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CA-MRSA Striking Children with Bone Infections

Jul 1, 2008 It began with the staph bacteria—Staphylococcus aureus—and moved to the drug resistant MRSA—Methicillin-Resistant Staphylococcus aureus.  Recently, there has been a rapid emergence of CA-MRSA—Community-Acquired Methicillin-Resistant Staphylococcus aureus—with the germ moving out of its traditional environment of hospitals and healthcare facilities and into the general population.  Now, CA-MRSA is attacking children and is leading to increased complications and longer hospital stays for children with acute bone infections, or acute osteomyelitis, according to UT Southwestern Medical Center researchers report.

Acute osteomyelitis is typically found in children and caused by staph. Because treatment of staph was generally treated with basic antibiotic therapy, osteomyelities treatment was pretty basic.  Now that the deadlier CA-MRSA is gaining ground, children with Staphylococcus aureus seem to be developing the more severe, deadlier, antibiotic-resistant, CA-MRSA.  "This study shows the transition from the normal S. aureus to the methicillin-resistant one that everybody calls the superbug," said Dr. Octavio Ramilo, professor of pediatrics at UT Southwestern and senior author of a study available online and in the July/August issue of the Journal of Pediatric Orthopaedics.  "What's important about this is not only that MRSA infections are harder to treat because they are more resistant to the traditional antibiotics, but they are also more aggressive and cause more severe disease manifestations.  This is reflected very clearly in this study."

Dr. Asunción Mejías, assistant professor of pediatrics and co-lead author, said “The MRSA that we used to see was acquired in the hospital.  This is a different strain that patients acquire in the community.  Now, we see kids with osteomyelitis who have bone abscesses in the legs and who get blood clots that lead to pulmonary embolisms.  We don't want to alarm parents, but kids who limp or have backaches and fever after an otherwise minor trauma need to be evaluated by a physician."  Ramilo explained that osteomyelitis might be more common in children because they tend to be more accident-prone.  Typically, bones get infected when bacteria reach the bone through the blood; minor bone trauma likely facilitates the infection.

Researchers reviewed the medical records of 290 children admitted to Children's Medical Center Dallas between January 1999-December 2003 with acute osteomyelitis. The median age was six.  Patients were divided into two groups—January 1999-June 2001 and July 2001-December 2003—to determine if MRSA infections were becoming more common and more severe over time.  Patients with MRSA osteomyelitis were compared to non-MRSA osteomyelitis patients, which included methicillin-sensitive S. aureus (MSSA) infections.  The study revealed that children treated in the latter period fared far worse, Dr. Ramilo said.  In those children, bone abscesses were observed in 69 percent of the patients with MRSA osteomyelitis versus 26 percent among those with MSSA infections. Children admitted with MRSA osteomyelitis during the second study period spent an average of 42 days on antibiotics, almost two weeks longer than those diagnosed with MSSA.  Dr. Ramilo said the number of children requiring surgery was significant at 78 percent in the MRSA group versus 49 percent with MSSA.

Center of Disease Control (CDC) estimates place last year’s MRSA death toll at 19,000, with 2,000 healthy people dying from CA-MRSA.

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