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Updated: Jun 7, 2025
Subcutaneous Infection of Methicillin Resistant Staphylococcus Aureus MRSA
Published on: February 9, 2011
Association of Antibiotic Route and Outcomes in Children with Methicillin-Resistant Staphylococcus aureus Bacteremic
Jared Olson1,2, Rana F Hamdy3, Alice J Hsu4
1Department of Pharmacy, Primary Children's Hospital, 100 Mario Capecchi Dr, Salt Lake City, UT, 84113, USA. jared.olson@imail.org.
Introduction:
There remains uncertainty about whether transitioning to oral antibiotic therapy is appropriate for the management of children with methicillin-resistant Staphylococcus aureus (MRSA) bacteremic osteomyelitis. We compared clinical outcomes for children with MRSA osteomyelitis with associated bacteremia who were transitioned to discharge oral antibiotic therapy to those discharged on outpatient parenteral antibiotic therapy (OPAT).
Methods:
We performed a retrospective, multicenter, cohort study of children ≤ 18 years hospitalized with MRSA bacteremic osteomyelitis across four children's hospitals from 2007 to 2018 discharged on oral antibiotic therapy versus OPAT. The primary outcome was treatment failure within 6 months of discharge, defined as any of the following: diagnosis of chronic osteomyelitis, conversion from oral to IV antibiotic route, an operative procedure after the index hospitalization (abscess drainage, bone biopsy, arthrocentesis, or pathologic fracture) and/or recrudescence of MRSA bacteremia. Outcomes were analyzed in an inverse propensity score weighted (IPW) cohort.
Results:
A total of 106 cases of MRSA bacteremic osteomyelitis were included; 44 (42%) were discharged in the oral antibiotic therapy group and 62 (59%) patients were discharged in the OPAT group. In the IPW cohort, treatment failure within 6 months of discharge occurred in 3.4% of children in the discharge oral therapy group and 16.3% in the OPAT group (P = 0.03). The odds of 6-month composite treatment failure between discharge oral therapy and OPAT were 0.18 (95% CI 0.05-0.61).
Conclusions:
Discharge oral therapy was not associated with higher rates of treatment failure compared to OPAT for children with MRSA bacteremic osteomyelitis.
Insights
Oral antibiotic therapy for pediatric methicillin-resistant Staphylococcus aureus (MRSA) bacteremic osteomyelitis is safe. This study found no increased treatment failure rates when children were discharged on oral antibiotics compared to IV therapy.
Area of Science:
- Pediatric Infectious Diseases
- Orthopedic Surgery
- Antimicrobial Stewardship
Background:
- Uncertainty exists regarding the appropriateness of oral antibiotic therapy for children with methicillin-resistant Staphylococcus aureus (MRSA) bacteremic osteomyelitis.
- This study compares outcomes of oral antibiotic therapy versus outpatient parenteral antibiotic therapy (OPAT) for pediatric MRSA bacteremic osteomyelitis.
Purpose of the Study:
- To compare clinical outcomes between children with MRSA bacteremic osteomyelitis discharged on oral antibiotics versus OPAT.
- To determine if oral discharge therapy is associated with increased treatment failure.
Main Methods:
- Retrospective, multicenter cohort study of children (≤18 years) with MRSA bacteremic osteomyelitis from 2007-2018.
- Comparison of treatment failure within 6 months post-discharge between oral therapy and OPAT groups.
- Outcomes analyzed using inverse propensity score weighting (IPW).
Main Results:
- 106 cases included: 44 (42%) oral therapy, 62 (59%) OPAT.
- In the IPW cohort, 6-month treatment failure was 3.4% for oral therapy vs. 16.3% for OPAT (P=0.03).
- Oral discharge therapy showed significantly lower odds of treatment failure (OR 0.18).
Conclusions:
- Discharge oral antibiotic therapy is a viable option for pediatric MRSA bacteremic osteomyelitis.
- Oral therapy was not associated with higher treatment failure rates compared to OPAT.
- Findings support the use of oral antibiotics for select pediatric patients.
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