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Antibiotic Resistant Staph Infection in Children

Posted on: 08/21/2008
You may have heard how the overuse of antibiotics has led to bacteria that is resistant to most antibiotics. In the hospitals, this has been a major concern. Patients admitted are often already at risk for infection. And hospitals are a breeding ground for many infections.

These are referred to as hospital-acquired infections. Methicillin-resistant Staphylococcus aureus (MRSA) is the most important cause of hospital-acquired infections. S. aureus is a bacteria known by its shorter, abbreviated form: staph infection.

MRSA refers to the fact that S. aureus is resistant to most penicillins. For a long time, Methicillin (a penicillin derivative) was the only drug that could combat this infection. Eventually the staph bacteria became resistant to Methicillin.

Methicillin is no longer on the market but the term MRSA is still used. Other similar drugs (e.g., flucloxacillin, dicloxacillin, clindamycin) are now in use instead. If staph becomes resistant to all antibiotics, there may be no way to treat simple infections.

Now it appears that MRSA is becoming a community-acquired infection. This is especially true for skin and soft tissue infections in children, which were rare before. This report investigates the changing pattern of MRSA acute osteomyelitis (bone infection) in children.

Investigators reviewed the records of children at the Children's Medical Center of Dallas over a five-year period of time. They divided the overall time period into two segments for comparison. They were looking for trends or changes in the clinical pattern of acute osteomyelitis in young children.

Data was collected about a wide range of possible factors (age, gender, results of lab work and bone scans), patient treatment, and patient outcomes. They noted that S. aureus affected the bones of the lower extremity (leg and pelvis) and spine (vertebrae) most often. Staph infection was more likely than other infections to affect multiple sites (not just one bone). This was true in both time periods.

Analysis of the data showed that MRSA increased dramatically between the two time periods (more cases over time). There were other bacterial causes of osteomyelitis (e.g., streptococcus, S. pneumoniae) but most were caused by MRSA. African American and older children were the most susceptible.

And children with MRSA osteomyelitis had worse symptoms, more complications, and longer treatment. They also had more frequent and longer periods of hospitalization. The authors suggest the poor outcome of MRSA osteomyelitis was linked with more significant complications.

Children with MRSA osteomyelitis were more likely to have blood clots, spread of infection, and extensive bone involvement with bone abscesses. Children with anemia at the time of the MRSA osteomyelitis also had a worse prognosis. A smaller number of children developed long-term complications. The most common was delayed bone growth.

And although there was an increase in the number of cases of acute osteomyelitis caused by MRSA, there was no change in the resistance patterns to antibiotics during the five-year period. However, children with MRSA osteomyelitis in the later years had a more severe case with worse outcomes.

Knowing that MRSA osteomyelitis is an increasing problem among children (especially among older African American children), there is a need for more investigation and better treatment. Finding the right antibiotic and providing treatment in the optimal amount of time may help prevent serious complications. The authors suggest multicenter studies to address this problem.

References:
Jesús Saavedra-Lozano, MD, PhD, et al. Changing Trends in Acute Osteomyelitis in Children: Impact of Methicillin-Resistant Staphylococcus aureus Infections. In Journal of Pediatric Orthopaedics. July/August 2008. Vol. 28. No. 5. Pp. 569-575.

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