Program Schedule

695
Bone and Joint  Infections in Children in the Era of Community- Acquired Meticillin- Resistant S. aureus

Session: Poster Abstract Session: Approach to Clinical Infections
Friday, October 10, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Posters
  • Slide1.PNG (476.6 kB)
  • Background:  Osteoarticular infections (OAI) are common in children, and community -acquired meticillin resistant S. aureus(CA-MRSA) is the leading cause in some countries. The aim of this study was to evaluate epidemiological data, clinical and microbiological features and outcome of OAI with serial C-reactive protein (CRP) monitoring.

    Materials and Methods: A prospective study was conducted between December 2011 and December 2013. Forty patients were included. The course of illness was monitored using the erythrocyte sedimentation rate (ESR) and serum CRP. Main outcome measure was full recovery and no recurrence nor sequelae for at least 3 months after hospital discharge.

    Results: 40 patients (p) completed the study: 20p (50%) had arthritis, 17 (43%) osteomyelitis, and 3 (7%) osteoarthrithis. Median (Md) age was 90 months (r: 3-186 m). The most common site of infection was the hip (12p -30%), followed by the knee (9 p -22%). Md CRP value upon admission was 50 mg/l (r: 26.3-86.5) which normalized within Md of 7 days (r: 1-60 d). Md ESR level was 75 (r: 50-102) and normalized within Md of 28 days (r: 14-30). Bacterial cultures were positive in 30 p (75%): CA-MRSA was found in 19p, Meticillin-sensitive S aureusin 6 p, and others in 5 p.  Cultures were negative in 10 patients (25%). Md duration of intravenous treatment was 7 days (r: 5-10d).  Md treatment duration was 28 days (r: 21-40 d); Md hospital stay was 7 days (r: 3 to 10). The patients were followed for a Md of 12 months, during which 1 patient relapsed and 4 had sequelae. Analyzing patients with CA-MRSA  separately, initial CRP was higher (Md 76 vs 50, p< 0.02), normalization occurred later (Md 14 days vs 7days, p< 0.03), and duration of treatment (Md 32 days vs 23, p<0.004) as well as hospital stay (Md 9 days vs 7, p= 0.12) were longer Surgical drainage was necessary in all patients. Sequelae were present in 3 patients and 1 relapsed.

    Conclusion: CA-MRSA was the leading cause of osteoarticular infections and was associated with higher CRP on admission, later normalization, and longer treatment duration. Complications, drainage requirement, and sequelae were most common in those patients.

    Maria Teresa Rosanova, PhD1, Sandra Gimenez2, Rosa Bologna3, Ana Buchovsky2, Griselda Berberian, MD4, Natalia Escudé2, Guadalupe Perez2, Claudia Sarkis5, Jose L Pinheiro2 and Roberto Lede6, (1)Epídemiology and Infectious Diseases, Hospital de Pediatria JP Garrahan, Buenos Aires, Argentina, (2)Hospital J P Garrahan, Buenos Aires, Argentina, (3)Epidemiology and Infectious Diseases, Hospital J P Garrahan, Buenos Aires, Argentina, (4)Epidemiology and Infectious Disease, Hospital de Pediatría Juan P. Garrahan, Buenos Aires, Argentina, (5)Hospital J. P. Garrahan, Buenos Aires, Argentina, (6)Universidad Abierta Interamericana (UAI), Buenos Aires, Argentina

    Disclosures:

    M. T. Rosanova, None

    S. Gimenez, None

    R. Bologna, None

    A. Buchovsky, None

    G. Berberian, None

    N. Escudé, None

    G. Perez, None

    C. Sarkis, None

    J. L. Pinheiro, None

    R. Lede, None

    Findings in the abstracts are embargoed until 12:01 a.m. EDT, Oct. 8th with the exception of research findings presented at the IDWeek press conferences.

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