Changing patterns of acute hematogenous osteomyelitis and septic arthritis

Emergence of community-associated methicillin-resistant Staphylococcus aureus

Sandra Arnold, David Elias, Steven C. Buckingham, Eddie D. Thomas, Eduardo Novais, Alexandre Arkader, Cassandra Howard

Research output: Contribution to journalArticle

233 Citations (Scopus)

Abstract

INTRODUCTION: An increase in the incidence and severity of acute osteoarticular infections in children was perceived after the emergence of community-associated methicillin-resistant Staphylococcus aureus (MRSA) in our community. This study was performed to describe changes in the epidemiology and clinical features of acute osteoarticular infections. METHODS: The records of patients discharged from Le Bonheur Children's Medical Center with a diagnosis of acute osteoarticular infection between 2000 and 2004 were reviewed. Data regarding signs and symptoms, diagnostic testing, therapeutics, surgery, and hospital course were collected. RESULTS: There were 158 cases of acute osteoarticular infection. The incidence increased from 2.6 to 6.0 per 1000 admissions between 2000 and 2004. The proportion of infections caused by methicillin-susceptible S. aureus (MSSA) remained constant (10%-13%) and that caused by MRSA rose from 4% to 40%. There was no difference between MRSA and MSSA patients in the duration of fever or pain before diagnosis. Seventy-one percent of patients with MRSA had subperiosteal abscesses compared with 38% with MSSA (P = 0.02). Ninety-one percent of MRSA patients required a surgical procedure compared with 62% of MSSA patients (P < 0.001). Median hospital stay was 7 days for MSSA patients and 10 days for MRSA patients (P = 0.0001). Three patients developed chronic osteomyelitis, 2 with MRSA. There was no association between a delay in institution of appropriate antibiotic therapy and presence of subperiosteal abscess (P = 0.8). CONCLUSIONS: There has been an increase in the incidence and severity of acute osteoarticular infections in Memphis. Patients with community-associated MRSA infections are at higher risk of subperiosteal abscess requiring surgical intervention.

Original languageEnglish (US)
Pages (from-to)703-708
Number of pages6
JournalJournal of Pediatric Orthopaedics
Volume26
Issue number6
DOIs
StatePublished - Nov 1 2006

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Infectious Arthritis
Osteomyelitis
Methicillin-Resistant Staphylococcus aureus
Methicillin
Staphylococcus aureus
Infection
Abscess
Incidence
Signs and Symptoms
Length of Stay
Epidemiology
Fever
Anti-Bacterial Agents
Pain

All Science Journal Classification (ASJC) codes

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

Cite this

Changing patterns of acute hematogenous osteomyelitis and septic arthritis : Emergence of community-associated methicillin-resistant Staphylococcus aureus. / Arnold, Sandra; Elias, David; Buckingham, Steven C.; Thomas, Eddie D.; Novais, Eduardo; Arkader, Alexandre; Howard, Cassandra.

In: Journal of Pediatric Orthopaedics, Vol. 26, No. 6, 01.11.2006, p. 703-708.

Research output: Contribution to journalArticle

Arnold, Sandra ; Elias, David ; Buckingham, Steven C. ; Thomas, Eddie D. ; Novais, Eduardo ; Arkader, Alexandre ; Howard, Cassandra. / Changing patterns of acute hematogenous osteomyelitis and septic arthritis : Emergence of community-associated methicillin-resistant Staphylococcus aureus. In: Journal of Pediatric Orthopaedics. 2006 ; Vol. 26, No. 6. pp. 703-708.
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AB - INTRODUCTION: An increase in the incidence and severity of acute osteoarticular infections in children was perceived after the emergence of community-associated methicillin-resistant Staphylococcus aureus (MRSA) in our community. This study was performed to describe changes in the epidemiology and clinical features of acute osteoarticular infections. METHODS: The records of patients discharged from Le Bonheur Children's Medical Center with a diagnosis of acute osteoarticular infection between 2000 and 2004 were reviewed. Data regarding signs and symptoms, diagnostic testing, therapeutics, surgery, and hospital course were collected. RESULTS: There were 158 cases of acute osteoarticular infection. The incidence increased from 2.6 to 6.0 per 1000 admissions between 2000 and 2004. The proportion of infections caused by methicillin-susceptible S. aureus (MSSA) remained constant (10%-13%) and that caused by MRSA rose from 4% to 40%. There was no difference between MRSA and MSSA patients in the duration of fever or pain before diagnosis. Seventy-one percent of patients with MRSA had subperiosteal abscesses compared with 38% with MSSA (P = 0.02). Ninety-one percent of MRSA patients required a surgical procedure compared with 62% of MSSA patients (P < 0.001). Median hospital stay was 7 days for MSSA patients and 10 days for MRSA patients (P = 0.0001). Three patients developed chronic osteomyelitis, 2 with MRSA. There was no association between a delay in institution of appropriate antibiotic therapy and presence of subperiosteal abscess (P = 0.8). CONCLUSIONS: There has been an increase in the incidence and severity of acute osteoarticular infections in Memphis. Patients with community-associated MRSA infections are at higher risk of subperiosteal abscess requiring surgical intervention.

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