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Community-acquired methicillin-resistant Staphylococcus aureus: a cause of musculoskeletal sepsis in children
1Department of Paediatric Orthopaedic Surgery, Starship Children's Hospital, Auckland, New Zealand.
Abstract:
Between August 1996 and August 1997, 130 children were admitted to our pediatric orthopaedic unit with Staphylococcus aureus musculoskeletal infection. Twenty-six of the 130 staphylococcal isolates were resistant to methicillin, an incidence of 20%. All but one of the infections, a femoral fixator-pin infection, were community-acquired. Twenty-two of the infections were superficial; however, there were four cases of deep musculoskeletal sepsis due to methicillin-resistant S. aureus. In areas where methicillin-resistant S. aureus is prevalent in the community, methicillin resistance should be considered in any overwhelming staphylococcal infection not responding to conventional antibiotics despite adequate surgical debridement.
Insights
Methicillin-resistant Staphylococcus aureus (MRSA) caused 20% of pediatric musculoskeletal infections, including deep sepsis. Consider MRSA in severe staphylococcal infections unresponsive to antibiotics.
Area of Science:
- Pediatric Orthopaedics
- Infectious Diseases
- Microbiology
Background:
- Staphylococcus aureus is a common cause of pediatric musculoskeletal infections.
- The prevalence of antibiotic resistance in S. aureus strains is a growing concern.
Observation:
- A 20% incidence of methicillin resistance was observed in S. aureus isolates from pediatric musculoskeletal infections over a one-year period.
- Most methicillin-resistant S. aureus (MRSA) infections were community-acquired and superficial, but four cases of deep sepsis occurred.
Findings:
- Twenty-six out of 130 pediatric S. aureus musculoskeletal infections (20%) were caused by methicillin-resistant strains.
- Deep musculoskeletal sepsis was identified in four patients with MRSA infections.
Implications:
- In communities with high MRSA prevalence, methicillin resistance should be suspected in severe staphylococcal infections.
- Treatment decisions for pediatric S. aureus musculoskeletal infections should consider local MRSA resistance patterns and clinical presentation.