Pediatric Infection and Vaccine

The Korean Society of Pediatric Infectious Diseases (대한소아감염학회)
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The Etiology and Clinical Features of Acute Osteoarthritis in Children; 2003-2009

최근 6년간 소아청소년기 급성 화농성 골관절염의 원인균과 임상 양상; 2003-2009

  • Choi, Jin Hyoung (Department of Pediatrics, Seoul National University College of Medicine) ;
  • Choe, Young June (Department of Pediatrics, Seoul National University College of Medicine) ;
  • Hong, Ki Bae (Department of Pediatrics, Seoul National University College of Medicine) ;
  • Lee, Jina (Department of Pediatrics, Seoul National University College of Medicine) ;
  • Yoo, Won Joon (Department of Orthopedic Surgery, Seoul National University College of Medicine) ;
  • Kim, Han Soo (Department of Orthopedic Surgery, Seoul National University College of Medicine) ;
  • Park, Moon Seok (Department of Orthopedic Surgery, Seoul National University College of Medicine) ;
  • Cho, Tae Joon (Department of Orthopedic Surgery, Seoul National University College of Medicine) ;
  • Chung, Chin Youb (Department of Orthopedic Surgery, Seoul National University College of Medicine) ;
  • Lee, Hoan Jong (Department of Pediatrics, Seoul National University College of Medicine) ;
  • Choi, In Ho (Department of Orthopedic Surgery, Seoul National University College of Medicine) ;
  • Choi, Eun Hwa (Department of Pediatrics, Seoul National University College of Medicine)
  • 최진형 (서울대학교 의과대학 소아과학교실) ;
  • 최영준 (서울대학교 의과대학 소아과학교실) ;
  • 홍기배 (서울대학교 의과대학 소아과학교실) ;
  • 이진아 (서울대학교 의과대학 소아과학교실) ;
  • 유원준 (서울대학교 의과대학 정형외과학교실) ;
  • 김한수 (서울대학교 의과대학 정형외과학교실) ;
  • 박문석 (서울대학교 의과대학 정형외과학교실) ;
  • 조태준 (서울대학교 의과대학 정형외과학교실) ;
  • 정진엽 (서울대학교 의과대학 정형외과학교실) ;
  • 이환종 (서울대학교 의과대학 소아과학교실) ;
  • 최인호 (서울대학교 의과대학 정형외과학교실) ;
  • 최은화 (서울대학교 의과대학 소아과학교실)
  • Received : 2010.10.11
  • Accepted : 2010.10.19
  • Published : 2011.06.25
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Abstract

Purpose : This study was performed for the purpose of finding causative organisms and clinical features of septic arthritis or acute osteomyelitis in children. Methods : The study involved a retrospective review of the medical records of 63 microbiologically confirmed cases of acute pyogenic arthritis and osteomyelitis. All of the cases were brought about by community-associated infections and managed at the Seoul National University Children's Hospital or Seoul National University Bundang Hospital from June 2003 to July 2009. Results : The median age of all cases was 60 months and there were 35 males and 28 females. Major involved joints included the hip joint (15 cases), knee joint (7 cases), shoulder joint (4 cases), and elbow joint (4 cases). Also, major involved bones included the femur (20 cases), tibia (13 cases), humerus (7 cases), and radius (7 cases). Staphylococcus aureus was the most commonly identified causative organism, accounting for 49 cases (77.8%). Of the 49 isolates of S. aureus, methicillin-resistant S. aureus (MRSA) accounted for 8 cases (16.3%). Group B streptococcus spp. (GBS) and Salmonella spp. accounted for 3 cases, respectively. Nafcillin or cefazolin was often prescribed as an initial empirical antibiotic. There were 9 cases that were managed by a regimen that included vancomycin as the first choice. Fifty four cases (85.7%) recovered without any complications. Methicillin-sensitive S. aureus (MSSA), responsible for 41 cases, caused chronic complications in 3 cases. Of 8 cases caused by MRSA, 1 case showed chronic complication. There were no fatal cases. Conclusion : S. aureus remains the most common organism causing acute pyogenic arthritis and osteomyelitis of childhood acquired in the community. The high prevalence of methicillin resistance among S. aureus should be considered carefully in the selection of initial empirical antibiotics.

목 적 : 급성 화농성 관절염 및 골수염은 성인에 비해 소아에서 비교적 흔히 볼 수 있는 질환으로 진단 및 치료가 지연되거나 부적절할 경우 만성적인 후유증을 초래할 수 있다. 본 연구에서는 최근 6년간 우리나라 2개 대학병원에서 경험한 급성 관절염 및 골수염의 원인균과 임상 양상을 분석하였다. 방 법: 2003년 6월부터 2009년 7월까지 지역사회에서 발생한 급성 화농성 골관절염으로 서울대학교 어린이 병원과 분당 서울대학교병원에 입원한 15세 이하 환아들 중 혈액이나 관절액, 조직에서 시행한 세균 배양 검사상 원인균이 증명된 63례를 대상으로 하여 의무 기록을 후향적으로 분석하였다. 결 과:총 63명의 중앙 연령은 60개월이고, 남아는 35명, 여아는 28명으로 약 1.25:1의 비율을 보였다. 침범 부위 중 관절은 고관절을 침범한 것이 15례(37.5%) 로 다수를 차지하였고, 슬관절 7례(17.5%), 견관절과 주관절이 각각 4례(10%)에서 침범되었고, 골수 침범 부위는 대퇴골이 20례(33.9%), 경골이 13례(22%), 요골과 상완골이 각각 7례(11.9%)씩 차지하였다. 원인균 중 S. aureus가 49례로 77.8%를 차지하였고, 이 49례 중 MSSA가 41례(83.7%), MRSA는 8례(16.3%)를 나타내었다. GBS, Salmonella spp.는 각각 3례를 차지하였다. 한편 생후 1개월 미만의 신생아 4례중 3례에서 GBS가 동정되었다. 초기 항생제로는 1세대 cephalosporin 또는 nafcillin 단독 요법을 선택한 경우가 27례(42.9%)로 가장 흔했고 vancomycin을 포함한 경우는 총 9례 (14.3%)이었다. 총 63례 중 54례(85.7%)에서 합병증 없이 호전되었고, 만성 골수염, 성장판 손상, 관절 신전 장애, 재감염 및 재수술 등 합병증을 동반한 호전을 보인 경우가 9례(14.3%)이었고 사망례는 없었다. 결 론 : 지역사회에서 발생한 소아청소년 관절염 및 골수염의 가장 흔한 원인균은 S.aureus이고 이 중 MRSA 는 16.3%를 차지하므로 신중한 항생제 선택을 필요로 한다.

Keywords

References

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