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Changing Patterns of Acute Hematogenous Osteomyelitis and Septic Arthritis: Emergence of Community-associated Methicillin-resistant Staphylococcus aureus

Arnold, Sandra R. MD, MS*; Elias, David MD‡; Buckingham, Steven C. MD*; Thomas, Eddie D. MD†§; Novais, Eduardo MD‡¶; Arkader, Alexandre MD‡∥; Howard, Cassandra MD†**

doi: 10.1097/01.bpo.0000242431.91489.b4
Infection: Original Article

Introduction: An increase in the incidence and severity of acute osteoarticular infections in children was perceived after the emergence of community-associated methicillin-resistant Staphylococcus aureus (MRSA) in our community. This study was performed to describe changes in the epidemiology and clinical features of acute osteoarticular infections.

Methods: The records of patients discharged from Le Bonheur Children's Medical Center with a diagnosis of acute osteoarticular infection between 2000 and 2004 were reviewed. Data regarding signs and symptoms, diagnostic testing, therapeutics, surgery, and hospital course were collected.

Results: There were 158 cases of acute osteoarticular infection. The incidence increased from 2.6 to 6.0 per 1000 admissions between 2000 and 2004. The proportion of infections caused by methicillin-susceptible S. aureus (MSSA) remained constant (10%-13%) and that caused by MRSA rose from 4% to 40%. There was no difference between MRSA and MSSA patients in the duration of fever or pain before diagnosis. Seventy-one percent of patients with MRSA had subperiosteal abscesses compared with 38% with MSSA (P = 0.02). Ninety-one percent of MRSA patients required a surgical procedure compared with 62% of MSSA patients (P < 0.001). Median hospital stay was 7 days for MSSA patients and 10 days for MRSA patients (P = 0.0001). Three patients developed chronic osteomyelitis, 2 with MRSA. There was no association between a delay in institution of appropriate antibiotic therapy and presence of subperiosteal abscess (P = 0.8).

Conclusions: There has been an increase in the incidence and severity of acute osteoarticular infections in Memphis. Patients with community-associated MRSA infections are at higher risk of subperiosteal abscess requiring surgical intervention.

From the *Department of Pediatrics, †Le Bonheur Children's Medical Center, University of Tennessee Health Science Center, Memphis, TN; ‡Department of Orthopedic Surgery, Campbell Clinic/University of Tennessee Health Science Center, Memphis, TN; §The Peachtree Center, Jesup, GA; ¶Hospital Das Clínicas Da Universidade Federal De Minas Gerais, Belo Horizonte, Brazil; &spar;Cortel Clinica Ortopedica, Rio De Janeiro, Brazil; and **Methodist Le Bonheur Germantown Hospital, Germantown, TN.

None of the authors received financial support for this study.

Reprints: Sandra R. Arnold, MD, MS, Department of Pediatrics, Le Bonheur Children's Medical Center, University of Tennessee Health Science Center, 50 N Dunlap St, Memphis, TN 38120. E-mail: sarnold5@utmem.edu.

© 2006 Lippincott Williams & Wilkins, Inc.