The Contemporary Microbiology and Rates of Concomitant Osteomyelitis in Acute Septic Arthritis
The Contemporary Microbiology and Rates of Concomitant Osteomyelitis in Acute Septic Arthritis
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DOI：
10.1097/inf.0000000000001417
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发表时间：
2017-03-01
影响因子：
3.6
通讯作者：
McNeil, J. Chase
中科院分区：
文献类型：
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作者：
Branson, Jessica;Vallejo, Jesus G.;McNeil, J. Chase
背景：化脓性关节炎(SA)和急性骨髓炎(AO)是儿童最常见的严重细菌感染。对金黄色葡萄球菌微生物学的了解对治疗至关重要。意识到伴随的AO的存在对指导临床治疗也很重要。我们试图描述目前儿童SA的微生物学和与并存的AO相关的临床特征。材料和方法：SA患者是从2010年至2014年的传染病中确诊的，查阅服务记录。排除穿透性/开放性创伤和骨科五金件就位患者。结果：共纳入168例SA患者。最常见的致病菌为金黄色葡萄球菌，占47.7%(29.1%为甲氧西林敏感金黄色葡萄球菌，18.5%为耐甲氧西林金黄色葡萄球菌)，其次为A组链球菌(8.9%)。从2011年到2014年，因胃肠道疾病引起的病例所占比例上升(3.3%-16.7%；P=0.1)。108例(64.3%)患者并发急性呼吸窘迫综合征。骨髓炎的出现与年龄中位数较大(5.9vs.2.4岁；P=0.04)、症状持续时间较长(5vs.2.5d；P<；0.001)、金黄色葡萄球菌(62.1%vs.21.7%；p<；0.001)、菌血症(46.2%vs.20.3%；P=0.001)、入院后发热时间较长(5vs.2天；p<；0.001)和住院时间较长(10vs.6天；P<；0.001；P<；0.001)。结论：耐甲氧西林金黄色葡萄球菌仍然是SA的重要原因，尽管GAS的频率可能正在增加。伴发骨髓炎的发生率比以前报道的要高，并且与年龄较大、症状和发热持续时间较长、菌血症和金黄色葡萄球菌有关。
Background: Septic arthritis (SA) and acute osteomyelitis (AO) are among the most common serious bacterial infections of childhood. Knowledge of the microbiology of SA is critical to treatment. Awareness of the presence of attendant AO is also important to guide clinical management. We sought to describe the current microbiology of SA in children and clinical features associated with coexisting AO.Materials and Methods: Patients with SA were identified from the infectious diseases consult service records from 2010 to 2014. Patients with penetrating/open trauma and orthopedic hardware in situ were excluded.Results: A total of 168 patients with SA were included. The most common causative organism was Staphylococcus aureus accounting for 47.7% of cases (29.1% were methicillin-susceptible S. aureus and 18.5% were methicillin-resistant S. aureus), followed by group A streptococcus (GAS, 8.9%). The proportion of cases due to GAS increased from 2011 to 2014 (3.3%-16.7%; P = 0.1). One hundred eight (64.3%) patients had concurrent AO. The presence of osteomyelitis was associated with older median age (5.9 vs. 2.4 years; P = 0.04), a longer duration of symptoms (5 vs. 2.5 days; P < 0.001), S. aureus (62.1% vs. 21.7%; P < 0.001), bacteremia (46.2% vs. 20.3%; P = 0.001), a longer duration of fever after admission (5 vs. 2 days; P < 0.001) and a longer length of stay (10 vs. 6 days; P < 0.001).Conclusions: Methicillin-resistant S. aureus continues to be an important cause of SA though GAS may be increasing in frequency. The presence of concomitant osteomyelitis is higher than previously reported and associated with older age, a longer duration of symptoms and fever, bacteremia and S. aureus.