been associated with adverse events and drug reactions. Among these, drug reactions with eosinophilia and systemic symptoms (DRESS) syndrome is particularly severe and potentially life-threatening. We aimed to evaluate the cases of DRESS syndrome that develop during the treatment of bone and joint infections.
A retrospective study was conducted at a tertiary-level university hospital between 2015 and 2022 to determine the incidence and outcomes of definite DRESS Syndrome in children under 18 years of age with bone and joint infections.
Of 73 patients with bone and joint infections, 16 (21.9 %) children developed antimicrobial therapy-induced DRESS syndrome. Eight (50 %) of these children were boys; the mean age of the patients was 9.76 ± 5.5 years. DRESS syndrome occurred in 16 children, including 13 children with osteomyelitis, 1 child with osteomyelitis and septic arthritis, and 2 children with septic arthritis and sacroiliitis. The mean duration of intravenous antibiotic therapy was 40.6 ± 16.6 days; the mean hospital stay was 48.7 ± 23.7 days; the mean time for the development of DRESS syndrome after starting antibiotics was 19.6 ± 7.68 days. New onset fever (68.8 %) and rash (43.8 %) were the most common symptoms of DRESS Syndrome. Cefotaxime and vancomycin were drugs responsible for DRESS syndrome in 8 (50 %) of 16. The causative antibiotics were switched to another class of antibiotic, most commonly preferred was ciprofloxacin (n:5; 31.3 %). For children with persistent symptoms, steroids were used in 5 (31.25) patients.
Clinicians should be aware of DRESS syndrome in children who develop fever and rash under long-term antibiotics and should check hematological and biochemical parameters to predict the severity of DRESS syndrome. In patients with persistent symptoms, steroids may be used to control the symptoms.
骨与关节感染在儿童中很常见，尤其是10岁以下的儿童。虽然抗菌治疗通常可以成功治疗这些感染，但手术引流可能也是必要的。需要注意的是，延长治疗疗程与不良事件和药物反应有关。其中，伴有嗜酸性粒细胞增多和全身症状的药物反应（DRESS）综合征尤为严重，甚至可能危及生命。我们旨在评估在骨与关节感染治疗过程中发生的DRESS综合征病例。
在一家三级大学医院于2015年至2022年进行了一项回顾性研究，以确定18岁以下患有骨与关节感染的儿童中确诊DRESS综合征的发病率和预后。
在73例骨与关节感染患者中，16名（21.9%）儿童发生了抗菌治疗引起的DRESS综合征。其中8名（50%）儿童为男孩；患者的平均年龄为9.76±5.5岁。16名儿童发生了DRESS综合征，包括13名骨髓炎患儿、1名骨髓炎合并化脓性关节炎患儿以及2名化脓性关节炎合并骶髂关节炎患儿。静脉抗生素治疗的平均持续时间为40.6±16.6天；平均住院时间为48.7±23.7天；开始使用抗生素后发生DRESS综合征的平均时间为19.6±7.68天。新发发热（68.8%）和皮疹（43.8%）是DRESS综合征最常见的症状。头孢噻肟和万古霉素是16例中8例（50%）导致DRESS综合征的药物。致病抗生素被换为另一类抗生素，最常用的是环丙沙星（n = 5；31.3%）。对于症状持续的儿童，5名（31.25%）患者使用了类固醇。
临床医生应警惕长期使用抗生素的儿童发生发热和皮疹时出现DRESS综合征，并应检查血液学和生化参数以预测DRESS综合征的严重程度。对于症状持续的患者，可使用类固醇来控制症状。
