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Hematogenous Osteomyelitis

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DBX is a Epidemiologist, Infection Control Specialist, Disease Intervention Specialist, Research Analyst, Environmental and Occupational Health Consultant with world-class expertise in infectious disease epidemiology, environmental and occupational health, and use of epidemiology in clinical decision-making.

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Hematogenous Osteomyelitis Caused by Methicillin Resistant Staphylococcus aureus

Abstract

Background: Staphylococcus aureus remains the most common cause of hematogenous osteomyelitis in children, but recently emerged more virulent methicillin-resistant (MRSA) strains now predominate. It remains uncertain whether these pathogens cause a measurably more severe illness than methicillin-sensitive (MSSA) strains.

Patients and Methods: We reviewed records of 97 pediatric patients with hematogenous osteomyelitis of varying etiolo-gies to determine whether there were significant differences among the groups in terms of predetermined measures of disease severity. These measures included degree and duration of fever, acute-phase reactants, length of hospitalization, the number of surgical procedures required, and long-term sequelae.

Results: Differences in the clinical course of illness were observed. With MRSA patients there were significantly in-creased degree and duration of fever (p = 0.0001 for both), acute-phase reactant measures (WBC p = 0.0001; CRP p = 0.0058; ESR p = 0.0046), initial length of hospital stay (p = 0.0001), and required number of surgical interventions (all procedures p = 0.0001; therapeutic procedures only p = 0.0002) as compared to patients with osteomyelitis caused by other bacterial pathogens and culture-negative osteomyelitis. A similar general pattern was observed when the analysis was restricted to culture-positive staphylococcal cases only.

Conclusion: Our results support the hypothesis that MRSA produces more severe bone infection and is likely to require more aggressive surgical and medical management.

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