Clinical Epidemiology and Outcomes of Pediatric Musculoskeletal Infections.
Clinical Epidemiology and Outcomes of Pediatric Musculoskeletal Infections.
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DOI：
10.1016/j.jpeds.2021.03.028
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发表时间：
2021-07
期刊：
影响因子：
--
通讯作者：
Thomsen I
中科院分区：
文献类型：
--
作者：
Yi J;Wood JB;Creech CB;Williams D;Jimenez-Truque N;Yildirim I;Sederdahl B;Daugherty M;Hussaini L;Munye M;Tomashek KM;Focht C;Watson N;Anderson EJ;Thomsen I
了解急性血源性骨髓炎和脓毒性关节炎的流行病学，包括临床和人口统计学特征、微生物学、治疗方法、治疗相关并发症和结局。2009 - 2015年453例AHO和/或SA儿童的回顾性队列研究。在453例患者中，218例（48%）患有AHO，132例（29%）患有SA，103例（23%）同时患有AHO/SA。41例（9%）发生治疗失败/复发感染。并发AHO/SA的患者住院时间更长，抗生素治疗持续时间更长，更可能出现长期菌血症并需要重症监护。在228例（51%）患者中鉴定出金黄色葡萄球菌，其中114例（50%）为耐甲氧西林葡萄球菌。金黄色葡萄球菌（MRSA）。与SA相比，AHO和同时发生AHO/SA与更高的治疗失败几率相关（OR分别为8.19，95% CI 2.02，33.21; p= 0.003; OR 14.43，95% CI 3.39，61.37; p<0.001）。需要一次以上的外科手术也与治疗失败的几率较高相关（OR 2.98，95% CI 1.18，7.52; P = .021）。早期改为口服抗生素治疗与治疗失败无关（OR 0.64，95% CI 0.24，1.74; p= 0.386）。大多数（73%）医疗护理治疗并发症发生在肠外治疗期间。肌肉骨骼感染是具有挑战性的儿科感染。S.金黄色葡萄球菌仍然是最常见的病原体，MRSA占所有病例的25%。并发AHO/SA与更严重的疾病和更差的结局相关。口服治疗时发生的治疗相关并发症较少。早期转为口服治疗与治疗失败无关。
To understand the epidemiology of acute hematogenous osteomyelitis and septic arthritis, including clinical and demographic features, microbiology, treatment approaches, treatment-associated complications, and outcomes. Retrospective cohort study of 453 children with AHO and/or SA from 2009 – 2015. Among the 453 patients, 218 (48%) had AHO, 132 (29%) had SA, and 103 (23%) had concurrent AHO/SA. Treatment failure/recurrent infection occurred in 41 (9%). Patients with concurrent AHO/SA had longer hospital stays, longer duration of antibiotic therapy, and were more likely to have prolonged bacteremia and require intensive care. Staphylococcus aureus was identified in 228 (51%) of patients, of which 114 (50%) were methicillin-resistant S. aureus (MRSA). Compared with SA, AHO and concurrent AHO/SA were associated with higher odds of treatment failure (OR 8.19, 95% CI 2.02, 33.21; p=.003; and OR 14.43, 95% CI 3.39, 61.37; p<.001, respectively). Need for more than one surgical procedure was also associated with higher odds of treatment failure (OR 2.98, 95% CI 1.18, 7.52; P = .021). Early change to oral antibiotic therapy was not associated with treatment failure (OR 0.64, 95% CI 0.24, 1.74; p=.386). Most (73%) medically-attended treatment complications occurred while on parenteral therapy. Musculoskeletal infections are challenging pediatric infections. S. aureus remains the most common pathogen, with MRSA accounting for 25% of all cases. Concurrent AHO/SA is associated with more severe disease and worse outcomes. Fewer treatment-related complications occurred while on oral therapy. Early transition to oral therapy was not associated with treatment failure.
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