Jia Haiting,Wang Yuting,Sun Lin,et al.Clinical features of acute osteomyelitis due to methicillin-resistant Staphylococcus aureus in children[J].Journal of Clinical Pediatric Surgery,2024,(05):452-457.[doi:10.3760/cma.j.cn101785-202206023-010]
耐甲氧西林和甲氧西林敏感性金黄色葡萄球菌致儿童急性骨髓炎的临床特征比较
- Title:
- Clinical features of acute osteomyelitis due to methicillin-resistant Staphylococcus aureus in children
- 关键词:
- 骨髓炎; 耐甲氧西林金黄色葡萄球菌; 外科手术; 儿童
- Keywords:
- Osteomyelitis; Methicillin-Resistant Staphylococcus Aureus; Surgical Procedures; Operative; Child
- 摘要:
- 目的 对比分析耐甲氧西林金黄色葡萄球菌(methicillin-resistant Staphylococcus aureus,MRSA)和甲氧西林敏感性金黄色葡萄球菌(methicillin-susceptible Staphylococcus aureus,MSSA)致儿童急性骨髓炎的临床特征。 方法 本研究为回顾性研究,选取2017年11月至2022年3月山东大学附属儿童医院脓液培养均为金黄色葡萄球菌的68例急性骨髓炎患儿作为研究对象,按照金黄色葡萄球菌种类分为MRSA组(24例)和MSSA组(44例)。对比分析MRSA组和MSSA组起病初期最高体温、炎症指标、年龄、性别、发病时间、发病部位、有无关节炎、住院天数、手术次数以及并发症情况。 结果 两组性别、发病部位、并发症、年龄、发病时间、起病初期最高体温、白细胞升高程度、中性粒细胞升高程度、红细胞沉降率升高程度比较,差异均无统计学意义(P＞0.05)。MRSA组和MSSA组C-反应蛋白升高程度分别为(93.99±61.38) mg/L和(65.90±49.14) mg/L,住院天数分别为(39.75±15.16)天和(29.52±8.45)天,手术次数分别为(3.58±1.61)次和(2.68±0.77)次;MRSA组、MSSA组分别有11例(11/24,45.83%)、9例(9/44,20.45%)伴有临近关节炎;在同时出现C-反应蛋白和红细胞沉降率升高的患儿中(MRSA组18例、MSSA组40例),MRSA组和MSSA组的C-反应蛋白/红细胞沉降率比值分别为(2.17±0.98)和(1.46±1.07);上述指标差异均有统计学意义(P＜0.05)。 结论 和MSSA致儿童急性骨髓炎相比,MRSA引起的急性骨髓炎易合并关节炎,需要接受更多次手术治疗,住院时间较长。MRSA致儿童急性骨髓炎在起病初期C-反应蛋白升高程度较高,在同时出现C-反应蛋白和红细胞沉降率升高的患儿中,MRSA致儿童急性骨髓炎C-反应蛋白/红细胞沉降率的比值较MSSA致儿童急性骨髓炎高。
- Abstract:
- Objective To explore the clinical characteristics of acute osteomyelitis (AO) due to methicillin-resistant Staphylococcus aureus (MRSA) versus AO due to methicillin-susceptible Staphylococcus aureus (MSSA) in children.Methods From November 2017 to March 2022,68 AO children cultured positively Staphylococcus aureus in pus were recruited from Children’s Hospital Affiliated to Shandong University.They were assigned into two groups of MRSA (n=24) and MSSA (n=44).Two groups were compared with regards to peak onset temperature,inflammatory parameters,age,gender,time of onset,location of onset,arthritis,hospitalization stay,number of operations and complications.Results No statistically significant inter-group differences existed in gender,site of onset,complications,age,duration of symptoms pre-admission,peak onset temperature,degree of leukocyte elevation,degree of neutrophil elevation and degree of erythrocyte sedimentation rate (ESR).Statistically significant inter-group differences existed in concurrent arthritis,hospitalization stay [(39.75±15.16) vs.(29.52±8.45) day],operative duration [(3.58±1.61) vs.(2.68±0.77)],C-reactive protein elevation (CRP) [(93.99±61.38) vs.(65.90±49.14) mg/L].Among children with CRP/ESR elevation (18 cases in MRSA group and 40 cases in MSSA group),ratio of CRP to ESR in MRSA group was statistically significant compared with that in MSSA group [(2.17±0.98) vs.(1.46±1.07)].Conclusions As compared with MSSA-induced AO in children,AO due to MRSA is more likely to be accompanied with arthritis,requiring more surgical procedures and a longer hospital stay.Degree of CRP elevation and ratio of CRP to ESR are higher in children with OA due to MRSA.
参考文献/References:
[1] Funk SS,Copley LAB.Acute hematogenous osteomyelitis in children:pathogenesis,diagnosis,and treatment[J].Orthop Clin North Am,2017,48(2):199-208.DOI:10.1016/j.ocl.2016.12.007.
[2] Peltola H,P??kk?nen M.Acute osteomyelitis in children[J].N Engl J Med,2014,370(4):352-360.DOI:10.1056/NEJMra1213956.
[3] Yeo A,Ramachandran M.Acute haematogenous osteomyelitis in children[J].BMJ,2014,348:g66.DOI:10.1136/bmj.g66.
[4] Hatzenbuehler J,Pulling TJ.Diagnosis and management of osteomyelitis[J].Am Fam Physician,2011,84(9):1027-1033.
[5] Harik NS,Smeltzer MS.Management of acute hematogenous osteomyelitis in children[J].Expert Rev Anti Infect Ther,2010,8(2):175-181.DOI:10.1586/eri.09.130.
[6] Saavedra-Lozano J,Mejías A,Ahmad N,et al.Changing trends in acute osteomyelitis in children:impact of methicillin-resistant Staphylococcus aureus infections[J].J Pediatr Orthop,2008,28(5):569-575.DOI:10.1097/BPO.0b013e31817bb816.
[7] Kaushik A,Kest H.Pediatric methicillin-resistant Staphylococcus aureus osteoarticular infections[J].Microorganisms,2018,6(2):40.DOI:10.3390/microorganisms6020040.
[8] 李论,徐涛涛,杨佳.儿童急性血源性骨髓炎致病菌分布及耐药性分析[J].中国临床研究,2021,34(4):486-488,492.DOI:10.13429/j.cnki.cjcr.2021.04.011. Li L,Xu TT,Yang J.Pathogenic bacteria and drug resistance in children with acute hematogenous osteomyelitis[J].Chin J Clin Res,2021,34(4):486-488,492.DOI:10.13429/j.cnki.cjcr.2021.04.011.
[9] Woods CR,Bradley JS,Chatterjee A,et al.Clinical practice guideline by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America:2021 guideline on diagnosis and management of acute hematogenous osteomyelitis in pediatrics[J].J Pediatric Infect Dis Soc,2021,10(8):801-844.DOI:10.1093/jpids/piab027.
[10] Agrawal R,Sharma D,Dhiman P,et al.Clinical and haematological predictors of acute hematogenous Methicillin Resistant Staphylococcus aureus(MRSA) osteomyelitis & septic arthritis[J].J Orthop,2015,12(3):137-141.DOI:10.1016/j.jor.2015.01.014.
[11] Davis WT,Gilbert SR.Comparison of methicillin-resistant versus susceptible Staphylococcus aureus pediatric osteomyelitis[J].J Pediatr Orthop,2018,38(5):e285-e291.DOI:10.1097/BPO.0000000000001152.
[12] Butbul-Aviel Y,Koren A,Halevy R,et al.Procalcitonin as a diagnostic aid in osteomyelitis and septic arthritis[J].Pediatr Emerg Care,2005,21(12):828-832.DOI:10.1097/01.pec.0000190226.12610.24.
[13] Hawkshead JJ 3rd,Patel NB,Steele RW,et al.Comparative severity of pediatric osteomyelitis attributable to methicillin-resistant versus methicillin-sensitive Staphylococcus aureus[J].J Pediatr Orthop,2009,29(1):85-90.DOI:10.1097/BPO.0b013e3181901c3a.
[14] Kini AR,Shetty V,Kumar AM,et al.Community-associated,methicillin-susceptible,and methicillin-resistant Staphylococcus aureus bone and joint infections in children:experience from India[J].J Pediatr Orthop B,2013,22(2):158-166.DOI:10.1097/BPB.0b013e32835c530a.
[15] Ju KL,Zurakowski D,KocherMS.Differentiating between methicillin-resistant and methicillin-sensitive Staphylococcus aureus osteomyelitis in children:an evidence-based clinical prediction algorithm[J].J Bone Joint Surg Am,2011,93(18):1693-1701.DOI:10.2106/JBJS.J.01154.
[16] Gaviria-Agudelo C,Aroh C,Tareen N,et al.Genomic heterogeneity of methicillin resistant Staphylococcus aureus associated with variation in severity of illness among children with acute hematogenous osteomyelitis[J].PLoS One,2015,10(6):e0130415.DOI:10.1371/journal.pone.0130415.
[17] 陶锐,覃承诃,方佳,等.儿童急性血源性骨髓炎的诊治进展[J].中华创伤骨科杂志,2020,22(9):818-823.DOI:10.3760/cma.j.cn115530-20200329-00214. Tao R,Qin CH,Fang J,et al.Recent advances in the diagnosis and treatment of pediatric acute hematogenous osteomyelitis[J].Chin J Orthop Trauma,2020,22(9):818-823.DOI:10.3760/cma.j.cn115530-20200329-00214.
[18] Liu C,Bayer A,Cosgrove SE,et al.Clinical practice guidelines by the Infectious Diseases Society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children:executive summary[J].Clin Infect Dis,2011,52(3):285-292.DOI:10.1093/cid/cir034.
[19] 耐甲氧西林金黄色葡萄球菌感染防治专家委员会.耐甲氧西林金黄色葡萄球菌感染防治专家共识2011年更新版[J].中华实验和临床感染病杂志(电子版),2011,5(3):372-384.DOI:10.3877/cma.j.issn.1674-1358.2011.03.020. Expert Committee on Prevention and Treatment of Methicillin-Resistant Staphylococcus aureus Infections:Expert Consensus on the Prevention and Treatment of Methicillin-resistant Staphylococcus aureus Infections (2011 Updated Version)[J].Chin J Exp Clin Infect Dis (Electron Ed),2011,5(3):372-384.DOI:10.3877/cma.j.issn.1674-1358.2011.03.020.
[20] Kaplan SL,Mason EOJr,Feigin RD.Clindamycin versus nafcillin or methicillin in the treatment of Staphylococcus aureus osteomyelitis in children[J].South Med J,1982,75(2):138-142.DOI:10.1097/00007611-198202000-00005.
[21] Lv CM,Lv JT,Liu Y,et al.Pediatric pharmaceutical care with anti-infective medication in a patient with acute hematogenous osteomyelitis caused by methicillin-resistant Staphylococcus aureus[J].Int J Immunopathol Pharmacol,2020,34:2058738420925713.DOI:10.1177/2058738420925713.
[22] Williams AW,Newman PM,Ocheltree S,et al.Ceftaroline fosamil use in 2 pediatric patients with invasive methicillin-resistant Staphylococcus aureus infections[J].J Pediatr Pharmacol Ther,2015,20(6):476-480.DOI:10.5863/1551-6776-20.6.476.
[23] 贾海亭,刘涛,于嘉智,等.负压辅助愈合治疗系统对儿童骨髓炎的治疗体会及文献复习[J].中国研究型医院,2021,8(5):50-53.DOI:10.19450/j.cnki.jcrh.2021.05.014. Jia HT,Liu T,Yu JZ,et al.Vacuum-assisted closure healing therapy system for osteomyelitis in children:treatments with a review of literature[J].Chin Res Hosp,2021,8(5):50-53.DOI:10.19450/j.cnki.jcrh.2021.05.014.
相似文献/References:
[1]张晓乐,赵国强,赵旭飞.18例儿童手和足骨髓炎诊治分析[J].临床小儿外科杂志,2020,19(10):921.[doi:10.3969/j.issn.1671-6353.2020.10.011]
Zhang Xiaole,Zhao Guoqiang,Zhao Xufei.Analysis of diagnosis and treatment of 18 cases of hand and foot osteomyelitis in children[J].Journal of Clinical Pediatric Surgery,2020,19(05):921.[doi:10.3969/j.issn.1671-6353.2020.10.011]
[2]文玉伟,贾海亭,王春华,等.儿童短管状骨及扁平骨骨髓炎的治疗[J].临床小儿外科杂志,2023,22(02):158.[doi:10.3760/cma.j.cn101785-202202018-012]
Wen Yuwei,Jia Haiting,Wang Chunhua,et al.Treatment of osteomyelitis of short tubular and flat bones in children[J].Journal of Clinical Pediatric Surgery,2023,22(05):158.[doi:10.3760/cma.j.cn101785-202202018-012]
[3]李雅琴,李论,徐涛涛,等.儿童亚急性骨髓炎的研究进展[J].临床小儿外科杂志,2023,22(05):485.[doi:10.3760/cma.j.cn101785-202211063-016]
Li Yaqin,Li Lun,Xu Taotao,et al.Research advances of subacute osteomyelitis in children[J].Journal of Clinical Pediatric Surgery,2023,22(05):485.[doi:10.3760/cma.j.cn101785-202211063-016]
[4]伍江雁,胡雄科,曾凌嵘,等.儿童股骨远端具核梭杆菌感染致亚急性骨骺骨髓炎1例并文献综述[J].临床小儿外科杂志,2023,22(12):1189.[doi:10.3760/cma.j.cn101785-202310052-017]
Wu Jiangyan,Hu Xiongke,Zeng Lingrong,et al.Subacute epiphyseal osteomyelitis caused by Fusobacterium nucleatum in distal femur:one case report with a literature review[J].Journal of Clinical Pediatric Surgery,2023,22(05):1189.[doi:10.3760/cma.j.cn101785-202310052-017]
备注/Memo
收稿日期:2023-06-09。
基金项目:山东省儿童健康与疾病临床医学研究中心立项项目(RC006)
通讯作者:刘涛,Email:ltetyy@163.com