Declining Prevalence of Methicillin-Resistant Staphylococcus aureus Septic Arthritis and Osteomyelitis in Children: Implications for Treatment
Declining Prevalence of Methicillin-Resistant Staphylococcus aureus Septic Arthritis and Osteomyelitis in Children: Implications for Treatment
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DOI：
10.3390/antibiotics9030101
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发表时间：
2020-03-01
影响因子：
4.8
通讯作者：
Kirpalani, Anjali
中科院分区：
文献类型：
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作者：
Weiss, Lindsay;Lansell, Amanda;Kirpalani, Anjali
本研究旨在评估耐甲氧西林金黄色葡萄球菌（MRSA）和甲氧西林敏感金黄色葡萄球菌（MSSA）骨髓炎或脓毒性关节炎患儿的临床特征和结局差异，以及初始抗生素治疗方案是否影响患者结局。我们分析了2009年至2016年期间在两家三级儿童医院住院的15天至18岁儿童的记录，这些儿童被诊断患有骨关节感染并鉴定出微生物。共有584名患者符合入选标准，其中365名（62.5%）进行了微生物学诊断。MSSA是最常见的病原体（45.5%），其次是MRSA（31.2%）。与MSSA相比，MRSA患者的初始C反应蛋白较高，住院时间较长。初始抗生素方案包括万古霉素的患者比开始使用克林霉素而不使用万古霉素的患者住院时间更长，即使在排除了进入儿科重症监护室的病情较重的患者后。与MSSA相比，MRSA与骨关节感染的严重程度增加相关，但在我们的机构中，MRSA的发病率一直在下降。住院时间较长的患者更可能使用万古霉素。克林霉素应考虑在初始抗生素方案骨髓炎和脓毒性关节炎与当地的微生物学和结果进行持续监测。
This study sought to assess clinical characteristics and differences in outcomes between children with Methicillin-resistant Staphylococcus aureus (MRSA) and Methicillin-sensitive Staphylococcus aureus (MSSA) osteomyelitis or septic arthritis and whether initial antibiotic regimen affects patient outcomes. We analyzed records of children ages 15 days to 18 years admitted between 2009 and 2016 to two tertiary children's hospitals who were diagnosed with an osteoarticular infection and had a microorganism identified. A total of 584 patients met inclusion criteria, of which 365 (62.5%) had a microbiological diagnosis. MSSA was the most common pathogen identified (45.5%), followed by MRSA (31.2%). Compared to MSSA, patients with MRSA had a higher initial C-reactive protein and longer hospitalization. Patients whose initial antibiotic regimens included vancomycin had a longer hospitalization than those initiated on clindamycin without vancomycin, even after removing sicker patients admitted to the pediatric intensive care unit. While MRSA was associated with increased severity of osteoarticular infections compared to MSSA, the incidence of MRSA has been declining at our institution. Patients with longer lengths of stay were more likely to be on vancomycin. Clindamycin should be considered in the initial antibiotic regimen for osteomyelitis and septic arthritis with ongoing surveillance of local microbiology and outcomes.