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Community-acquired MRSA Causing Severe Complications Among Some Children.

Posted on: 12/10/2009
Methicillin-resistant Staphylococcus aureus, otherwise known as MRSA, has been making the news for the past few years because of its seemingly sudden presence everywhere. MRSA was once an infection that was only contracted within a hospital or institutional setting, but more people in the community have been diagnosed with it - so many so that there is a new name, community-acquired S. aureus, or CA-MRSA, while the original MRSA is often referred to now as HA-MRSA, or hospital-acquired MRSA.

As CA-MRSA becomes more common, it is found to be the major cause of infections in the skin, soft tissue, and necrotizing fasciitis, the so-called flesh-eating disease. At this point, CA-MRSA is the most common cause of musculoskeletal infections in children and its resistance to typical antibiotics makes it particularly difficult to treat.

There are certain factors that increase your risk of developing CA-MRSA. They include:

- using antibiotics within the previous year
- living in crowded living conditions
- broken skin or problems with skin
- participating in team sports

The authors of this article looked at children who had been diagnosed with CA-MRSA infections to evaluate their symptoms, treatment, progress, and outcomes. To do this, researchers reviewed the records of 27 children (nine girls), 23 of whom had infections in an arm or leg. All children had been healthy before sustaining a minor trauma or sports injury that led to the infection. The children came with complaints of chest wall pain (one child), neck pain (one child), pain in various parts (2 children), temperature of over 38.5 degrees Celsius (17 children), with six being over 40 degrees. Twelve of the children ended up being admitted to intensive care units.

Through the test results, the researchers found that three children had osteomyelitis (infection in the bone), one of whom had a fracture. Eleven children had pyomyositis(infection in the muscle), and six had subperiosteal abscesses (abscess in the bone). Medical complications in seven children included septic pulmonary emboli (infected clots in the lungs) and deep vein thrombosis (blood clots in the veins). One child had DVT but without the signs that the others had. Six of the patients were treated for three to six months with the blood thinner warfarin and two had to have surgery to implant a special filter near the heart to prevent clots from traveling to and entering it.

The majority of the patients (16) were treated with the antibiotic vancomycin alone, nine received clindamycin, and two were given vancomycin along with linezolid. All the children had to undergo surgery to help clean out the wounds and the average hospital stay was a month long.

Complications included four patients having chronic (repeat) osteomyelitis, one child's elbow contracted, limiting the use of the arm. Another patients developed stiffness in the hip and another had to have a hip replacement because of the damage the infection did to his own joint. Finally, one other patient ended up with an amputation of the lower leg because of complications in the tibial bone.

The authors of this article wrote, "Given its rapid emergence, the orthopaedic surgeon needs to have a high level of suspicion for CA-MRSA infection." This is crucial to prevent such complications from occurring among those who are infected.

References:
Kelly L. Vander Have, MD, et al. Community-associated Methicillin-resistant Staphylococcus aureus in Acute Musculoskeletal Infection in Children: A Game Changer. In Journal of Pediatric Orthopedics. Dec. 2009. Vol. 29. No. 8. Pp. 927 to 931.

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