Abstract
Osteoarticular infections (OSI) are a significant cause of hospitalizations and morbidity in young children. The pediatric patient with OSI presents unique challenges in diagnosis and management due to higher morbidity, effect on growth plate with associated long-lasting sequelae, and challenges in early identification and management. Methicillin-resistant Staphylococcus aureus (MRSA), first described in the 1960s, has evolved rapidly to emerge as a predominant cause of OSI in children, and therefore empiric treatment for OSI should include an antibiotic effective against MRSA. Characterizing MRSA strains can be done by antimicrobial susceptibility testing, detection of Panton–Valentine leukocidin (PVL) gene, staphylococcal cassette chromosome mec (SCCmec) typing, pulsed-field gel electrophoresis (PFGE), and multilocus sequence typing (MLST). Worldwide, community-onset methicillin-resistant staphylococcal disease is widespread and is mainly associated with a PVL-producing clone, ST8/USA300. Many studies have implied a correlation between PVL genes and more severe infection. We review MRSA OSI along with the pertinent aspects of its pathogenesis, clinical spectrum, diagnosis, and current guidelines for management.
Highlights
Staphylococcus aureus (S. aureus) is a major cause of bacterial infections in humans worldwide
The clinical spectrum of Methicillin-resistant Staphylococcus aureus (MRSA) osteoarticular infections in children can range from uncomplicated infection with minimal tenderness or redness in the extremity to MRSA bacteremia and disseminated disease presenting with signs of sepsis, such as fever, chills, hemodynamic instability, tachycardia, and hypotension
Short courses of antibiotics have not been evaluated in pediatric MRSA Osteoarticular infections (OSI), and further studies examining the successful use of shorter courses of IV and total antibiotic therapy in children with MRSA OSI are needed
Summary
Staphylococcus aureus (S. aureus) is a major cause of bacterial infections in humans worldwide. In the U.S, virulent community-associated MRSA (CA-MRSA) clones, characterized by the presence of the cytoxin Panton–Valentine leukocidin (PVL), have become increasingly common over the past several decades, spreading first in the community and later in healthcare facilities. This distinction between CA-MRSA and HA-MRSA is beginning to fade. S. aureus is the leading cause of skin/skin structure infections and osteoarticular infections (OSI) at most children’s hospitals, and MRSA has emerged as a common pathogen with more soft-tissue destruction, a rapid spread, and a higher mortality rate [6]. Infection is usually contained by the growth plate and the joint is spared unless the metaphysis is intracapsular
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