[Analysis of clinical features and poor prognostic factors of acute hematogenous osteomyelitis in children].

Objective: To analyze the clinical characteristics, pathogenic bacteria, complications and risk factors of prognosis of acute hematogenous osteomyelitis in children. Methods: The clinical manifestations, laboratorg tests, etiological charateristics and clinical data of 107 patients with acute hematogenous osteomyelitis admitted to Beijing Children's Hospital from January 2017 to December 2020 were retrospectively analyzed. According to the drug sensitivity results of Staphylococcus aureus, the group was divided into methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-susceptible Staphylococcus aureus (MSSA) group; according to the presence or absence of complications, the group was divided into the group with and without complications; according to the prognosis of the follow-up children, the group was divided into good prognosis and poor prognosis. The χ2 test or Mann-Whitney U test used for comparison between groups, and Logistic regression was used to analyze the risk factors for complications and prognosis. Results: Of the 107 patients, 62 were males and 45 were females. The age of presentation was 5.6 (1.7, 10.0) years, including 5 patients (4.7%) age from >28 days to 3 months, 46 patients (43.0%) age from >3 months to 5 years, 43 patients (40.2%)>5-12 years of age, and 13 patients (12.1%)>12-18 years of age. The first symptoms were acute fever in 35 patients (32.7%), limb pain in 24 patients (22.4%), and fever with limb pain in 23 patients (21.5%). Pathogen culture was positive in 75 patients (70.1%), Streptococcus pyogenes, Salmonellaenterica and Escherichiacoli in 1 case (1.4%) each, and Staphylococcus aureus in 72 cases (96.0%), among them, 47 cases were MSSA, 22 cases were MRSA, and 3 cases had positive reports of Staphylococcus aureus from other hospitals without drug-sensitive tests. The proportion of infected children living in rural areas and receiving surgical treatment was higher in the MRSA group than in the MSSA group (14 cases (63.6%) vs. 18 cases (38.3%) and 21 cases (95.5%) vs. 33 cases (70.2%), χ2=3.87, 4.23, both P<0.05). Sixty-five children had no complications while 42 children (39.3%) suffered from complications. Common complications consisted of 19 cases (17.8%) of sepsis, 17 cases (15.9%) of septic arthritis, and 12 cases (11.2%) of venous thrombosis. The group with complications showed higher mental changes, decreased appetite and (or) weakness, positive pathogenic cultures, and time from admission to surgery than the group without complications (18 cases (42.9%) vs. 9 cases (13.8%), 20 cases (47.6%) vs. 12 cases (18.5%), 34 cases (81.0%) vs. 41 cases (63.1%), 3.5 (2.0, 6.0) vs. 2.0 (1.0, 4.0) d,χ2=11.38, 10.35, 3.89, Z=2.21, all P<0.05). The poor prognosis group had more comorbidities, combined local complications, and positive aureus than the good prognosis group (10/15 vs. 34.9% (30/86), 7/15 vs. 17.4% (15/86), 14/15 vs. 61.6% (53/86), χ2=5.39, 6.40, 4.42, all P<0.05). Multifactorial Logistic regression analysis showed that acute phase C-reactive protein (CRP) was both an independent risk factor for complications (OR=1.01, 95%CI 1.01-1.02) and an independent risk factor for poor prognosis (OR=1.01, 95%CI 1.00-1.02). Conclusions: The first symptoms of acute hematogenous osteomyelitis are acute fever, limb pain, and fever with limb pain are most common. Staphylococcus aureus is the most common pathogenic organism. Those with loss of appetite and (or) weakness, mental changes, positive pathogenic cultures, and longer time between admission and surgery are prone to complications. Those with complications, combined local complications, and positive for Staphylococcus aureus had a poor prognosis. Elevated CRP is an independent risk factor not only for complications but for poor prognosis as well.目的： 分析儿童急性血源性骨髓炎的临床特征、致病菌种类、并发症及影响预后的危险因素。 方法： 回顾分析2017年1月至2020年12月北京儿童医院收住的107例急性血源性骨髓炎患儿的临床表现、实验室检查、病原学特征等临床资料，根据金黄色葡萄球菌药敏结果分为耐甲氧西林金黄色葡萄球菌（MRSA）组和甲氧西林敏感金黄色葡萄球菌（MSSA）组；根据有无并发症分为有并发症组和无并发症组；根据随访患儿的预后情况分为预后良好组及预后不良组，组间比较应用χ2检验或Mann-Whitney U检验，采用Logistic回归分析并发症及预后的危险因素。 结果： 107例患儿中男62例、女45例。就诊年龄5.6（1.7，10.0）岁，其中>28日龄至3月龄 5例（4.7%）、>3月龄至5岁 46例（43.0%），>5~12岁 43例（40.2%），>12~18岁 13例（12.1%）。首发症状包括急性发热35例（32.7%）、肢体疼痛24例（22.4%）、发热伴肢体疼痛23例（21.5%）。75例（70.1%）病原菌培养阳性中，化脓性链球菌、肠炎沙门菌及大肠杆菌各1例（1.4%），金黄色葡萄球菌72例（96.0%），其中MSSA组47例、MRSA组22例，仅外院培养阳性且无药敏金黄色葡萄球菌3例。MRSA组感染患儿居住农村、接受手术治疗的比例均高于MSSA组［14例（63.6%）比 18例（38.3%），21例（95.5%）比33例（70.2%），χ2=3.87、4.23，均P<0.05］。无并发症组患儿65例，有并发症组患儿42例。常见的并发症包括脓毒症19例（17.8%）、化脓性关节炎17例（15.9%）、静脉血栓12例（11.2%）。有并发症组出现精神改变、食欲减低和（或）乏力、病原培养阳性的患儿比例及入院至手术时间均高于无并发症组［18例（42.9%）比9例（13.8%）、20例（47.6%）比12例（18.5%）、34例（81.0%）比41例（63.1%）、3.5（2.0，6.0）比2.0（1.0，4.0）d，χ2=11.38、10.35、3.89，Z=2.21，均P<0.05］。预后不良组有合并症、合并局部并发症、金黄色葡萄球菌阳性比例均高于预后良好组［10/15比34.9%（30/86）、7/15比17.4%（15/86）、14/15比61.6%（53/86），χ2=5.39，6.40、4.42，均P<0.05］。多因素Logistic回归分析示急性期C反应蛋白是并发症（OR=1.01，95%CI 1.01~1.02）和不良预后（OR=1.01，95%CI 1.00~1.02）的独立危险因素。 结论： 急性血源性骨髓炎首发症状以急性发热、肢体疼痛、发热伴疼痛多见。金黄色葡萄球菌是最常见的病原菌。精神改变、食欲减退和（或）乏力、病原培养阳性、入院至手术时间长者易发生并发症。患并发症、合并局部并发症、金黄色葡萄球菌阳性者预后差。急性期C反应蛋白高是并发症及预后不良的独立危险因素。.