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.
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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