Issue: May 2006
May 01, 2006
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More aggressive initial treatment regimen needed for pediatric MRSA patients

Eleven percent of MRSA patients also have vascular complications and longer hospital stays.

Issue: May 2006
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A dramatic increase in community-acquired methicillin-resistant Staphylococcus aureus in pediatric patients has caused some centers to implement aggressive, initial antibiotic treatment.

Researchers discovered that 27 of 104 pediatric patients with acute hematogenous osteomyelitis or septic arthritis tested positive for community-acquired methicillin-resistant Staphylococcus aureus (MRSA). The investigators also found that MRSA patients had nearly double the complications and three times the rate of subperiosteal abscesses compared to patients without MRSA.

These cases require more complex treatment.

“You’ll end up having to do more surgeries to try to clear the infections, and multiple surgeries might be required,� William C. Warner Jr., MD, an orthopedist at the Campbell Clinic in Tennessee, said during his presentation at the American Academy of Orthopaedic Surgeons 73rd Annual Meeting.

“There is an increased risk of chronic osteomyelitis and vascular problems. It’s led us to change our initial treatment for our antibiotic recommendation. And so, our choice for antibiotics is clindamycin and sometimes vancomycin in our initial treatment for patients being treated for infection,� Warner said.

The investigators retrospectively reviewed the charts of patients treated between 2000 and 2003. The study included patients with positive blood cultures, positive physical exams or abnormal magnetic resonance images. The researchers excluded patients with trauma injuries and infections at previous surgical sites.

Of the 104 patients in the study, 27 had MRSA infections and 38 had non-MRSA infections. A comparison of these groups showed a 41% complication rate for MRSA patients vs. 21% in the non-MRSA cohort. Researchers also found that 72% of MRSA-infected patients had subperiosteal abscesses, while only 24% of the non-MRSA cases had the condition.

In addition, the MRSA patients stayed in the hospital longer (11 vs. 7 days) and more required surgery to resolve their infection (85% vs. 45%). If an initial surgery proved unsuccessful to clear the infection, more MRSA patients underwent multiple procedures (8% vs. 4%).

“Another interesting finding was that we had 11% vascular complications in the methicillin-resistant staph population,� Warner said.

The study not only showed the difficulty in treating these patients, but also illustrated an increase in pediatric MRSA cases. The researchers noted an average 18 cases of infection per year between 2000 and 2002. By the end of 2003, 48 patients had infections and nearly half of these were MRSA cases, Warner said.

“Somewhere around 2002, we had a significant increase [in infections], where almost half were related to methicillin-resistant staph infections,� he said.

To combat the rising number of MRSA cases, the center uses clindamycin as an initial antibiotic treatment. Still, Warner cautioned that some cases could also be resistant to this antibiotic and require additional testing.

“What can happen is you treat the infection for methicillin-resistant staph and you’ll do fine for about a week,� he said. “Then, they develop an additional resistance that's not checked for. They have another chronic problem and the infection [starts to] flare back up.�

For more information:

  • Warner WC, Elias DW, Arkader A, et al. Emergence of community acquired Methicillin resistant Staphylococcus aureus in a pediatric population. #510. Presented at the American Academy of Orthopaedic Surgeons 73rd Annual Meeting. March 22-26, 2006. Chicago.