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Declining Prevalence of Methicillin-Resistant Staphylococcus aureus Septic Arthritis and Osteomyelitis in Children: Implications for Treatment

This study sought to assess clinical characteristics and differences in outcomes between children with Methicillin-resistant Staphylococcus aureus (MRSA) and Methicillin-sensitive Staphylococcus aureus (MSSA) osteomyelitis or septic arthritis and whether initial antibiotic regimen affects patient ou...

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Autores principales: Weiss, Lindsay, Lansell, Amanda, Figueroa, Janet, Suchdev, Parminder S., Kirpalani, Anjali
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7148457/
https://www.ncbi.nlm.nih.gov/pubmed/32121093
http://dx.doi.org/10.3390/antibiotics9030101
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author Weiss, Lindsay
Lansell, Amanda
Figueroa, Janet
Suchdev, Parminder S.
Kirpalani, Anjali
author_facet Weiss, Lindsay
Lansell, Amanda
Figueroa, Janet
Suchdev, Parminder S.
Kirpalani, Anjali
author_sort Weiss, Lindsay
collection PubMed
description This study sought to assess clinical characteristics and differences in outcomes between children with Methicillin-resistant Staphylococcus aureus (MRSA) and Methicillin-sensitive Staphylococcus aureus (MSSA) osteomyelitis or septic arthritis and whether initial antibiotic regimen affects patient outcomes. We analyzed records of children ages 15 days to 18 years admitted between 2009 and 2016 to two tertiary children’s hospitals who were diagnosed with an osteoarticular infection and had a microorganism identified. A total of 584 patients met inclusion criteria, of which 365 (62.5%) had a microbiological diagnosis. MSSA was the most common pathogen identified (45.5%), followed by MRSA (31.2%). Compared to MSSA, patients with MRSA had a higher initial C-reactive protein and longer hospitalization. Patients whose initial antibiotic regimens included vancomycin had a longer hospitalization than those initiated on clindamycin without vancomycin, even after removing sicker patients admitted to the pediatric intensive care unit. While MRSA was associated with increased severity of osteoarticular infections compared to MSSA, the incidence of MRSA has been declining at our institution. Patients with longer lengths of stay were more likely to be on vancomycin. Clindamycin should be considered in the initial antibiotic regimen for osteomyelitis and septic arthritis with ongoing surveillance of local microbiology and outcomes.
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spelling pubmed-71484572020-04-21 Declining Prevalence of Methicillin-Resistant Staphylococcus aureus Septic Arthritis and Osteomyelitis in Children: Implications for Treatment Weiss, Lindsay Lansell, Amanda Figueroa, Janet Suchdev, Parminder S. Kirpalani, Anjali Antibiotics (Basel) Article This study sought to assess clinical characteristics and differences in outcomes between children with Methicillin-resistant Staphylococcus aureus (MRSA) and Methicillin-sensitive Staphylococcus aureus (MSSA) osteomyelitis or septic arthritis and whether initial antibiotic regimen affects patient outcomes. We analyzed records of children ages 15 days to 18 years admitted between 2009 and 2016 to two tertiary children’s hospitals who were diagnosed with an osteoarticular infection and had a microorganism identified. A total of 584 patients met inclusion criteria, of which 365 (62.5%) had a microbiological diagnosis. MSSA was the most common pathogen identified (45.5%), followed by MRSA (31.2%). Compared to MSSA, patients with MRSA had a higher initial C-reactive protein and longer hospitalization. Patients whose initial antibiotic regimens included vancomycin had a longer hospitalization than those initiated on clindamycin without vancomycin, even after removing sicker patients admitted to the pediatric intensive care unit. While MRSA was associated with increased severity of osteoarticular infections compared to MSSA, the incidence of MRSA has been declining at our institution. Patients with longer lengths of stay were more likely to be on vancomycin. Clindamycin should be considered in the initial antibiotic regimen for osteomyelitis and septic arthritis with ongoing surveillance of local microbiology and outcomes. MDPI 2020-02-28 /pmc/articles/PMC7148457/ /pubmed/32121093 http://dx.doi.org/10.3390/antibiotics9030101 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Weiss, Lindsay
Lansell, Amanda
Figueroa, Janet
Suchdev, Parminder S.
Kirpalani, Anjali
Declining Prevalence of Methicillin-Resistant Staphylococcus aureus Septic Arthritis and Osteomyelitis in Children: Implications for Treatment
title Declining Prevalence of Methicillin-Resistant Staphylococcus aureus Septic Arthritis and Osteomyelitis in Children: Implications for Treatment
title_full Declining Prevalence of Methicillin-Resistant Staphylococcus aureus Septic Arthritis and Osteomyelitis in Children: Implications for Treatment
title_fullStr Declining Prevalence of Methicillin-Resistant Staphylococcus aureus Septic Arthritis and Osteomyelitis in Children: Implications for Treatment
title_full_unstemmed Declining Prevalence of Methicillin-Resistant Staphylococcus aureus Septic Arthritis and Osteomyelitis in Children: Implications for Treatment
title_short Declining Prevalence of Methicillin-Resistant Staphylococcus aureus Septic Arthritis and Osteomyelitis in Children: Implications for Treatment
title_sort declining prevalence of methicillin-resistant staphylococcus aureus septic arthritis and osteomyelitis in children: implications for treatment
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7148457/
https://www.ncbi.nlm.nih.gov/pubmed/32121093
http://dx.doi.org/10.3390/antibiotics9030101
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