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Updated: Feb 19, 2026
Subcutaneous Infection of Methicillin Resistant Staphylococcus Aureus MRSA
Published on: February 9, 2011
The orthopaedic manifestation and outcomes of methicillin-sensitive Staphylococcus aureus septicaemia
D Makki1, T Elgamal1, P Evans1
1Wirral University Teaching Hospital NHS Trust, Arrowe Park Road, Upton, Wirral CH49 5PE, UK.
Aims:
The aim of this paper was to present the clinical features of patients with musculoskeletal sources of methicillin-sensitive Staphylococcus aureus (MSSA) septicaemia.
Patients And Methods:
A total of 137 patients presented with MSSA septicaemia between 2012 and 2015. The primary source of infection was musculoskeletal in 48 patients (35%). Musculoskeletal infection was considered the primary source of septicaemia when endocarditis and other obvious sources were excluded. All patients with an arthroplasty at the time were evaluated for any prosthetic involvement.
Results:
The most common site of infection was the spine, which occurred in 28 patients (58%), and was associated with abscess formation in 16. Back pain was the presenting symptom in these patients, with a positive predictive value of 100%. A total of 24 patients had a total of 42 arthroplasties of the hip or knee in situ. Prosthetic joint infection occurred in six of these patients (25%). In five patients, the infection originated outside the musculoskeletal system. Three patients (6%) with MSSA septicaemia from a musculoskeletal sources died.
Conclusion:
Amongst the musculoskeletal sources of MSSA septicaemia, the spine was the most commonly involved. We recommend an MRI scan of the whole spine and pelvis in patients with MSSA septicaemia with back pain, when the primary source of infection has not been identified or clinical examination is unreliable. Cite this article: Bone Joint J 2017;99-B:1545-51.
Insights
Methicillin-sensitive Staphylococcus aureus (MSSA) septicaemia commonly originates from the spine, particularly with associated back pain. Early MRI is recommended for unidentified MSSA septicaemia sources, especially in patients with back pain.
Area of Science:
- Infectious Diseases
- Orthopedics
- Clinical Medicine
Background:
- Methicillin-sensitive Staphylococcus aureus (MSSA) can cause severe bloodstream infections (septicaemia).
- Identifying the primary source of MSSA septicaemia is crucial for effective treatment.
- Musculoskeletal infections represent a significant, though sometimes overlooked, source of MSSA septicaemia.
Purpose of the Study:
- To delineate the clinical characteristics of patients experiencing MSSA septicaemia originating from musculoskeletal sources.
- To identify common sites and clinical presentations associated with musculoskeletal MSSA septicaemia.
- To evaluate the incidence of prosthetic joint infections in patients with MSSA septicaemia and implants.
Main Methods:
- Retrospective analysis of 137 patients with MSSA septicaemia between 2012 and 2015.
- Identification of musculoskeletal infections as the primary source in 48 patients (35%), excluding other obvious sources.
- Assessment of prosthetic joint involvement in patients with existing hip or knee arthroplasties.
Main Results:
- The spine was the most frequent musculoskeletal source (58%), often associated with abscess formation (58%).
- Back pain demonstrated a 100% positive predictive value for spinal involvement.
- Prosthetic joint infection occurred in 25% of patients with hip or knee arthroplasties.
Conclusions:
- The spine is the predominant musculoskeletal source of MSSA septicaemia.
- An MRI of the spine and pelvis is recommended for patients with unexplained MSSA septicaemia and back pain.
- Prompt diagnosis and source identification are vital for managing MSSA septicaemia, with a 6% mortality rate observed in this cohort.
