Related Experiment Video
Updated: Apr 16, 2026
Subcutaneous Infection of Methicillin Resistant Staphylococcus Aureus MRSA
Published on: February 9, 2011
Community-acquired Methicillin-resistant Staphylococcus aureus Musculoskeletal Infections: Emerging Trends Over the
Eric J Sarkissian1, Itai Gans, Melissa A Gunderson
1*Department of Orthopaedic Surgery, Stanford University Medical Center, Palo Alto, CA †Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD ‡Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA §Colorado Orthopedic Consultants, Aurora, CO.
Background:
The emergence of community-acquired methicillin-resistant Staphylococcus aureus (MRSA) has altered the management of pediatric musculoskeletal infections. Yet, institution-to-institution differences in MRSA virulence may exist, suggesting a need to carefully examine local epidemiological characteristics. The purpose of this study was to compare MRSA and methicillin-sensitive S. aureus (MSSA) musculoskeletal infections with respect to prevalence and complexity of clinical care over the past decade at a single children's hospital.
Methods:
We retrospectively reviewed a series of patients presenting to The Children's Hospital of Philadelphia with a diagnosis of osteomyelitis, septic arthritis, or both over a 10-year period. Inclusion criteria were S. aureus (SA) infections proven by positive culture of blood, bone, or joint aspirate. Exclusion criteria were non-SA infectious etiologies. Hospital-acquired infections were also not included to exclusively evaluate acute, community-acquired cases. Data related to hospital course, laboratory values, and number of surgical interventions were collected and compared between MRSA and MSSA cohorts.
Results:
In our series of pediatric patients, we identified 148 cases of acute, community-acquired musculoskeletal SA infections (MRSA, n=37 and MSSA, n=111). The prevalence of MRSA musculoskeletal infections increased from 11.8% in 2001 to 2002 to 34.8% in 2009 to 2010. Compared with MSSA, MRSA infections resulted in higher presenting C-reactive protein levels (10.4 vs. 7.8 mg/L, P=0.04), longer inpatient stays (10 vs. 5 d, P<0.01), multiple surgical procedures (n>1) (38% vs. 14%, P<0.01), increased sequelae (27% vs. 6%, P<0.01), and more frequent admissions to the intensive care unit (16% vs. 3%, P<0.01).
Conclusions:
At our institution over the past decade, we found an approximate 3-fold rise in community-acquired pediatric MRSA musculoskeletal infections accompanied by an elevated risk for complications during inpatient management. Awareness of the epidemiological trends of MRSA within the local community may guide parental counseling and facilitate timely and accurate clinical diagnosis and treatment.
Level Of Evidence:
Level II-prognostic retrospective study.
Insights
Community-acquired methicillin-resistant Staphylococcus aureus (MRSA) pediatric musculoskeletal infections rose threefold over a decade. These MRSA infections led to more complex care, including longer hospital stays and increased surgical interventions compared to methicillin-sensitive S. aureus (MSSA).
Area of Science:
- Pediatric Infectious Diseases
- Musculoskeletal Infections
- Epidemiology
Background:
- Community-acquired methicillin-resistant Staphylococcus aureus (MRSA) has significantly impacted pediatric musculoskeletal infections.
- Variations in MRSA virulence across institutions necessitate local epidemiological analysis.
- This study addresses the changing landscape of pediatric S. aureus musculoskeletal infections.
Purpose of the Study:
- To compare the prevalence and clinical care complexity of MRSA versus methicillin-sensitive S. aureus (MSSA) musculoskeletal infections in pediatric patients.
- To analyze trends in MRSA and MSSA musculoskeletal infections over a 10-year period at a single children's hospital.
- To evaluate differences in patient outcomes and treatment intensity between MRSA and MSSA infections.
Main Methods:
- Retrospective review of pediatric patients diagnosed with osteomyelitis, septic arthritis, or both.
- Inclusion of acute, community-acquired S. aureus infections confirmed by positive cultures.
- Exclusion of non-S. aureus and hospital-acquired infections.
- Data collection on hospital course, laboratory values, and surgical interventions for comparison between MRSA and MSSA cohorts.
- Study design classified as Level II-prognostic retrospective study.
Main Results:
- A total of 148 cases of S. aureus musculoskeletal infections were identified (37 MRSA, 111 MSSA).
- The prevalence of MRSA infections increased from 11.8% to 34.8% between 2001-2002 and 2009-2010.
- MRSA infections were associated with higher C-reactive protein levels, longer hospital stays, more frequent multiple surgeries, increased sequelae, and higher ICU admission rates compared to MSSA infections.
Conclusions:
- A significant rise in community-acquired pediatric MRSA musculoskeletal infections was observed over the past decade.
- MRSA infections are linked to a greater risk of complications during inpatient management.
- Understanding local MRSA epidemiological trends is crucial for guiding parental counseling and ensuring timely diagnosis and treatment.
Related Concept Videos
01:25Clinical Significance of Antibiotic Resistance
01:29Staphylococcal Skin Infections
01:25Mechanism of Antibiotic Resistance in MRSA
01:26Healthcare Associated Infections I: Iatrogenic, Exogenic and Endogenic
HAIs significantly increase the cost of health care. Extended stays in healthcare institutions, increased disability, increased costs of medications, including specialized antibiotics, and prolonged recovery times add to the patient's expenses and the healthcare institution and funding bodies.
01:28Disorders of the Skeletal Muscle
Musculoskeletal disorders
Musculoskeletal disorders involve injuries and conditions affecting the skeletal muscles and associated connective tissues. These disorders can arise from acute biomechanical stresses or chronic overuse and can occur across different age groups. Common injuries include sprains, fractures, and muscular strains, often resulting from...