Severe Bone Infection from MRSA Needs Aggressive Treatment
One of the so-called super-bugs, MRSA (methicillin-resistant Staphylococcus aureus, is one of the most common causes of bone infections, called osteomyelitis, as well as other infections in the musculoskeletal system of children. MRSA is very difficult to treat with antibiotics, compared with methicillin-sensitive, Staphylococcus aureus (MSSA). Infections with MRSA usually result in longer hospital stays and poorer outcomes.
The authors of this article wanted to investigate the differences between MRSA infections and others. To do this, they reviewed 97 records of children (aged four months to 19 years) who had varying types of osteomyelitis to find out information such as how long the children were sick, how sick they were, how long it took them to recover, and if there were any lasting effects from the infection.
The researchers found that 21 of the patients had infections caused by MRSA, 27 by MSSA, 34 by another cause, and 15 didn't have an infection. When children had osteomyelitis, the ones who were infected with MRSA had significantly worse infections than those with MSSA or other bacteria. The severity was judged by taking the children's temperature, checking the length of the hospital stay, blood test findings, surgery if needed, how often they had to be hospitalized, and the number of antibiotics and how long they had to be taken.
The children with MRSA infections usually had higher fevers, longer hospital stays, and more initial treatments. However, there wasn't a big difference between them in terms of the number of antibiotics and how long they were taken or in the number of times they were admitted to the hospital. One child with MRSA infection, a three-year-old, died after receiving several treatments with antibiotics.
The authors wrote that around 60 percent of staphylococcal infections in the United States are MRSA and that it's known that MRSA infections are more severe than MSSA or other bacterial infections. This is even more so if the infection is hospital-acquired. Earlier studies have weighed in on both sides though - some found that people with MRSA osteomyelitis were sicker than those with MSSA, but other studies didn't. As well, some studies found that there wasn't a significant difference between the number of people with MRSA who died compared with those with MSSA.
Diagnosing osteomyelitis MRSA versus another type can be done by blood in about 60 percent of patients but by taking specimens from the infection itself, the rate is about 80 percent. Some doctors feel that surgery is the best way to diagnose and can be used to start treatment at the same time.
Treating osteomyelitis usually starts with removing the dead or necrotic tissue. The area is usually irrigated or washed out, as well. Intravenous antibiotics are called for and this may be for as long as almost six weeks. However, the antibiotic may be switched to pill form after a while, depending on the progress of the treatment and the doctor's usual treatment. Sometimes, further surgery is needed, but that's not a usual next step. In fact, of the children studied, the 35 who were from the Children's Hospital, didn't have any surgery other than the original biopsy for the diagnosis.
In conclusion, the authors wrote that they did have a strong association between MRSA infections and lengthier and more difficult treatments. They recommend that if a child's biopsy comes back as positive for MRSA, that aggressive treatment begin immediately.
John J. Hawkshead III, MPH, et al. Comparative Severity of Pediatric Osteomyelitis Attributable to Methicillin-Resistant Versus Methicillin-Sensitive Staphylococcus aureus. In Journal of Pediatric Orthopaedics January/February 2009. Vol. 29, No. 1. Pp. 85-90.