Predictors of Methicillin-resistant Staphylococcus aureus infection in children with acute osteomyelitis.


Journal

Italian journal of pediatrics
ISSN: 1824-7288
Titre abrégé: Ital J Pediatr
Pays: England
ID NLM: 101510759

Informations de publication

Date de publication:
10 Oct 2024
Historique:
received: 02 07 2024
accepted: 22 09 2024
medline: 11 10 2024
pubmed: 11 10 2024
entrez: 10 10 2024
Statut: epublish

Résumé

This study aims to identify risk factors associated with Methicillin-resistant Staphylococcus aureus (MRSA) infection in children diagnosed with acute osteomyelitis (AO) and to elucidate the laboratory characteristics of these MRSA-infected children to enhance early targeted therapeutic interventions. We conducted a retrospective analysis involving 123 children with acute osteomyelitis treated at our hospital. Upon admission, we measured white blood cell (WBC) counts, C-reactive protein (CRP) levels, erythrocyte sedimentation rates (ESR), and platelet counts. Patients were categorized into two groups: the non-MRSA group (n = 73) and the MRSA group (n = 50), with values assigned as follows (non-MRSA group = 0, MRSA group = 1). The MRSA group had a significantly higher average age compared to the non-MRSA group (P < 0.05). Notably, the incidence of suppurative arthritis was significantly lower in the MRSA group (P < 0.05). At the time of admission, CRP levels in the MRSA group were markedly elevated compared to those in the non-MRSA group (P < 0.01). After three days of empirical therapy, both WBC and CRP levels remained significantly higher in the MRSA group compared to the non-MRSA group (P < 0.05). In children newly admitted with acute osteomyelitis, a CRP level exceeding 73.23 µg/mL may indicate a high likelihood of MRSA infection. For children with AO who have been hospitalized for three days on empirical therapy, the presence of WBC > 10.95 × 10^9/L, CRP > 49.56 µg/mL, age > 3.5 years, and the absence of suppurative arthritis suggests a heightened risk of MRSA infection.

Sections du résumé

BACKGROUND BACKGROUND
This study aims to identify risk factors associated with Methicillin-resistant Staphylococcus aureus (MRSA) infection in children diagnosed with acute osteomyelitis (AO) and to elucidate the laboratory characteristics of these MRSA-infected children to enhance early targeted therapeutic interventions.
METHODS METHODS
We conducted a retrospective analysis involving 123 children with acute osteomyelitis treated at our hospital. Upon admission, we measured white blood cell (WBC) counts, C-reactive protein (CRP) levels, erythrocyte sedimentation rates (ESR), and platelet counts. Patients were categorized into two groups: the non-MRSA group (n = 73) and the MRSA group (n = 50), with values assigned as follows (non-MRSA group = 0, MRSA group = 1).
RESULTS RESULTS
The MRSA group had a significantly higher average age compared to the non-MRSA group (P < 0.05). Notably, the incidence of suppurative arthritis was significantly lower in the MRSA group (P < 0.05). At the time of admission, CRP levels in the MRSA group were markedly elevated compared to those in the non-MRSA group (P < 0.01). After three days of empirical therapy, both WBC and CRP levels remained significantly higher in the MRSA group compared to the non-MRSA group (P < 0.05).
CONCLUSIONS CONCLUSIONS
In children newly admitted with acute osteomyelitis, a CRP level exceeding 73.23 µg/mL may indicate a high likelihood of MRSA infection. For children with AO who have been hospitalized for three days on empirical therapy, the presence of WBC > 10.95 × 10^9/L, CRP > 49.56 µg/mL, age > 3.5 years, and the absence of suppurative arthritis suggests a heightened risk of MRSA infection.

Identifiants

pubmed: 39390563
doi: 10.1186/s13052-024-01780-0
pii: 10.1186/s13052-024-01780-0
doi:

Substances chimiques

C-Reactive Protein 9007-41-4
Anti-Bacterial Agents 0

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

212

Informations de copyright

© 2024. The Author(s).

Références

Le Saux N. Diagnosis and management of acute osteoarticular infections in children.Paediatr. Child Health. 2018;23(5):336–43. Epub 2018 Jul 18.
Arnold JC, Bradley JS. Osteoarticular infections in children. Infect DisClin North Am. 2015;29(3):557–74.
doi: 10.1016/j.idc.2015.05.012
Chiappini E, Camposampiero C, Lazzeri S, Indolfi G, De Martino M, Galli L. Epidemiology and management of Acute Haematogenous Osteomyelitis in a Tertiary Paediatric Center. Int J Environ Res Public Health. 2017;14(5):477.
doi: 10.3390/ijerph14050477 pubmed: 28471400 pmcid: 5451928
Jaramillo D, Dormans JP, Delgado J, Laor T, St Geme. JW 3rd. Hematogenous Osteomyelitis in infants and children: imaging of a changing disease. Radiology. 2017;283(3):629–43.
doi: 10.1148/radiol.2017151929 pubmed: 28514223
Sukswai P, Kovitvanitcha D, Thumkunanon V, Chotpitayasunondh T, Sangtawesin V, Jeerathanyasakun Y. Acute hematogenous osteomyelitis and septic arthritis in children: clinical characteristics and outcomes study. J Med Assoc Thai. 2011;94(Suppl 3):S209–16.
pubmed: 22043778
Safdieh G, Silberman J, Nguyen J, Doyle SM, Blanco JS, Scher DM, Green DW, Widmann RF, Dodwell ER. Pediatric Septic Arthritis and Osteomyelitis in the USA: A National KID Database Analysis. HSS J. 2019;15(2):159–66.
doi: 10.1007/s11420-018-9644-2 pubmed: 31327948
Song KM, Sloboda JF. Acute hematogenous osteomyelitis in children. J Am AcadOrthop Surg 2001 May-Jun;9(3):166–75.
Yeo A, Ramachandran M. Acute haematogenous osteomyelitis in children. BMJ. 2014;348:g66.
doi: 10.1136/bmj.g66 pubmed: 24446020
Alex L, Gornitzky AE, Kim, Jennifer M, O’Donnell, et al. Diagnosis and management of Osteomyelitis in children :a critical analysis review. JBJS Rev. 2020;8(6):e1900202.
doi: 10.2106/JBJS.RVW.19.00202
Thakolkaran N, Shetty AK. Acute hematogenous osteomyelitis in children.Ochsner J. 2019 Summer;19(2):116–22.
Chalmers SJ. WylamME.Methicillin-Resistant Staphylococcus aureus infection and treatment options. Methods Mol Biol. 2020;2069:229–51.
doi: 10.1007/978-1-4939-9849-4_16 pubmed: 31523777
Cheng Y, Zhang Y, Zhao Z, Li G, Li J, Li A, Xue Y, Zhu B, Wu Z, Zhang X. Guanidinium-decorated nanostructure for Precision Sonodynamic-Catalytic Therapy of MRSA-Infected Osteomyelitis. Adv Mater. 2022;34(50):e2206646.
doi: 10.1002/adma.202206646 pubmed: 36245331
Peltola H, Pääkkönen M. Acute osteomyelitis in children. N Engl J Med. 2014;370(4):352–60.
doi: 10.1056/NEJMra1213956 pubmed: 24450893
Diagnosis. and Treatment of neonatal sepsis. Chin J Pediatr, 2003; 41(12).
Liu Y, Zhao K, Liu Y, Sun YH, Li MX, Yu M, Zhu LQ, Wang XD. Bone and joint infection complicated with sepsis in neonates and infants under three months of age. J Pediatr (Rio J). 2023 Oct;12:S0021. 7557(23)00116-X.
Theologis T, Brady MA, Hartshorn S, Faust SN, Offiah AC. Diagnosing acute bone and joint infection in children. Bone Joint J. 2023;105–B(3):227–9.
doi: 10.1302/0301-620X.105B3.BJJ-2022-1179.R1 pubmed: 36876449
Dodwell ER. Osteomyelitis and septic arthritis in children: current concepts. CurrOpinPediatr. 2013;25(1):58–63.
Dartnell J, Ramachandran M, Katchburian M. Haematogenous acute and subacutepaediatric osteomyelitis: a systemic review of the literature. J Bone Joint Surg Br. 2012;94(5):584–95.
doi: 10.1302/0301-620X.94B5.28523 pubmed: 22529075
Peltola H, Pääkkönen M, Kallio P, Kallio MJ, Osteomyelitis-Septic Arthritis Study Group. Short-versus long-term antimicrobial treatment for acute hematogenous osteomyelitis of childhood: prospective, randomized trial on 131 culture-positive cases. Pediatr Infect Dis J. 2010;29(12):1123–8.
doi: 10.1097/INF.0b013e3181f55a89 pubmed: 20842069
Kaplan SL. Recent lessons for the management of bone and joint infections. JInfect. 2014;68Suppl(1):51–6. https://doi.org/10.1016/j.jinf.2013.09.014
doi: 10.1016/j.jinf.2013.09.014
DohinB, Gillet Y, Kohler R, et al. Pediatric bone and joint infections caused by Panton-Valentine leukocidin-positive Staphylococcus aureus. Pediatr Infect Dis J. 2007;26(11):1042–8.
doi: 10.1097/INF.0b013e318133a85e pubmed: 17984813
Roine I, Faingezicht I, Arguedas A, Herrera JF, Rodríguez F. Serial serum C-reactive protein to monitor recovery from acute hematogenous osteomyelitis in children. Pediatr Infect Dis J. 1995;14(1):40–4.
doi: 10.1097/00006454-199501000-00008 pubmed: 7715988
Saavedra-Lozano J, Falup-Pecurariu O, Faust SN, Girschick H, Hartwig N, Kaplan S, et al. Bone and joint infections. Pediatr Infect Dis J. 2017;36:788–99.
doi: 10.1097/INF.0000000000001635 pubmed: 28708801
Russell CD, Ramaesh R, Kalima P, Murray A, Gaston MS. Microbiological characteristics of acute osteoarticular infections in children. J Med Microbiol. 2015;64:446–53.
doi: 10.1099/jmm.0.000026 pubmed: 25596125
Arnold JC, Bradley JS. Osteoarticular infections in children. Infect Dis Clin N Am. 2015;29:557–74.
doi: 10.1016/j.idc.2015.05.012
Shusterman N, Kimmel PL, Kiechle FL, et al. Factors influencing erythrocyte sedimentation in patients with chronic renal failure. Arch Intern Med. 1985;145:1796–9.
doi: 10.1001/archinte.1985.00360100056007 pubmed: 4037939
Fincher RM, Page MI. Clinical significance of extreme elevation of the erythrocyte sedimentation rate. Arch Intern Med. 1986;146:1581–3.
doi: 10.1001/archinte.1986.00360200151024 pubmed: 3729639

Auteurs

Kang Wang (K)

Department of Orthopedics, Children's Hospital of Hebei Province, No. 133 Jianhua South Street, Shijiazhuang City, Hebei Province, China. wangkang5@126.com.

Chen Wang (C)

Department of Orthopedics, Children's Hospital of Hebei Province, No. 133 Jianhua South Street, Shijiazhuang City, Hebei Province, China.

Hua Zhu (H)

Department of Orthopedics, Children's Hospital of Hebei Province, No. 133 Jianhua South Street, Shijiazhuang City, Hebei Province, China.

Yan Zou (Y)

Department of Orthopedics, Children's Hospital of Hebei Province, No. 133 Jianhua South Street, Shijiazhuang City, Hebei Province, China.

Yanhua Feng (Y)

Department of Orthopedics, Children's Hospital of Hebei Province, No. 133 Jianhua South Street, Shijiazhuang City, Hebei Province, China.

Fang Zhang (F)

Department of Orthopedics, Children's Hospital of Hebei Province, No. 133 Jianhua South Street, Shijiazhuang City, Hebei Province, China.

Yi Qu (Y)

Scientific Research Department, Children's Hospital of Hebei Province, Shijiazhuang, Hebei, China.

Yiren Tian (Y)

Department of Orthopedics, Children's Hospital of Hebei Province, No. 133 Jianhua South Street, Shijiazhuang City, Hebei Province, China.

Articles similaires

[Redispensing of expensive oral anticancer medicines: a practical application].

Lisanne N van Merendonk, Kübra Akgöl, Bastiaan Nuijen
1.00
Humans Antineoplastic Agents Administration, Oral Drug Costs Counterfeit Drugs

Smoking Cessation and Incident Cardiovascular Disease.

Jun Hwan Cho, Seung Yong Shin, Hoseob Kim et al.
1.00
Humans Male Smoking Cessation Cardiovascular Diseases Female
Humans United States Aged Cross-Sectional Studies Medicare Part C
1.00
Humans Yoga Low Back Pain Female Male

Classifications MeSH