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

1
Division of Hospital Medicine, Joe DiMaggio Children’s Hospital, Hollywood, FL 33021, USA
2
Pediatric Hospital Medicine, Rainbow Babies & Children’s Hospital, Cleveland, OH 44106, USA
3
Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA
4
Division of Hospital Medicine, Children’s Healthcare of Atlanta, Atlanta, GA 30322, USA
*
Author to whom correspondence should be addressed.
Antibiotics 2020, 9(3), 101; https://doi.org/10.3390/antibiotics9030101
Received: 26 December 2019 / Revised: 25 February 2020 / Accepted: 26 February 2020 / Published: 28 February 2020
(This article belongs to the Section Antibiotics Use and Antimicrobial Stewardship)
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. View Full-Text
Keywords: osteoarticular; bone and joint; microbiology; epidemiology; MRSA; MSSA; resistance trends; antimicrobial stewardship osteoarticular; bone and joint; microbiology; epidemiology; MRSA; MSSA; resistance trends; antimicrobial stewardship
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MDPI and ACS Style

Weiss, L.; Lansell, A.; Figueroa, J.; Suchdev, P.S.; Kirpalani, A. Declining Prevalence of Methicillin-Resistant Staphylococcus aureus Septic Arthritis and Osteomyelitis in Children: Implications for Treatment. Antibiotics 2020, 9, 101. https://doi.org/10.3390/antibiotics9030101

AMA Style

Weiss L, Lansell A, Figueroa J, Suchdev PS, Kirpalani A. Declining Prevalence of Methicillin-Resistant Staphylococcus aureus Septic Arthritis and Osteomyelitis in Children: Implications for Treatment. Antibiotics. 2020; 9(3):101. https://doi.org/10.3390/antibiotics9030101

Chicago/Turabian Style

Weiss, Lindsay, Amanda Lansell, Janet Figueroa, Parminder S. Suchdev, and Anjali Kirpalani. 2020. "Declining Prevalence of Methicillin-Resistant Staphylococcus aureus Septic Arthritis and Osteomyelitis in Children: Implications for Treatment" Antibiotics 9, no. 3: 101. https://doi.org/10.3390/antibiotics9030101

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