Acute haematogenous osteomyelitis in children
Acute haematogenous osteomyelitis in children
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DOI：
10.1136/bmj.g66
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发表时间：
2014-01
期刊：
影响因子：
--
通讯作者：
A. Yeo;M. Ramachandran
中科院分区：
文献类型：
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作者：
A. Yeo;M. Ramachandran
急性骨髓炎是一种罕见但重要的疾病，影响以前健康的儿童。需要高度怀疑，因为早期治疗对良好结局至关重要。在过去的十年中，疾病流行病学的快速变化，特别是由于耐甲氧西林金黄色葡萄球菌（MRSA）的感染，以及诊断学的进步，突出了根据现有证据改变实践的必要性。我们回顾了急性骨髓炎的相关方面，突出了诊断中的陷阱，并提供了一个管理框架。#总结要点骨髓炎是由化脓性微生物引起的骨骼炎症。在急性情况下，症状的持续时间不到两周。感染的主要来源是血源性传播、从邻近感染灶追踪以及创伤或手术直接接种。1血源性传播是儿童最常见的感染来源，通常影响长骨。2股骨和胫骨最常受累（分别为27%和26%，图1）。3 #来源和选择标准我们使用术语“p（a）ediatric”、“acute osteomyelitis”、“bone infection”、“septic arthritis”、“antibiotics”和“imaging”检索Medline和Google Scholar。我们尽可能使用来自随机对照试验、系统综述（包括科克伦综述）和专家综述的证据。
Acute osteomyelitis is an uncommon but important disease that affects previously healthy children. A high index of suspicion is required as early treatment is essential for a good outcome. In the past decade, rapid changes in the epidemiology of the condition, in particular of infections as a result of meticillin resistant Staphylococcus aureus (MRSA), and advances in diagnostics have highlighted a need to change practice based on current evidence. We review the pertinent aspects of acute osteomyelitis, highlighting the pitfalls in diagnosis and providing a framework for management. #### Summary points Osteomyelitis is the inflammation of bone caused by pyogenic organisms. In the acute setting, the duration of symptoms is less than two weeks. The major sources of infection are haematogenous spread, tracking from adjacent foci of infection, and direct inoculation from trauma or surgery.1 Haematogenous spread is the most common source of infection in children, typically affecting the long bones. The infection seeds in the metaphysis, where blood flow is rich but sluggish.2 The femur and tibia are most commonly affected (27% and 26%, respectively, fig 1⇓).3 #### Sources and selection criteria We searched Medline and Google Scholar using the terms “p(a)ediatric”, “acute osteomyelitis”, “bone infection”, “septic arthritis”, “antibiotics” and “imaging”. Wherever possible we used evidence from randomised controlled trials, systematic reviews (including Cochrane reviews), and expert review …