Hospital Regional Universitario de Málaga, Málaga, Spain; Universidad de Málaga, Málaga, Spain.
Hospital Regional Universitario de Málaga, Málaga, Spain.
An Pediatr (Engl Ed). 2024 Aug;101(2):75-83. doi: 10.1016/j.anpede.2024.07.004. Epub 2024 Jul 25.
Pediatric spondylodiscitis (PSD) is an uncommon condition, for which there are no specific international clinical guidelines. Factors related to complications have not been stablished. Our aim was to describe clinical and epidemiological characteristics of PSD, to analyze factors associated with complications and to evaluate adherence to the recommendations of the Spanish National Consensus Document (NCD) for the diagnostic and therapeutic approach to acute osteoarticular infections.
Ambispective, multicenter, national study of two PSD cohorts: historical (2008-2012) and prospective (2015-2020, after publication of NCD). Patients with diagnosis of PSD were included. Demographic, clinical, microbiological and radiological data were recorded. Factors related to the development of complications were analized by logistic regression. Comparisons between both cohorts were performed.
Ninety-eight PSD were included. In 84.7%, diagnosis was confirmed by magnetic resonance imaging. Microbiological isolation was obtained in 6.1%, with methicillin-sensitive S. aureus as the main etiologic agent. Complications occurred in 18.9%, the most frequent being soft tissue abscess. Of the 8.6% of patients with sequelae, persistent pain was the most common. Comparing cohorts, there was better adherence to NCD treatment recommendations in the prospective one (57.6% vs. 12.9%, p < 0.01), including a reduction in the length of intravenous antibiotic therapy (10 vs. 14 days, p < 0.01).
The evolution of PSD in our series was favorable, with low frequency of complications and sequelae. The adherence to the recommendations of the NCD was high. Studies with larger sample size are needed to establish new recommendations to optimize the approach to these infections.
小儿脊柱骨髓炎（PSD）是一种罕见的疾病，目前尚无特定的国际临床指南。尚未确定与并发症相关的因素。我们的目的是描述 PSD 的临床和流行病学特征，分析与并发症相关的因素，并评估对西班牙国家共识文件（NCD）中关于急性骨关节感染诊断和治疗方法的建议的遵循情况。
这是一项回顾性、多中心、全国性的研究，包含两个 PSD 队列：历史队列（2008-2012 年）和前瞻性队列（2015-2020 年，在 NCD 发布后）。纳入诊断为 PSD 的患者。记录人口统计学、临床、微生物学和影像学数据。通过逻辑回归分析与并发症发展相关的因素。对两个队列进行比较。
共纳入 98 例 PSD。84.7%的诊断通过磁共振成像（MRI）得到证实。微生物学分离培养阳性率为 6.1%，主要病原体为甲氧西林敏感的金黄色葡萄球菌。18.9%的患者发生并发症，最常见的是软组织脓肿。8.6%的患者有后遗症，最常见的是持续性疼痛。与历史队列相比，前瞻性队列更遵循 NCD 的治疗建议（57.6% vs. 12.9%，p<0.01），包括静脉抗生素治疗时间的缩短（10 天 vs. 14 天，p<0.01）。
我们的系列研究中 PSD 的演变是有利的，并发症和后遗症的发生率较低。对 NCD 建议的遵循率很高。需要更大样本量的研究来制定新的建议，以优化这些感染的治疗方法。
