Die akute Osteomyelitis des Kindes

Zusammenfassung

Die akute hämatogene Osteomyelitis ist eine schwere Erkrankung im Kindesalter, die bei verzögerter Diagnose und Therapie bleibende Schäden am Skelettapparat verursachen kann. Die Virulenz der Erkrankung kann von einer unterschwelligen Betroffenheit bis zu septischen Krankheitsbildern reichen. Das Keimspektrum hat sich über die Jahre verändert, aktuell ist Staphylococcus aureus der häufigste ursächliche Keim. Der prozentuale Anteil der Methicillin-resistenten Spezies (MRSA) variiert regional beträchtlich. Eine schnelle Diagnose unter Berücksichtigung der klinischen Symptome, des Labors und der bildgebenden Diagnostik, in der die Sonografie und das MRT die größte Bedeutung besitzen, ist die Basis. Die Therapie wird im Sinne einer Notfallindikation entweder konservativ antibiotisch oder zusätzlich durch operative Maßnahmen sofort eingeleitet. Die Operationen dienen zur Entlastung von intraossären, subperiostalen und Weichteilabszessen oder zur Kürettage und Ausräumung nekrotischen Knochens. Eine begleitende Gelenkinfektion wird arthroskopisch gespült. Folgeoperationen sind keine Seltenheit. Die Dauer der anti-biotischen Behandlung orientiert sich an der Schnelligkeit der Normalisierung des klinischen Bildes und des CRP-Wertes. Trotz suffizienter Frühbehandlung kann es zu Spätfolgen wie Rezidiven, Wachstumsstörungen und geschädigten Gelenken kommen.

Summary

Acute haematogenous osteomyelitis is known as a severe paediatric infection which may produce serious sequelae of the musculo-skeletal system, if diagnosis and treatment are delayed. The clinical picture can range from a mild illness to a generalised sepsis. There is a changing bacteriological spectrum over the years with staphylococcus aureus being the most frequent causative agent. The methicillin resistent species (MRSA) varies a lot between regions. A very early diagnosis by analysing clinical symptoms, blood tests and imaging modalities, of which sonography and MRI are of greatest importance, is mandatory. The treatment has to be established on an emergency schedule by either conservative antibiotic therapy or immediate additional surgical interventions. The surgical goal is to eliminate intraosseous, subperiosteal or soft tissue abscesses or remove necrotic bone by curettage. In cases of adjacent joint infection an arthroscopic lavage is needed. Repeat surgeries are frequently required. The duration of antibiotic therapy is adapted according to the timeline of normalisation of clinical symptoms and CRP-values. Despite of efficient early treatment complications such as recurrences, growth disturbances and joint damage may occur.

Schlüsselwörter

Akute hämatogene Osteomyelitis - Säuglings -osteomyelitis - Staphylococcus aureus - anti-biotische Therapie - Notfallindikation

Keywords

Acute haematogenous osteomyelitis - neo -natal osteomyelitis - staphylococcus aureus - antiobiotic treatment - emergency

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