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Clinical and Microbiologic Variables Predictive of Orthopedic Complications Following Staphylococcus aureus Acute Hematogenous Osteoarticular Infections in Children
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Clinical and Microbiologic Variables Predictive of Orthopedic Complications Following Staphylococcus aureus Acute Hematogenous Osteoarticular Infections in Children
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Journal Article
Clinical and Microbiologic Variables Predictive of Orthopedic Complications Following Staphylococcus aureus Acute Hematogenous Osteoarticular Infections in Children
2019
Overview
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.
Among children with Staphylococcus aureus acute hematogenous osteoarticular infections, orthopedic complications develop in 9.4%. The development of complications was associated with delayed source control, prolonged fever on the index admission, and infection with agr III strains.
Publisher
Oxford University Press
Subject
