An Analysis Of Pathogens Causing Childhood Acute Bone And Joint Infection And Clinical Treatment

Objective: In this study,we aimed to analyze the bacterial species causing infection,investigate the reason for the drug resistance,and summarize our experience on the diagnosis and treatment of childhood acute bone and joint infection.Methods: Overall 223 patients(aged between 16 days to 15 years old(average 5.4 years))presented with childhood acute bone and joint infection and received treatment(with a hospital stay of 2-13 days(average 5.6 days))in Anhui children hospital were chose to be analyzed in this study.The patients were and encountered between January 2011 and March 2015,among which: 71 cases of osteomyelitis,95 cases of pyogenic arthritis,20 cases of osteomyelitis with suppurative arthritis,32 cases of merge sepsis systemic infection and 5 cases of merge multiple site of infection.The data of patients were classified and analyzed according to the result of pathogenic bacteria during the hospital culture,drug sensitive test,combined with the diagnosis and treatment choice(the usage of antibiotics)in hospital and half a year follow-upResults: When analyzed by the infected bacterial species,among all 223 cases,117 cases were germiculture positive(52.5%)including a total of produce 93 strains gram-positive(G +)cocci and 30 strains of gram-negative(G)such as bacillus,the top three presented as staphylococcus aureus(85 cases,69%),verdigris false single spore fungus(7 cases,5.7%),and e.coli(5 cases,4.1%).Notably,special strains(such as fungi and tubercle bacillus)were not found,but 6 cases were pus culture positive,4cases were infected with same pathogenic bacteria,and 38 cases were infected with drug-resistant strains(36.6%).The proportion of drug-resistant bacteria in all ages was close.Additionally,when analyzed by treatment choice making,all patients received anti-infection treatment immediately after admitted being admitted to hospital,which consist of of 13 cases received conservative treatment and 210 cases received combined surgical treatment.Among which,6 cases received two or more times of surgical management,206 cases undergone postoperative continuous irrigation drainage(including 90 cases of continuous lavage and drainage of antibiotics).When analyzed by the hospital day,198 cases were less than one week but 25 cases were more than one week(less than 13 days).Furthermore,the excellent half a year follow-up was 88.8%,excluding 12 cases of bone joint dysfunction,6 cases of epiphyseal plate injury caused by long-term growth obstacle,5 cases of pathological dislocation or fracture and 2 cases of death.Conclusion: Taken those results together,staphylococcus aureus still was the main pathogenic bacteria causing childhood acute bone and joint infection which is similar to adult bone osteomyelitis(compared to reported data).According to our data,the proportion of gram-negative bacteria(G-)infection was not significantly increased,but gram negative bacillus infection always combined with systemic infection,and the proportion of positive pus culture was increased.Additionally,the proportions of multiple drug-resistant bacteria infection and severe systemic infection were markedly raised,but there was no correlation between the proportion of multi-resistant bacteria infection and age.The results also indicating that the Severity of infection exerted positive correlation to the hospital day.Antibiotic treatment should be timely and adequate,and combination therapy should be taken before the pathogenic bacteria culture or negative result of pathogenic bacteria culture Antibiotic choice for treatment should be considered to cover the most common species of G-and G + bacteria and adjusted according to drug sensitivity of each patient,for instance,the more drug-resistant bacteria the more antibiotic dosage.Moreover,incision drainage should implemented immediately after the operative indication is observed,because of the outcomes of patients received operation within one week were much better than patients received operation post one week.In conclusion,the critical factor for childhood acute bone and joint infection treatment and care are choosing reasonable treatment and cutting hospital day.