Declining Prevalence of Methicillin-Resistant Staphylococcus aureus Septic Arthritis and Osteomyelitis in Children: Implications for Treatment

• Type of Material: Article
• Authors: Lindsay Weiss, Joe DiMaggio Children's Hospital; Amanda Lansell, Rainbow Babies & Children’s Hospital; Janet Figueroa, Emory University; Parminder Suchdev, Emory University; Anjali Kirpalani, Emory University
• Language: English
• Date: 2020-03-01
• Publisher: MDPI
• Publication Version: Final Published Version
• Copyright Statement: © 2020 by the authors. Licensee MDPI, Basel, Switzerland.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.3390/antibiotics9030101
• Title of Journal or Parent Work: Antibiotics
• ISSN: 2079-6382
• Volume: 9
• Issue: 3
• Grant/Funding Information: This article published with support from Emory Libraries' Open Access Publishing Fund.; This research received no external funding.
• Keywords: resistance trends; BONE; MSSA; osteoarticular; ACUTE HEMATOGENOUS OSTEOMYELITIS; Infectious Diseases; bone and joint; MRSA; MUSCULOSKELETAL INFECTIONS; MANAGEMENT; Science & Technology; Life Sciences & Biomedicine; Pharmacology & Pharmacy; antimicrobial stewardship; microbiology; TRENDS; epidemiology
• Research Categories: Health Sciences, Pharmacology; Biology, Microbiology; Health Sciences, Epidemiology

Abstract

This study sought to assess clinical characteristics and differences in outcomes between children with Methicillin-resistant Staphylococcus aureus (MRSA) and Methicillin-sensitive Staphylococcus aureus (MSSA) osteomyelitis or septic arthritis and whether initial antibiotic regimen affects patient outcomes. We analyzed records of children ages 15 days to 18 years admitted between 2009 and 2016 to two tertiary children’s hospitals who were diagnosed with an osteoarticular infection and had a microorganism identified. A total of 584 patients met inclusion criteria, of which 365 (62.5%) had a microbiological diagnosis. MSSA was the most common pathogen identified (45.5%), followed by MRSA (31.2%). Compared to MSSA, patients with MRSA had a higher initial C-reactive protein and longer hospitalization. Patients whose initial antibiotic regimens included vancomycin had a longer hospitalization than those initiated on clindamycin without vancomycin, even after removing sicker patients admitted to the pediatric intensive care unit. While MRSA was associated with increased severity of osteoarticular infections compared to MSSA, the incidence of MRSA has been declining at our institution. Patients with longer lengths of stay were more likely to be on vancomycin. Clindamycin should be considered in the initial antibiotic regimen for osteomyelitis and septic arthritis with ongoing surveillance of local microbiology and outcomes.