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Bakterielle Arthritis bei Kindern und Jugendlichen, Schwerpunkt Diagnostik

Ergebnisse der Wörlitzer Konsensusgespräche 2016, Teil 1

Bacterial arthritis in children and adolescents, core theme diagnostics

Results of the Wörlitz consensus meeting 2016, part 1

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Zusammenfassung

Bakterielle Arthritiden (BA) im Kindes- und Jugendalter sind selten. Aus diesem Grund bestand lange ein quantitativer und qualitativer Datenmangel für eine rationale Handlungsempfehlung. Dies hat sich in den letzten Jahren durch umfangreichere – auch randomisierte – Studien geändert. Die vorliegenden Empfehlungen basieren auf den Ergebnissen einer Expertendiskussion pädiatrischer Infektiologen, Kinderorthopäden, Kinderradiologen und pädiatrischer Rheumatologen, die im Rahmen der Wörlitzer Konsensusgespräche vom 17.04.2016 bis 18.04.2016 stattfand. Dabei wurde statt der häufig üblichen Bezeichnung „septische Arthritis“ der Begriff „bakterielle Arthritis“ gewählt, da die Kinder nicht zwangsläufig ein septisches Bild zeigen. Aufgrund der umfangreichen und detaillierten Literaturrecherche, die den Empfehlungen zugrunde liegt, wird die Arbeit in 2 Teilen publiziert: Der vorliegende Teil 1 fokussiert den Schwerpunkt Diagnostik, Teil 2 wird sich schwerpunktmäßig mit der Therapie der BA befassen. In der Diagnostik der BA bleibt der mikrobiologische Erregernachweis essenziell, und die Magnetresonanztomographie hat sich als wichtigste bildgebende Untersuchung etabliert.

Abstract

Bacterial arthritis is rare in childhood and adolescence. Consequently, there has been a lack of qualitative and quantitative data on which to base rational treatment recommendations. Recently, this situation has changed with the publication of more comprehensive studies including some randomized trials. The recommendations presented in this article are the result of discussions by an expert panel of specialists in pediatric infectious diseases, pediatric orthopedic surgeons, pediatric rheumatologists and pediatric radiologists that took place during the annual Wörlitz Consensus Meeting in April, 17–18th 2016. It was decided to replace the commonly used term “septic arthritis” with the term “bacterial arthritis” as children do not always have a clinical presentation of sepsis. Due to the comprehensive and detailed literature search, which forms the basis for the recommendations, the article is to be published in two parts. The present Part 1 focuses on the core theme of diagnostics and Part 2 will be concerned with the core theme of treatment of bacterial arthritis. The microbiological detection of the pathogen is still essential for the diagnostics of bacterial arthritis and magnetic resonance imaging has become established as the most important imaging investigation.

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Danksagung

Wir danken Frau Dr. H. Taut (Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinik Dresden) für hilfreiche fachliche Diskussionen. Wir danken Prof. F. Gunzer und Dr. A. Thürmer für die Überlassung der mikroskopischen Befunde sowie die kompetente fachliche Unterstützung und Diskussion bei der Erstellung des Manuskripts (Universitätsklinik Dresden). Zudem bedanken wir uns bei Hr. PD Dr. H. Mellerowicz, HELIOS Kinderzentrum Berlin-Südwest, Klinik für Kinderorthopädie und Kindertraumatologie, und Hr. PD Dr. A. Trampuz, Sektionsleiter Infektiologie, Centrum für Muskuloskeletale Chirurgie, Charité – Universitätsmedizin Berlin, für wertvolle Anregungen.

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Authors and Affiliations

  1. Zentrum für Pädiatrische Rheumatologie, Olgahospital, Klinikum Stuttgart, Kriegsbergstr. 62, 70174, Stuttgart, Deutschland

    T. Hospach

  2. Arbeitsbereich Pädiatrische Rheumatologie und Immunologie, Universitätskinderklinik Dresden, Dresden, Deutschland

    C. Hedrich

  3. Orthopädische Klinik, Schwerpunkt Kinderorthopädie, Olgahospital, Klinikum Stuttgart, Stuttgart, Deutschland

    F. Fernandez

  4. Klinik für Kinder- und Jugendmedizin, Vivantes Klinikum im Friedrichshain, Berlin, Deutschland

    H. Girschick

  5. Klinik für Kinder- und Jugendmedizin, Klinikum St. Georg, Leipzig, Deutschland

    M. Borte

  6. Klinik für Kinder- und Jugendmedizin, Helios, Berlin, Deutschland

    A. Günther

  7. Klinik für Pädiatrie, Sektion Rheumatologie und Autoimmunologie, Universitätsklinik Charité Berlin, Berlin, Deutschland

    L. Martin & T. Kallinich

  8. Institut und Poliklinik für Radiologische Diagnostik, Universitätsklinik Dresden, Dresden, Deutschland

    G. Hahn

  9. Kinderradiologisches Institut, Olgahospital, Klinikum Stuttgart, Stuttgart, Deutschland

    T. von Kalle

  10. Klinik für Kinder- und Jugendmedizin, Asklepios Klinik St. Augustin, Sankt Augustin, Deutschland

    G. Horneff

  11. Prof. Hess Kinderklinik, Klinikum Bremen Mitte, Bremen, Deutschland

    H.-I. Huppertz

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  1. T. Hospach
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  2. C. Hedrich
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  7. L. Martin
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  12. H.-I. Huppertz
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Corresponding author

Correspondence to T. Hospach.

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Interessenkonflikt

T. Hospach, C. Hedrich, F. Fernandez, H. Girschick, M. Borte, A. Günther, L. Martin, G. Hahn, T. von Kalle, G. Horneff, T. Kallinich und H.-I. Huppertz geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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A. Borkhardt, Düsseldorf

S. Wirth, Wuppertal

Der vorliegende Beitrag ist Teil 1 „Schwerpunkt Diagnostik“ der Wörlitzer Konsensusgespräche 2016 zur bakteriellen Arthritis. Der 2. Teil beschäftigt sich mit dem Schwerpunkt Therapie (doi: 10.1007/s00112-017-0327-8)

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Hospach, T., Hedrich, C., Fernandez, F. et al. Bakterielle Arthritis bei Kindern und Jugendlichen, Schwerpunkt Diagnostik. Monatsschr Kinderheilkd 166, 141–147 (2018). https://doi.org/10.1007/s00112-017-0326-9

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