Young TP, Maas L, Thorp AW, Brown L. Etiology of septic arthritis in children: an
update for the new millennium. Am J Emerg Med. 2011 Oct;29(8):899-902. Epub
2010 Aug 1. PubMed PMID: 20674219.
-Septic arthritis still occurs in hip and knee
-MRSA freq increasing
Saavedra-Lozano J, Mejías A, Ahmad N, Peromingo E, Ardura MI, Guillen S, Syed A,
Cavuoti D, Ramilo O. Changing trends in acute osteomyelitis in children:impact of
methicillin-resistant Staphylococcus aureus infections. J Pediatr Orthop. 2008 JulAug;28(5):569-75. PubMed PMID: 18580375.
-Osteomyelitis from MRSA increasing
-MRSA = worse severity
-Dallas TX from 1999-2003
-290 kids with osteo
-Foot, then femur, then tibia
-MRSA in 23%, increased from 6% to 31%
-DVT in 11% with MRSA, 4% with MSSA (not sig)
-MRSA osteo had sig. more bone abscess and dissemination
-Data on presenting labs and exam for period 1999-2001 vs 2001-2003
Harik NS, Smeltzer MS. Management of acute hematogenous osteomyelitis in
children. Expert Rev Anti Infect Ther. 2010 Feb;8(2):175-81. Review. PubMed
PMID:20109047; PubMed Central PMCID: PMC2836799.
-Review of dx and tx of osteo with respect to MRSA
Ju KL, Zurakowski D, Kocher MS. Differentiating between methicillin-resistant and
methicillin-sensitive Staphylococcus aureus osteomyelitis in children: an evidencebased clinical prediction algorithm. J Bone Joint Surg Am. 2011 Sep 21;93(18):1693701. PubMed PMID: 21938373.
-Differentiating MSSA vs MRSA
-Fever, Hct <34, CRP >13 and WBC >12
Hawkshead JJ 3rd, Patel NB, Steele RW, Heinrich SD. Comparative severity of
pediatric osteomyelitis attributable to methicillin-resistant versus methicillinsensitive Staphylococcus aureus. J Pediatr Orthop. 2009 Jan-Feb;29(1):85-90.
PubMed PMID: 19098653.
-MRSA produces more severe infection
-New Orleans
-97 kids with osteo
-MRSA osteo was more severe than MSSA osteo (longer stay and more surgical
procedures)
-Didn’t look at complications
Jackson MA, Nelson JD. Etiology and medical management of acute suppurative bone
and joint infections in pediatric patients. J Pediatr Orthop. 1982 Aug;2(3):313-23.
Review. PubMed PMID: 6752200.
-Review from prior to MRSA
Martínez-Aguilar G, Avalos-Mishaan A, Hulten K, Hammerman W, Mason EO Jr,
Kaplan SL. Community-acquired, methicillin-resistant and methicillin-susceptible
Staphylococcus aureus musculoskeletal infections in children. Pediatr Infect Dis J.
2004 Aug;23(8):701-6. PubMed PMID: 15295218.
-MRSA increased fever, hospital days and complications
Arnold SR, Elias D, Buckingham SC, Thomas ED, Novais E, Arkader A, Howard
C.Changing patterns of acute hematogenous osteomyelitis and septic
arthritis:emergence of community-associated methicillin-resistant Staphylococcus
aureus. J Pediatr Orthop. 2006 Nov-Dec;26(6):703-8. PubMed PMID: 17065930
-Emergence of MRSA, increase 4-40%
-Le Bonheur 2000-2004
-Osteo and septic arthritis
-Incidence of MRSA increased over that time period
-Incidence of osteo increased over the course of the study
-MRSA infections stayed longer and had subperiosteal abscesses more frequently
Gutierrez K. Bone and joint infections in children. Pediatr Clin North Am.2005
Jun;52(3):779-94, vi. Review. PubMed PMID: 15925662.
-Review of bone and joint infections in children
-Increasing incidence of MRSA
Dartnell J, Ramachandran M, Katchburian M. Haematogenous acute and subacute
paediatric osteomyelitis: a systematic review of the literature. J Bone Joint Surg Br.
2012 May;94(5):584-95. Review. PubMed PMID: 22529075.
-SA still most common, but isolates of klingella increasing
Mantadakis E, Plessa E, Vouloumanou EK, Michailidis L, Chatzimichael A,
Falagas ME. Deep venous thrombosis in children with musculoskeletal infections:
the clinical evidence. Int J Infect Dis. 2012 Apr;16(4):e236-43. Epub 2012 Feb 22.
Review. PubMed PMID: 22361432.
-Boys >Girls dvT
-complications of MSI DVT. SPE. Pulm Involvement
-MRSA >MSSA
Hollmig ST, Copley LA, Browne RH, Grande LM, Wilson PL. Deep venous thrombosis
associated with osteomyelitis in children. J Bone Joint Surg Am. 2007
Jul;89(7):1517-23. PubMed PMID: 17606791.
-dVT more likely in kids >8
-More likely with MRSa and CRP >6
Bouchoucha S, Benghachame F, Trifa M, Saied W, Douira W, Nessib MN, Ghachem
MB. Deep venous thrombosis associated with acute hematogenous osteomyelitis in
children. Orthop Traumatol Surg Res. 2010 Dec;96(8):890-3. Epub 2010 Sep 15.
PubMed PMID: 20833120.
-Children with MRSA worse outcomes, more DVT
Crary SE, Buchanan GR, Drake CE, Journeycake JM. Venous thrombosis and
thromboembolism in children with osteomyelitis. J Pediatr. 2006
Oct;149(4):537-41. PubMed PMID: 17011328.
-35 kids with osteo, 10 with DVT, only 1 without DVT without severe complications
Blyth MJ, Kincaid R, Craigen MA, Bennet GC. The changing epidemiology of acute and
subacute haematogenous osteomyelitis in children. J Bone Joint Surg Br. 2001
Jan;83(1):99-102. PubMed PMID: 11245548.
-Glasgow 1990-1997
-Osteo incidence decreased in this region by 44%
Craigen MA, Watters J, Hackett JS. The changing epidemiology of osteomyelitis in
children. J Bone Joint Surg Br. 1992 Jul;74(4):541-5. PubMed PMID: 1624513.
-Glasgow 1970-1990
-Incidence of osteo decreased by 50%
Gillespie WJ. The epidemiology of acute haematogenous osteomyelitis of childhood.
Int J Epidemiol. 1985 Dec;14(4):600-6. PubMed PMID: 4086146.
-Osteo in New Zealand, Australia, UK generally declining at that time
Gonzalez BE, Teruya J, Mahoney DH Jr, Hulten KG, Edwards R, Lamberth LB,
Hammerman WA, Mason EO Jr, Kaplan SL. Venous thrombosis associated with
staphylococcal osteomyelitis in children. Pediatrics. 2006 May;117(5):1673-9.
PubMed PMID: 16651323.
-9 cases in Texas of DVT associated with osteo
-7/9 had MRSA
-7/9 had PVL
-5/9 had no hypercoagulability
-4 patients had septic emboli
-2 had CVLs
-USA300 version of MRSA
Chang FY, MacDonald BB, Peacock JE Jr, Musher DM, Triplett P, Mylotte JM,
O'Donnell A, Wagener MM, Yu VL. A prospective multicenter study of
Staphylococcus aureus bacteremia: incidence of endocarditis, risk factors for
mortality, and clinical impact of methicillin resistance. Medicine (Baltimore). 2003
Sep;82(5):322-32. PubMed PMID: 14530781.
-Adults
-Over 500 subjects, multicenter, largest number of staph bacteremia
-Endocarditis had higher mortality when due to MRSA
-MRSA was more commonly hospital acquired
Kuhfahl KJ, Fasano C, Deitch K. Scapular abscess, septic emboli, and deep vein
thrombosis in a healthy child due to community-acquired methicillin-resistant
Staphylococcus aureus: case report. Pediatr Emerg Care. 2009 Oct;25(10):677-80.
PubMed PMID: 19834418.
-Case report in philly of a kid who had osteo, DVT, deep scapular abscess and septic
emboli without cutaneous abscess
-Good review of cases out there with septic emboli and DVT as a complication of
staph osteo
Gorenstein A, Gross E, Houri S, Gewirts G, Katz S. The pivotal role of deep vein
thrombophlebitis in the development of acute disseminated staphylococcal disease
in children. Pediatrics. 2000 Dec;106(6):E87. PubMed PMID: 11099630.
-3 cases of DVT and disseminated staph
-2 of 3 were MRSA
Nourse C, Starr M, Munckhof W. Community-acquired methicillin-resistant
Staphylococcus aureus causes severe disseminated infection and deep venous
thrombosis in children: literature review and recommendations for management. J
Paediatr Child Health. 2007 Oct;43(10):656-61. Epub 2007 Jun 29. Review. PubMed
PMID: 17608655.
-4 children in Australia with MRSA osteo, PNA, DVT and septic emboli
Karwowska A, Davies HD, Jadavji T. Epidemiology and outcome of osteomyelitis in
the era of sequential intravenous-oral therapy. Pediatr Infect Dis J. 1998
Nov;17(11):1021-6. PubMed PMID: 9849986.
-146 kids with osteo in Calgary from 1984-1996
-S. aureus most common, no H. Flu after 1990
-Tibia, then femur, then calcaneus
-Followed 137 subjects by chart only
-no DVT reported
Yüksel H, Ozgüven AA, Akil I, Ergüder I, Yilmaz D, Cabuk M. Septic pulmonary emboli
presenting with deep venous thrombosis secondary to acute osteomyelitis. Pediatr
Int. 2004 Oct;46(5):621-3. PubMed PMID: 15491398.
-Case report in Turkey of osteo, DVT and SPE
-Does not mention if it was MRSA
Jones NS, Anderson DJ, Stiles PJ. Osteomyelitis in a general hospital: a five-year
study showing an increase in subacute osteomyelitis. J Bone and Joint Surg [Br]
1987; 69-B :779-83.
-Increase in subacute OM leads to increased complications 2/2 longer time to
diagnosis