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154 CHANGING PATTERNS OF ACUTE HEMATOGENOUS OSTEOMYELITIS AND SEPTIC ARTHRITIS FOLLOWING THE EMERGENCE OF METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS IN A COMMUNITY
  1. D. Elias,
  2. S. R Arnold
  1. Memphis, TN.

Abstract

Following the emergence of MRSA infections in our community in 2001-2002, we noted an increase in the incidence and severity of acute hematogenous osteomyelitis and septic arthritis episodes in children. We reviewed the records of patients discharged from our pediatric hospital with these diagnoses over the period 2000-2003. All MRSA infections were community rather than hospital onset. Twenty-seven (26%) of 104 infections were due to MSRA, 26 (96%) occurring during the 2002 and 2003. From 2000 to 2002 the average number of bone and joint infections per year was 18, increasing to 48 in 2003. Although the proportion of infections due to methicillin-susceptible S. aureus remained constant (11-28%) over the study period, the proportion due to MRSA rose from 4% in 2000 to 42% in 2003. Patients with MRSA infections suffered a more severe clinical course compared with those with non-MRSA infections: 72% of MRSA patients had a subperiosteal abscess versus 24% of non- MRSA patients (p < .0001). Surgery was required in 85% of MRSA patients versus 45% of non-MRSA patients (p = .0003). Multiple surgical procedures were needed to control infection in 14 patients, 11 of whom had MRSA infections. The median hospital stay was 7 days for non-MRSA and 11 days for MRSA patients (p < .0001). 55% of patients with MRSA infections had a complicated clinical course (severe sepsis, multifocal osteomyelitis, endocarditis, septic thrombophlebitis, regional abscess) compared to 23% of non-MRSA patients. The majority of MRSA infections were successfully treated with clindamycin. As a result of this concerning trend, we have changed empiric therapy for these infections to clindamycin. In addition, we have a low threshold for performing an MRI to assess for subperiosteal or other regional abscess.

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