骨髓炎英文教科书.docxVIP

Chapter 52 - Acute and Chronic OsteomyelitisAnthony R BerendtCarl W NordenEPIDEMIOLOGYThe character of osteomyelitis changed with the advent of antibiotics, evolving from a disease of high mortality to a disease with high morbidity. Certain trends are apparent. Bone and joint tuberculosis has become less common in the developed world, although the advent of HIV-related diseasemay bring about a reversal in that trend. An increasing number of chronic bone infections are now associated with trauma, surgery and joint replacement rather than being secondary to hematogenous spread.The epidemiology of acute hematogenous osteomyelitis has been detailed.[1]The incidence is higher in males, it varies among geographic areas (Fig. 52.1) and, in some areas, classical acute hematogenous infection is in long-term decline.[2]The male-to-female ratio increases with age from 1.25 in the 0- to 4-year age group to 3.69 in the 13- to 19-year age group. There are substantially higher rates in Maori children from New Zealand and Aboriginal children from Western Australia compared both with white children living in the same areas and with children living in Europe. Although almost certainly socioeconomic in origin, these differences may also be influenced by host genetic factors.There is less clear information on the epidemiology of chronic osteomyelitis, with the exception of diabetic foot infections.[3]There are an estimated 11 million people in the USA with diabetes; the majority of these have type 2 disease and hence are older adults. Some 3% of diabetic people developa foot ulcer annually and 10–30% of patients with an ulcer will eventually need an amputation. Of all amputations in people with diabetes, 60% are preceded by an infected ulcer. Foot problems have been estimated to be responsible for 15% of the hospital admissions and 25% of the hospital bed usage among diabetic patients. The annual hospital costs for limb amputations that are related to diabetes amount to more than US$35