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Published on: December 3, 2017
Staphylococcus aureus pyomyositis compared with non-Staphylococcus aureus pyomyositis
Steven D Burdette1, Richard R Watkins, Ken K Wong
1Department of Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH 45409, United States. burdette08@gmail.com
Objectives:
Pyomyositis is an acute bacterial infection of skeletal muscle not arising from contiguous infection. It is often hematogenous in origin and typically associated with abscess formation. Our objective was to determine if there were any differences in the clinical presentation of disease between Staphylococcus aureus (SA) and non-Staphylococcus aureus pyomyositis. We also sought to determine if methicillin-resistant SA (MRSA) occurred more frequently during the final years of the study period.
Methods:
A retrospective chart review study at three institutions in two cities.
Results:
Sixty cases of pyomyositis were identified between 1990 and 2010. Twenty-nine patients were infected with SA while 31 had other bacterial etiologies or were culture negative. Those with a traumatic event prior to the onset of infection were more likely to have a SA infection while SA infected patients were younger. Our first documented case of MRSA occurred in 2005, but the frequency of MRSA infection remained static over the following five years.
Conclusions:
Pyomyositis is an emerging infection that is underappreciated by many physicians. While MRSA has emerged as the foremost cause of SA infections in a majority of clinical conditions, in this series most patients still had methicillin-sensitive SA as their cause of pyomyositis. In light of the severity of pyomyositis and the potential for bacteremia (either as a source or complication of the infection), empiric SA therapy should be initiated in all patients until the culture results are available.
Insights
Pyomyositis, a bacterial skeletal muscle infection, presents differently based on the pathogen. While methicillin-resistant Staphylococcus aureus (MRSA) is emerging, methicillin-sensitive Staphylococcus aureus remains a common cause of pyomyositis.
Area of Science:
- Infectious Diseases
- Bacteriology
- Musculoskeletal Infections
Background:
- Pyomyositis is an acute bacterial infection of skeletal muscle, often originating from hematogenous spread and typically involving abscess formation.
- It is crucial to understand the clinical nuances between different causative agents, particularly Staphylococcus aureus (SA), and the evolving landscape of antibiotic resistance.
Purpose of the Study:
- To compare the clinical presentation of pyomyositis caused by Staphylococcus aureus versus non-Staphylococcus aureus pathogens.
- To investigate the incidence and frequency of methicillin-resistant Staphylococcus aureus (MRSA) pyomyositis over time.
Main Methods:
- A retrospective chart review was conducted across three institutions in two cities.
- Data from sixty pyomyositis cases identified between 1990 and 2010 were analyzed.
Main Results:
- Of the sixty cases, 29 were attributed to Staphylococcus aureus (SA) and 31 to other bacterial etiologies or were culture-negative.
- Patients with a history of trauma were more likely to have SA pyomyositis, and SA-infected patients were generally younger.
- The first MRSA case was documented in 2005, with no significant increase in its frequency in the subsequent five years.
Conclusions:
- Pyomyositis is an underrecognized emerging infection with potential for severe complications like bacteremia.
- Despite the rise of MRSA in other conditions, methicillin-sensitive SA remains a significant cause of pyomyositis.
- Empirical SA treatment is recommended for all pyomyositis patients until culture results are available.
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