Hematogenous Osteomyelitis

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 etiologies 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 increased 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.

Consultant 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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