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Updated: Mar 2, 2026
Subcutaneous Infection of Methicillin Resistant Staphylococcus Aureus MRSA
Published on: February 9, 2011
Similar Clinical Severity and Outcomes for Methicillin-Resistant and Methicillin-Susceptible Staphylococcus aureus
Thomas J An1, Michael A Benvenuti1, Megan E Mignemi2
1Vanderbilt University School of Medicine, Nashville, Tennessee.
Background:
Prior studies of pediatric musculoskeletal infection have suggested that methicillin-resistant Staphylococcus aureus (MRSA) infections result in worse outcomes compared with infections with methicillin-susceptible S aureus (MSSA) strains. Based on these results, clinical prediction algorithms have been developed to differentiate between MRSA and MSSA early in a patient's clinical course. This study compares hospital outcomes for pediatric patients with MRSA and MSSA musculoskeletal infection presenting to the emergency department at a large tertiary care children's hospital.
Methods:
A retrospective study identified pediatric patients with S aureus musculoskeletal infection over a 5-year period (2008-2013) by sequential review of all pediatric orthopedic consults. Relevant demographic information, laboratory values, and clinical outcomes were obtained from the electronic medical record.
Results:
Of the 91 identified cases of S aureus pediatric musculoskeletal infection, there were 49 cases of MRSA infection (53%) and 42 cases of MSSA infection (47%). There were no significant differences between MRSA and MSSA infections in median hospital length of stay (4.8 vs 5.7 days, P = .50), febrile days (0.0 vs 1.5 days, P = .10), and antibiotic duration (28 vs 34 days, P = .18). Methicillin-resistant S aureus infections were more likely to require operative intervention than MSSA infection (85% vs 62%, P = .15). A logistic regression model based on C-reactive protein, temperature, white blood cell count, pulse, and respiratory rate at presentation demonstrated poor ability to differentiate between MRSA and MSSA infection.
Conclusions:
The results demonstrated no significant differences between MSSA and MRSA musculoskeletal infections for most hospital outcomes measured. However, MRSA infections required more operative interventions than MSSA infections. In addition, a predictive model based on severity markers obtained at presentation was unable to effectively differentiate between MRSA and MSSA infection. The clinical utility and capacity for early differentiation of MRSA and MSSA depends on virulence patterns that may vary temporally and geographically.
Insights
Pediatric methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-susceptible Staphylococcus aureus (MSSA) musculoskeletal infections showed similar hospital outcomes. However, MRSA cases more frequently required surgery, and early prediction models were ineffective.
Area of Science:
- Pediatric infectious diseases
- Musculoskeletal infections
- Staphylococcus aureus epidemiology
Background:
- Previous research suggested worse outcomes for pediatric MRSA musculoskeletal infections compared to MSSA.
- Clinical prediction algorithms have been developed to differentiate MRSA and MSSA early in patient care.
- This study investigates hospital outcomes for pediatric MRSA vs. MSSA musculoskeletal infections.
Purpose of the Study:
- To compare hospital outcomes between pediatric patients with MRSA and MSSA musculoskeletal infections.
- To evaluate the effectiveness of a predictive model for differentiating MRSA from MSSA at presentation.
Main Methods:
- Retrospective study of pediatric patients with S. aureus musculoskeletal infections from 2008-2013.
- Data collected from electronic medical records, including demographics, lab values, and clinical outcomes.
- Analysis included comparison of length of stay, febrile days, antibiotic duration, and operative interventions.
Main Results:
- Out of 91 S. aureus infections, 49 were MRSA (53%) and 42 were MSSA (47%).
- No significant differences were found in median hospital length of stay, febrile days, or antibiotic duration.
- MRSA infections were more likely to require operative intervention (85% vs. 62%). A predictive model using clinical markers showed poor differentiation ability.
Conclusions:
- MRSA and MSSA musculoskeletal infections in pediatric patients showed similar hospital outcomes, except for a higher need for operative intervention in MRSA cases.
- A predictive model based on presenting severity markers was ineffective in differentiating MRSA from MSSA.
- Early differentiation of MRSA and MSSA may depend on varying virulence patterns.
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