Changing trends in acute osteomyelitis in children: Impact of methicillin-resistant staphylococcus aureus infections

Jesús Saavedra-Lozano, Asunción Mejías, Naveed Ahmad, Estrella Peromingo, Monica I. Ardura, Sara Guillen, Ali Syed, Dominick Cavuoti, Octavio Ramilo

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95 Scopus citations

Abstract

BACKGROUND: Staphylococcus aureus remains the most common etiologic agent of acute osteomyelitis in children. Recently, methicillin-resistant S. aureus (MRSA) has emerged as a major pathogen. METHODS: Records of all children admitted with acute osteomyelitis from January 1999 to December 2003 were reviewed. For the comparative analysis, the study population was evenly distributed in 2 periods: period A, January 1999 to June 2001; n = 113; and period B, July 2001 to December 2003; n = 177. In addition, clinical findings of MRSA osteomyelitis were compared with non-MRSA osteomyelitis, including methicillin-sensitive S. aureus infections. RESULTS: Two hundred ninety children (60% male subjects) with acute osteomyelitis were identified. Median (25th-75th percentile) age at diagnosis was 6 years (range, 2-11 years). Significant clinical findings included the following: localized pain (84%), fever (67%), and swelling (62%). Affected bones included the following: foot (23%), femur (20%), tibia (16%), and pelvis (7%). Thirty-seven percent of blood cultures were positive, and a bacterial isolate was obtained in 55% of cases. Bacteria most frequently isolated included the following: methicillin-sensitive S. aureus (45%) (57% in period Avs 40% in period B), MRSA (23%) (6% in A vs 31% in B; P < 0.001), Streptococcus pyogenes (6%), and Pseudomonas aeruginosa (5%). Children with MRSA compared with those with non-MRSA osteomyelitis had significantly greater erythrocyte sedimentation rate and C-reactive protein values on admission and increased length of hospital stay, antibiotic therapy, and overall rate of complications. We observed significant changes in antibiotic therapy related to increased use of agents with activity against MRSA. CONCLUSIONS: Methicillin-resistant S. aureus was isolated more frequently in the second study period and was associated with worse clinical outcomes. LEVEL OF EVIDENCE: II. Retrospective study.

Original languageEnglish (US)
Pages (from-to)569-575
Number of pages7
JournalJournal of Pediatric Orthopaedics
Volume28
Issue number5
DOIs
Publication statusPublished - Jul 2008

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Keywords

  • Children
  • Methicillin resistance
  • Osteomyelitis
  • Staphylococcus aureus

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Orthopedics and Sports Medicine

Cite this

Saavedra-Lozano, J., Mejías, A., Ahmad, N., Peromingo, E., Ardura, M. I., Guillen, S., ... Ramilo, O. (2008). Changing trends in acute osteomyelitis in children: Impact of methicillin-resistant staphylococcus aureus infections. Journal of Pediatric Orthopaedics, 28(5), 569-575. https://doi.org/10.1097/BPO.0b013e31817bb816