420. Acute Hematogenous Osteomyelitis in Children: A 10-year Retrospective Review
Session: Poster Abstract Session: Pediatric Infections
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
  • YUSEF-Sabella-74477-40x72-Sep 20.pdf (137.4 kB)
  • Background: Staphylococcus 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 over a 10-year period (January, 2003-December, 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 non-MRSA.

    Results: AHOM (n=50; ages 3m-17y, median 6y; 23 female) was caused by MSSA (n=22; 44%), MRSA (n=8; 16%), or Group A streptococci (n=2).  No pathogen was isolated in 13 patients (26%), all of whom were treated successfully with antimicrobial agents not active against MRSA. The incidence of AHOM due to MRSA has increased from 11% in the first half of the study duration (2003 through 2007) to 19% in the second half (2008 through 2012). The most common affected bones were femur (28%) and tibia (14%). In comparison to patients with non-MRSA infection, patients with MRSA infection had a higher rate of bacteremia (100% for MRSA vs. 28% for non-MRSA, P = 0.0001) and more inflammation at presentation evidenced by higher CRP, neutrophilia, and mean temperature (p = 0.01, 0.003, and 0.003; 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 non-MRSA infected patients. Clindamycin resistance occurred in none of the MRSA and 5 (23%) of MSSA isolates. 

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

    Dawood Yusef, MD1, Johanna Goldfarb, MD1, Blanca Gonzalez, M.D1, Charles Foster, 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

    J. Goldfarb, None

    B. Gonzalez, None

    C. Foster, None

    S. Worley, None

    C. Sabella, None

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