Methods: Cases of acute hematogenous osteomyelitis or septic arthritis in children with positive blood cultures for S. aureus at TCH from 2011-2014 were reviewed. Orthopedic complications included chronic osteomyelitis, growth arrest, pathologic fracture, avascular necrosis and chronic dislocation. Acute kidney injury (AKI) was defined as a doubling of the baseline creatinine.
Results: 102 cases were included (35 MRSA). Orthopedic complications developed in 18 patients (17.6%). Patients with MRSA had a longer duration of fever (7.5 vs. 4 days, p<0.001), bacteremia and length of stay, more frequent abscesses (68.6% vs. 34.3%, p=0.002) and repeat surgical procedures (62.9% vs. 16.4%, p<0.001). 25 patients (4 MRSA) were discharged home on oral antibiotics. Patients discharged on oral antibiotics had a shorter duration of fever (3 vs. 6 days, p=0.03), a more rapid decline in C-reactive protein (p=0.02), smaller abscesses (p=0.05) and less often had MRSA (16% vs. 40.3%, p=0.03). The frequency of orthopedic complications did not increase in patients who received early transition to oral antibiotics. For patients with MRSA bacteremia the median duration of vancomycin was 6.5 days (IQR: 4-23); the rates of complications between those who received ≥ 7 days vs. < 7 days of vancomycin did not differ. Vancomycin serum troughs > 15 µg/ml were not associated with a decreased duration of fever, bacteremia or hospitalization, need for repeat operation or orthopedic complications but were associated with AKI (57.1%, p=0.001).
Conclusion: S. aureus BOAI are associated with substantial morbidity. Early transition to oral therapy may be a safe option for select patients with S. aureus BOAI, including those due to MRSA. Prolonged courses of vancomycin and elevated vancomycin troughs were not associated with improved outcomes for MRSA OAI. Prospective studies are necessary to determine optimal management of S. aureus BOAI.
Site-Co-investigator on clinical trial that is unrelated to research presented
E. O. Mason Jr., None
S. L. Kaplan, Forest Labs: Grant Investigator , Research support and Site-PI for clinical trial unrelated to presented research
Pfizer: Grant Investigator , Research grant
Cubist: Grant Investigator , Research grant and Site-PI for clinical trial unrelated to presented research
J. G. Vallejo, Forest Labs: Grant Investigator , Research grant and Site-Co-investigator on clinical trial that is unrelated to research presented
See more of: Poster Abstract Session