儿童急性骨髓炎的流行病学、病因学、诊断及治疗最新进展

Recent Advances in Pediatric Acute Osteomyelitis: Epidemiology, Etiology, Diagnosis, and Management

摘要: 儿童急性骨髓炎(acute osteomyelitis, AO)是儿童严重肌肉–骨骼感染疾病，其虽少见，但若是诊断或治疗延误，可进展为亚急性/慢性感染并造成生长板损伤、肢体异常发育等并发症。近年来，多国研究提示报告发病率呈上升趋势，且病原谱出现一定变化，其中耐甲氧西林金黄色葡萄球菌(MRSA)相关感染的重症病例比例增加，同时随着分子诊断技术的应用金格杆菌(Kingella kingae)在低龄儿童中的检出率升高。在诊断领域中，血培养与影像学检查始终是临床诊断的基石，在面临已使用抗生素或培养结果为阴性的病例时，传统方法的检出效能常显不足；此时，聚合酶链式反应(PCR)、多重PCR及宏基因组测序(mNGS)等分子诊断技术，往往能够提高病原菌的识别率。治疗方面，经验性抗菌覆盖需结合患者年龄差异与地区耐药流行特征；对于无并发症AO患者，“短程静脉–序贯口服”的个体化策略在病情与炎症指标改善的前提下可降低导管并发症的同时维持疗效。本文旨在综述AO的流行病学现状、病原微生物学特点、诊断路径的演进以及治疗策略的最新进展，并对当前领域内的争议焦点与未来潜在的研究方向进行探讨。

Abstract: Acute osteomyelitis (AO) in children represents a serious musculoskeletal infection. Although relatively rare, delayed diagnosis or treatment can lead to progression to subacute/chronic infection and complications such as growth plate damage and limb deformity. Recent multinational studies indicate a rising reported incidence, alongside shifts in the pathogen spectrum. Notably, there has been an increase in severe cases associated with methicillin-resistant Staphylococcus aureus (MRSA), while the application of molecular diagnostics has revealed a higher detection rate of Kingella kingae in young children. In diagnosis, blood culture and imaging remain cornerstones. However, their yield is often limited in cases with prior antibiotic exposure or negative cultures. In such scenarios, molecular diagnostic techniques—including polymerase chain reaction (PCR), multiplex PCR, and metagenomic next-generation sequencing (mNGS)—can significantly improve pathogen identification. Regarding treatment, empirical antibiotic coverage must account for patient age and regional resistance patterns. For uncomplicated AO, an individualized strategy of short-course intravenous therapy followed by oral antibiotics, guided by clinical and inflammatory marker improvement, can maintain efficacy while reducing catheter-related complications. This review summarizes current epidemiology, evolving microbiological profiles, advances in diagnostic pathways, and updates in management strategies for AO, and discusses key controversies and potential future research directions within the field.