Hunter Sarah, Chan Heidi, Crawford Haemish, Baker Joseph F
Department of Surgery, University of Auckland, Auckland, New Zealand.
Department of Orthopaedic Surgery, Auckland Hospital, Auckland, New Zealand.
J Pediatr Soc North Am. 2024 Feb 5;5(4):736. doi: 10.55275/JPOSNA-2023-736. eCollection 2023 Nov.
Optimal duration of antibiotic therapy for childhood bone and joint infection (BJI) remains controversial, despite recent literature in support of shorter courses and early oral switch. We have reviewed the literature to summarize current evidence for reduced duration of antibiotic therapy with particular attention to regional variation in pathogen type and treatment success. Systematic review was undertaken of studies examining acute pediatric bone and joint infection over the period January 1980-December 2022 for children aged up to 18 years. Cohort studies, systematic reviews, randomized controlled trials, and prospective studies were analyzed for data on treatment success rates and duration of therapy. A total of 34 studies met inclusion criteria reporting treatment duration for 8337 cases of acute BJI. There were five prospective studies, 21 cohort studies, six randomized controlled trials, and three systematic reviews. The shortest duration of therapy tested prospectively was 10 days of combined IV and oral treatment. In the populations examined by this systematic review, there were no increased failure rates as a consequence of shorter therapy. Neonates and children with comorbid or complicated illness were routinely excluded from higher-level studies. There is moderate evidence for shortened duration of therapy with early switch to oral antibiotics in select patients. Studies reporting good success for reduced therapy included healthy patients with uncomplicated disease. Regional disease variation and study protocol heterogeneity limit widespread adoption of short-course treatment. Additionally, the experience of BJI is diverse. Although the majority of children respond well to treatment, there is a subset who demonstrate acute or chronically complicated disease. Further research is needed to define patient and disease factors that contribute to treatment failure. Systematic review Level III •In the populations examined in this systematic review, there was no evidence of increased failure rates as a consequence of shorter therapy.•It may be reasonable to recommend short course of IV therapy with early transition to oral medication in those >3 months of age without signs of complicated disease.•Clinicians need to be aware of regional disease variation and patient factors associated with treatment failure.•Pathogen and genetic variability likely contribute to the success of treatment in childhood BJI.
尽管近期有文献支持缩短儿童骨与关节感染（BJI）抗生素治疗疗程并尽早转为口服给药，但最佳治疗时长仍存在争议。我们回顾了相关文献，总结当前关于缩短抗生素治疗疗程的证据，特别关注病原体类型的区域差异和治疗效果。对1980年1月至2022年12月期间针对18岁及以下儿童急性骨与关节感染的研究进行了系统综述。分析队列研究、系统综述、随机对照试验和前瞻性研究，以获取治疗成功率和治疗疗程的数据。共有34项研究符合纳入标准，报告了8337例急性BJI的治疗时长。其中有5项前瞻性研究、21项队列研究、6项随机对照试验和3项系统综述。前瞻性试验中测试的最短治疗疗程为静脉注射和口服联合治疗10天。在此系统综述所研究的人群中，较短疗程治疗并未导致失败率增加。新生儿以及患有合并症或复杂疾病的儿童通常被排除在高级别研究之外。有中等证据表明，在部分患者中尽早转为口服抗生素可缩短治疗疗程。报告缩短疗程治疗效果良好的研究包括患有非复杂性疾病的健康患者。区域疾病差异和研究方案的异质性限制了短疗程治疗的广泛应用。此外，BJI的情况多种多样。虽然大多数儿童对治疗反应良好，但有一部分儿童表现出急性或慢性复杂性疾病。需要进一步研究以确定导致治疗失败的患者和疾病因素。系统综述III级 •在此系统综述所研究的人群中，没有证据表明较短疗程治疗会导致失败率增加。•对于3个月以上且无复杂疾病迹象的患者，推荐短疗程静脉治疗并尽早转为口服药物可能是合理的。•临床医生需要了解区域疾病差异以及与治疗失败相关的患者因素。•病原体和基因变异性可能有助于儿童BJI治疗的成功。
