870. Acute Haematogenous Osteomyelitis in Children in The Era of Community Associated-Methicillin Resistant Staphylococcus aureus: A Retrospective Review
Session: Poster Abstract Session: Bone, Joint, and Soft Tissue Infection
Friday, October 19, 2012
Room: SDCC Poster Hall F-H
  • YUSEF-Sabella-60294-40x72-FINAL.pdf (531.5 kB)
  • Background: Staphylococcus aureus (S. aureus) is the predominant organism isolated from children with acute hematogenous osteomyelitis (AHOM). Increasingly, there have been reports of children with AHOM due to CA-MRSA.  As the changing microbiologic pattern of AHOM impacts empiric therapy, long-term treatment and outcome, there is a need to identify those patients with AHOM who are at risk for infection with CA-MRSA.

    Methods: Cases of pediatric (2 month to 18 years) AHOM treated at our institution from 2007 to 2012 were retrospectively reviewed. Collected data included the demographics, symptoms and signs at presentation, laboratory values, and microbiology results. We compared the clinical and microbiology data for AHOM caused by MRSA to those caused by MSSA and non-MRSA.

    Results: AHOM (n=30; ages 6m-17y, median 7y; 16 female) was caused by MSSA (n=12; 40%), MRSA (n=6; 20%), or Group A streptococci (n=2).  No pathogen was isolated in 7 patients (23%), all of whom were treated successfully with antimicrobial agents not active against MRSA. The most common affected bones were femur (23%) and tibia (16%). In comparison to patients with MSSA, patients with MRSA infection had a higher rate of bacteremia (100% for MRSA vs. 20% for MSSA, P = 0.009) and more inflammation at presentation evidenced by higher CRP, ESR, neutrophilia, and mean temperature (p = 0.01, 0.04, 0.01, and 0.02; respectively).   Personal or family history of skin/soft tissue infection, symptoms and signs at presentation, recent hospitalization or antibiotic use, and co-morbidities were not significantly different between MRSA- and MSSA-infected patients. Comparable results were observed between MRSA- and non-MRSA infected patients (including those with culture negative osteomyelitis), with the exception that ESR was no longer significantly different between the groups. Clindamycin resistance occurred in none of the MRSA and 16% of MSSA isolates.

    Conclusion: MSSA remains the most common organism causing AHOM in children at our institution, where an anti-staphylococcal ß-lactam antibiotic remains appropriate empiric therapy. AHOM caused by MRSA is associated with a higher rate of bacteremia, higher fever and more elevated inflammatory markers.

    Dawood Yusef, MD1, Charles Foster, MD1, Lara Danziger-Isakov, MD1, Johanna Goldfarb, MD1, Sarah Worley, MS2 and Camille Sabella, MD1, (1)Center for Pediatric Infectious Diseases, Cleveland Clinic Children's Hospital, CLEVELAND, OH, (2)Biostatistics, Cleveland Clinic Children's Hospital, Cleveland, OH


    D. Yusef, None

    C. Foster, None

    L. Danziger-Isakov, None

    J. Goldfarb, None

    S. Worley, None

    C. Sabella, None

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