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Changing Trends in Acute Osteomyelitis in Children
- Source :
- Journal of Pediatric Orthopaedics. 28:569-575
- Publication Year :
- 2008
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2008.
-
Abstract
- Background: Staphylococcus aureus remains the most common etiologic agent of acute osteomyelitis in children. Recently, methicillin-resistant S. aureus (MRSA) has emerged as a major pathogen. Methods: Records of all children admitted with acute osteomyelitis from January 1999 to December 2003 were reviewed. For the comparative analysis, the study population was evenly distributed in 2 periods: period A, January 1999 to June 2001; n= 113; and period B, July 2001 to December 2003; n = 177. In addition, clinical findings of MRSA osteomyelitis were compared with non-MRSA osteomyelitis, including methicillin-sensitive S. aureus infections. Results: Two hundred ninety children (60% male subjects) with acute osteomyelitis were identified. Median (25th-75th percentile) age at diagnosis was 6 years (range, 2-11 years). Significant clinical findings included the following: localized pain (84%), fever (67%), and swelling (62%). Affected bones included the following: foot (23%), femur (20%), tibia (16%), and pelvis (7%). Thirty-seven percent of blood cultures were positive, and a bacterial isolate was obtained in 55% of cases. Bacteria most frequently isolated included the following: methicillin-sensitive S. aureus (45%) (57% in period A vs 40% in period B), MRSA (23%) (6% in A vs 31% in B; P < 0.001), Streptococcus pyogenes (6%), and Pseudomonas aeruginosa (5%). Children with MRSA compared with those with non-MRSA osteomyelitis had significantly greater erythrocyte sedimentation rate and C-reactive protein values on admission and increased length of hospital stay, antibiotic therapy, and overall rate of complications. We observed significant changes in antibiotic therapy related to increased use of agents with activity against MRSA. Conclusions: Methicillin-resistant S. aureus was isolated more frequently in the second study period and was associated with worse clinical outcomes.
- Subjects :
- Male
Staphylococcus aureus
medicine.medical_specialty
Micrococcaceae
medicine.disease_cause
Internal medicine
Prevalence
medicine
Humans
Orthopedics and Sports Medicine
Child
Retrospective Studies
medicine.diagnostic_test
biology
Pseudomonas aeruginosa
business.industry
Osteomyelitis
Infant
General Medicine
Staphylococcal Infections
medicine.disease
biology.organism_classification
Texas
Methicillin-resistant Staphylococcus aureus
Surgery
Logistic Models
Child, Preschool
Erythrocyte sedimentation rate
Acute Disease
Pediatrics, Perinatology and Child Health
Population study
Female
Methicillin Resistance
Osteitis
business
Subjects
Details
- ISSN :
- 02716798
- Volume :
- 28
- Database :
- OpenAIRE
- Journal :
- Journal of Pediatric Orthopaedics
- Accession number :
- edsair.doi.dedup.....6fb55497315b5e48a469749b342bede7