Clinical and Microbiologic Variables Predictive of Orthopedic Complications Following Staphylococcus aureus Acute Hematogenous Osteoarticular Infections in Children

Clin Infect Dis. 2019 Nov 13;69(11):1955-1961. doi: 10.1093/cid/ciz109.

Abstract

Background: Staphylococcus aureus is the most common cause of acute hematogenous osteoarticular infections (AHOAIs) in children. The risk factors for the development of orthopedic complications (OC) after AHOAI are poorly understood. We sought to describe clinical and microbiologic variables present on the index admission that may predict OC in S. aureus AHOAI.

Methods: Staphylococcus aureus AHOAI cases were identified from 2011-2017 at Texas Children's Hospital and reviewed for the development of OC. OC included chronic osteomyelitis, growth arrest, avascular necrosis, chronic dislocation, and pathologic fracture. All S. aureus isolates were characterized by pulsed-field gel electrophoresis and agr group.

Results: A total of 286 cases were examined of which 27 patients (9.4%) developed OC. Patients who developed OC more often had infection with an agr group III organism (P = .04), bacteremia (P = .04), delayed source control (P < .001), ≥2 surgical procedures (P < .001), intensive care unit admission (P = .09), and fever >4 days after admission (P = .008). There was no association with OC and patient age, methicillin resistance, or choice/route of antibiotics. In multivariable analyses of OC, infection with agr group III S. aureus, prolonged fever, and delayed source control remained statistically significant.

Conclusions: OC develop following S. aureus AHOAI in 9.4% of cases. Although the development of OC is likely multifactorial, agr group III organisms, prolonged fever, and delayed source control are independently associated with OC. Moreover, early aggressive surgical source control may be beneficial in children with S. aureus AHOAI.

Keywords: agr III; chronic osteomyelitis; osteomyelitis; pediatric; source control.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Bacteremia / drug therapy*
  • Bacteremia / microbiology
  • Child
  • Child, Preschool
  • Electrophoresis, Gel, Pulsed-Field
  • Female
  • Humans
  • Male
  • Methicillin-Resistant Staphylococcus aureus / drug effects
  • Methicillin-Resistant Staphylococcus aureus / pathogenicity
  • Microbial Sensitivity Tests
  • Multivariate Analysis
  • Osteomyelitis / drug therapy*
  • Osteomyelitis / microbiology
  • Staphylococcal Infections / drug therapy*
  • Staphylococcal Infections / microbiology
  • Staphylococcus aureus / drug effects
  • Staphylococcus aureus / pathogenicity*

Substances

  • Anti-Bacterial Agents