Bradley J S, Kaplan S L, Tan T Q, Barson W J, Arditi M, Schutze G E, Wald E R, Givner L B, Mason E O
Children's Hospital and University of California, San Diego, California, USA.
Pediatrics. 1998 Dec;102(6):1376-82. doi: 10.1542/peds.102.6.1376.
To describe the clinical and microbiological characteristics of infants and children with bone and joint infections caused by penicillin-susceptible and penicillin-nonsusceptible strains of Streptococcus pneumoniae.
Multicenter, prospective patient accrual; retrospective chart review of identified patients.
Eight children's hospitals in the United States.
Forty-two children with bone and/or joint infections prospectively enrolled in the United States Pediatric Multicenter Pneumococcal Surveillance Study from September 1, 1993 to August 31, 1996.
Data were collected on multiple variables, including age, gender, race, days of symptoms before and during hospitalization, antibiotic and surgical therapy, laboratory and imaging studies.
Of the 42 children enrolled (21 bone, 21 joint infections), 14 had isolates that were not susceptible to penicillin. Eight of 16 (50%) strains isolated from children who received antibiotics within 4 weeks before hospitalization were not susceptible to penicillin, compared with 4 of 15 (27%) strains isolated from children without previous antibiotic exposure. Clinical response to therapy was similar between children infected by penicillin-susceptible strains compared with those infected by penicillin-nonsusceptible strains, including duration of hospitalization (9.1 days vs 11.2 days), days of intravenous antibiotic therapy (25.3 days vs 24.6 days), days of fever (3.6 days vs 3.1 days), and sequelae (14% vs 7%). The most commonly prescribed single agents for parenteral therapy in definitive treatment were ceftriaxone (36%), penicillin (15%), and clindamycin (15%). Oral therapy followed parenteral therapy in 56% of children. The mean (+/- standard deviation) duration of total antibiotic therapy in children with osteomyelitis was 57.5 +/- 48.6 days (range, 23-196 days) and 29.2 +/- 11.8 days (range, 12-67 days) for arthritis. Late sequelae (long-term destructive changes of the bone or joint) were documented in 5 (12%) children, 4 with osteomyelitis, and 1 with arthritis. Sequelae occurred in 30% of children with long bone osteomyelitis associated with infection in the adjacent joint. The age of children with sequelae was younger than those without sequelae (6.4 months vs 18.6 months).
The demographic characteristics and anatomic sites of infection in our patients were similar to previously published series collected from single institutions before the emergence of significant antibiotic resistance in S pneumoniae. Our analysis suggests that children infected by penicillin-nonsusceptible strains have a similar clinical response to therapy when compared with children infected by penicillin-susceptible strains.
描述由青霉素敏感和青霉素不敏感的肺炎链球菌菌株引起的婴幼儿骨和关节感染的临床及微生物学特征。
多中心、前瞻性患者入组；对已识别患者进行回顾性病历审查。
美国八家儿童医院。
1993年9月1日至1996年8月31日期间前瞻性纳入美国儿科多中心肺炎球菌监测研究的42例患有骨和/或关节感染的儿童。
收集了多个变量的数据，包括年龄、性别、种族、住院前和住院期间的症状天数以及抗生素和手术治疗、实验室和影像学检查。
在入组的42例儿童中（21例骨感染，21例关节感染），14例分离出对青霉素不敏感的菌株。在住院前4周内接受过抗生素治疗的儿童中分离出的16株菌株中有8株（50%）对青霉素不敏感，而在未接受过抗生素治疗的儿童中分离出的15株菌株中有4株（27%）对青霉素不敏感。青霉素敏感菌株感染的儿童与青霉素不敏感菌株感染的儿童在治疗的临床反应方面相似，包括住院时间（9.1天对11.2天）、静脉抗生素治疗天数（25.3天对24.6天）、发热天数（3.6天对3.1天）和后遗症（14%对7%）。确定性治疗中最常用的单一胃肠外治疗药物是头孢曲松（36%）、青霉素（15%）和克林霉素（15%）。56%的儿童在胃肠外治疗后接受口服治疗。骨髓炎患儿的总抗生素治疗平均（±标准差）持续时间为57.5±48.6天（范围23 - 196天），关节炎患儿为29.2±11.8天（范围12 - 67天）。5例（12%）儿童记录有晚期后遗症（骨或关节的长期破坏性改变），4例为骨髓炎，1例为关节炎。与相邻关节感染相关的长骨骨髓炎患儿中30%出现后遗症。有后遗症的儿童年龄比无后遗症的儿童小（6.4个月对18.6个月）。
我们患者的人口统计学特征和感染的解剖部位与肺炎链球菌出现显著抗生素耐药性之前从单一机构收集的既往发表系列相似。我们的分析表明，与青霉素敏感菌株感染的儿童相比，青霉素不敏感菌株感染的儿童在治疗上有相似的临床反应。
