Cui Yingtie, Feng Shiguang, Luo Pengyuan, Mao Zhen, Zhou Xiaokang, Zhang Yunzhen
Department of Pediatric Orthopedics, Hebei Children's Hospital, Shijiazhuang, Hebei, China.
Department of Orthopaedics, The Ninth Hospital of Xingtai, Xingtai, Hebei, China.
Ital J Pediatr. 2025 May 28;51(1):160. doi: 10.1186/s13052-025-02007-6.
The aim of this study was to investigate the risk factors associated with Staphylococcus aureus (S. aureus) disseminated infection (DSAI) that occurs secondarily to acute osteoarticular infections (OAI) in children.
A retrospective analysis of 131 pediatric patients with acute OAI (July 2012-March 2024) was conducted. Patients were categorized into a DSAI group (33 cases) and a non-DSAI group (98 cases). Data analyzed included age, gender, pediatric intensive care unit (PICU) admission, surgical delay, initial symptoms, highest pre-hospital fever, inflammatory markers, pathogen type (MSSA/MRSA), bacteremia, antibiotic duration, postoperative fever length, surgeries (≥ 2), hospital stay, and prognosis.
DSAI primarily affected the lungs, brain, and thorax, with femur and hip joints being the most involved OAI sites. Fever (45.45%) and limb swelling/pain (42.42%) were common symptoms. The DSAI group showed significantly higher CRP levels, bacteremia incidence, MRSA infections, PICU admissions, surgical delays, ≥ 2 surgeries, longer postoperative fever, prolonged hospital stays, and worse prognosis (P < 0.05). No significant differences were found in age, gender, pre-admission time, initial symptoms, highest fever, WBC count, ESR, antibiotic duration, or neutrophil percentage (P > 0.05). Logistic regression identified bacteremia (OR: 32.232, 95% CI: [2.558-406.068], P = 0.007), CRP > 162.375 mg/L (OR: 7.499, 95% CI: [2.044-27.513], P = 0.002), and surgical delay > 9.50 days (OR: 7.462, 95% CI: [1.828-30.459], P = 0.005) as independent risk factors.
DSAI complicates OAI, leading to a severe course and poor prognosis. High vigilance and early intervention are crucial for pediatric patients with these risk factors.
本研究旨在调查儿童急性骨关节炎感染（OAI）继发的金黄色葡萄球菌（S. aureus）播散性感染（DSAI）的相关危险因素。
对131例急性OAI患儿（2012年7月至2024年3月）进行回顾性分析。患者分为DSAI组（33例）和非DSAI组（98例）。分析的数据包括年龄、性别、儿科重症监护病房（PICU）入院情况、手术延迟、初始症状、院前最高体温、炎症标志物、病原体类型（MSSA/MRSA）、菌血症、抗生素使用时间、术后发热时长、手术次数（≥2次）、住院时间和预后。
DSAI主要影响肺部、脑部和胸部，股骨和髋关节是最常受累的OAI部位。发热（45.45%）和肢体肿胀/疼痛（42.42%）是常见症状。DSAI组的CRP水平、菌血症发生率、MRSA感染、PICU入院率、手术延迟、≥2次手术、术后发热时间延长、住院时间延长及预后较差（P<0.05）。在年龄、性别、入院前时间、初始症状、最高体温、白细胞计数、血沉、抗生素使用时间或中性粒细胞百分比方面未发现显著差异（P>0.05）。逻辑回归确定菌血症（OR：32.232，95%CI：[2.558 - 406.068]，P = 0.007）、CRP>162.375mg/L（OR：7.499，95%CI：[2.044 - 27.513]，P = 0.002）和手术延迟>9.50天（OR：7.462，95%CI：[1.828 - 30.459]，P = 0.005）为独立危险因素。
DSAI使OAI复杂化，导致病程严重且预后不良。对具有这些危险因素的儿科患者保持高度警惕并进行早期干预至关重要。
