Abstract：
BACKGROUND: Tropical pyomyositis has had a recent increase in the United States, Europe, and other nontropical areas. The purpose of this study was to provide an accurate description of the demographics, presenting features, sites of involvement, microbiology, imaging modalities, medical and surgical management, complications, and predictors of clinical course.
METHODS: We searched PubMed, Cochrane, Web of Science Collection, Scopus, and Embase databases yielding 156 studies. Of these, 23 articles were selected for statistical analysis.
RESULTS: The average age at presentation was 8.4±1.9 years with males more commonly affected. Fever, painful limp, and localized pain were the most common presenting symptoms. Pelvis, lower extremity, trunk and spine, in descending order, were the most commonly affected locations. Iliopsoas, obturator musculature, and gluteus musculature were the most commonly affected muscle groups. The mean time to diagnosis was 6.6±3.05 days. Staphylococcus aureus was the most common offending organism. The mean length of hospital stay was 12.0±4.6 days. Medical management alone was successful in 40% of cases (143/361) with an average duration of 9.5±4.0 and 22.7±7.2 days of intravenous and oral antibiotics, respectively. Surgical management consisted of open drainage in 91.3% (199/218) or percutaneous drainage in 8.7% (19/218) of cases. Painful limp, fever, and larger values of white cell count and erythrocyte sedimentation rate were associated with an increased need for surgery. Obturator and calf muscle involvement were strongly associated with multifocal involvement. There were 42 complications in 41 patients (11.3%). Methicillin-resistant S. aureus was associated with an increased risk of complications. The most common complications were osteomyelitis, septicemia, and septic arthritis.
CONCLUSIONS: Primary pyomyositis should be considered in cases suggesting pediatric infection. Magnetic resonance imaging is the most commonly used imaging modality; however, ultrasound is useful given its accessibility and low cost. Medical management alone can be successful, but surgical treatment is often needed. The prognosis is favorable. Early diagnosis, appropriate medical management, and potential surgical drainage are required for effective treatment.
METHODS: Level IV-systematic review.
METHODS: We searched PubMed, Cochrane, Web of Science Collection, Scopus, and Embase databases yielding 156 studies. Of these, 23 articles were selected for statistical analysis.
RESULTS: The average age at presentation was 8.4±1.9 years with males more commonly affected. Fever, painful limp, and localized pain were the most common presenting symptoms. Pelvis, lower extremity, trunk and spine, in descending order, were the most commonly affected locations. Iliopsoas, obturator musculature, and gluteus musculature were the most commonly affected muscle groups. The mean time to diagnosis was 6.6±3.05 days. Staphylococcus aureus was the most common offending organism. The mean length of hospital stay was 12.0±4.6 days. Medical management alone was successful in 40% of cases (143/361) with an average duration of 9.5±4.0 and 22.7±7.2 days of intravenous and oral antibiotics, respectively. Surgical management consisted of open drainage in 91.3% (199/218) or percutaneous drainage in 8.7% (19/218) of cases. Painful limp, fever, and larger values of white cell count and erythrocyte sedimentation rate were associated with an increased need for surgery. Obturator and calf muscle involvement were strongly associated with multifocal involvement. There were 42 complications in 41 patients (11.3%). Methicillin-resistant S. aureus was associated with an increased risk of complications. The most common complications were osteomyelitis, septicemia, and septic arthritis.
CONCLUSIONS: Primary pyomyositis should be considered in cases suggesting pediatric infection. Magnetic resonance imaging is the most commonly used imaging modality; however, ultrasound is useful given its accessibility and low cost. Medical management alone can be successful, but surgical treatment is often needed. The prognosis is favorable. Early diagnosis, appropriate medical management, and potential surgical drainage are required for effective treatment.
METHODS: Level IV-systematic review.
摘要：
背景：热带化脓性肌炎最近在美国有所增加，欧洲,和其他非热带地区。这项研究的目的是提供人口统计学的准确描述，呈现特征，参与地点，微生物学,成像模式，医疗和外科管理，并发症,和临床病程的预测因素。
方法：我们搜索了PubMed，科克伦,WebofScience合集,Scopus,和Embase数据库产生156项研究。其中,选取23篇文献进行统计分析。
结果：出现时的平均年龄为8.4±1.9岁，男性更常受影响。发烧,痛苦的跛行，和局部疼痛是最常见的症状。骨盆,下肢,躯干和脊柱，按降序排列，是最常见的受影响的地点。Iliopsoas,闭孔肌肉组织，臀肌是最常见的肌肉群。平均诊断时间为6.6±3.05天。金黄色葡萄球菌是最常见的致病菌。平均住院时间为12.0±4.6天。仅在40％的病例（143/361）中，仅在静脉和口服抗生素的平均持续时间为9.5±4.0和22.7±7.2天，分别。手术治疗包括91.3％（199/218）的开放式引流或8.7％（19/218）的经皮引流。痛苦的跛行，发烧,白细胞计数和红细胞沉降率值较大与手术需求增加相关.闭孔和小腿肌肉受累与多灶性受累密切相关。41例患者出现42例(11.3%)并发症。耐甲氧西林金黄色葡萄球菌与并发症风险增加相关。最常见的并发症是骨髓炎，败血症,和脓毒性关节炎.
结论：提示小儿感染的病例应考虑原发性化脓性肌炎。磁共振成像是最常用的成像模式；然而，超声是有用的，因为它的可及性和低成本。仅靠医疗管理就能成功,但是经常需要手术治疗。预后良好。早期诊断,适当的医疗管理，和潜在的手术引流需要有效的治疗。
方法：IV级系统评价。
方法：我们搜索了PubMed，科克伦,WebofScience合集,Scopus,和Embase数据库产生156项研究。其中,选取23篇文献进行统计分析。
结果：出现时的平均年龄为8.4±1.9岁，男性更常受影响。发烧,痛苦的跛行，和局部疼痛是最常见的症状。骨盆,下肢,躯干和脊柱，按降序排列，是最常见的受影响的地点。Iliopsoas,闭孔肌肉组织，臀肌是最常见的肌肉群。平均诊断时间为6.6±3.05天。金黄色葡萄球菌是最常见的致病菌。平均住院时间为12.0±4.6天。仅在40％的病例（143/361）中，仅在静脉和口服抗生素的平均持续时间为9.5±4.0和22.7±7.2天，分别。手术治疗包括91.3％（199/218）的开放式引流或8.7％（19/218）的经皮引流。痛苦的跛行，发烧,白细胞计数和红细胞沉降率值较大与手术需求增加相关.闭孔和小腿肌肉受累与多灶性受累密切相关。41例患者出现42例(11.3%)并发症。耐甲氧西林金黄色葡萄球菌与并发症风险增加相关。最常见的并发症是骨髓炎，败血症,和脓毒性关节炎.
结论：提示小儿感染的病例应考虑原发性化脓性肌炎。磁共振成像是最常用的成像模式；然而，超声是有用的，因为它的可及性和低成本。仅靠医疗管理就能成功,但是经常需要手术治疗。预后良好。早期诊断,适当的医疗管理，和潜在的手术引流需要有效的治疗。
方法：IV级系统评价。
