title: Changing patterns of acute hematogenous osteomyelitis and septic arthritis: emergence of community-associated methicillin-resistant Staphylococcus aureus.
abstract: BACKGROUND
  An increase in the incidence and severity of acute osteoarticular infections in children was perceived after the emergence of community-associated methicillin-resistant Staphylococcus aureus (MRSA) in our community. This study was performed to describe changes in the epidemiology and clinical features of acute osteoarticular infections.
  
  
  METHODS
  The records of patients discharged from Le Bonheur Children's Medical Center with a diagnosis of acute osteoarticular infection between 2000 and 2004 were reviewed. Data regarding signs and symptoms, diagnostic testing, therapeutics, surgery, and hospital course were collected.
  
  
  RESULTS
  There were 158 cases of acute osteoarticular infection. The incidence increased from 2.6 to 6.0 per 1000 admissions between 2000 and 2004. The proportion of infections caused by methicillin-susceptible S. aureus (MSSA) remained constant (10%-13%) and that caused by MRSA rose from 4% to 40%. There was no difference between MRSA and MSSA patients in the duration of fever or pain before diagnosis. Seventy-one percent of patients with MRSA had subperiosteal abscesses compared with 38% with MSSA (P = 0.02). Ninety-one percent of MRSA patients required a surgical procedure compared with 62% of MSSA patients (P < 0.001). Median hospital stay was 7 days for MSSA patients and 10 days for MRSA patients (P = 0.0001). Three patients developed chronic osteomyelitis, 2 with MRSA. There was no association between a delay in institution of appropriate antibiotic therapy and presence of subperiosteal abscess (P = 0.8).
  
  
  CONCLUSIONS
  There has been an increase in the incidence and severity of acute osteoarticular infections in Memphis. Patients with community-associated MRSA infections are at higher risk of subperiosteal abscess requiring surgical intervention.
authors.affiliation: Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN 38120, USA. sarnold5@utmem.edu
authors.forename: Sandra R
authors.initials: SR
authors.lastname: Arnold
authors.forename: David
authors.initials: D
authors.lastname: Elias
authors.forename: Steven C
authors.initials: SC
authors.lastname: Buckingham
authors.forename: Eddie D
authors.initials: ED
authors.lastname: Thomas
authors.forename: Eduardo
authors.initials: E
authors.lastname: Novais
authors.forename: Alexandre
authors.initials: A
authors.lastname: Arkader
authors.forename: Cassandra
authors.initials: C
authors.lastname: Howard
mesh_terms: D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001170:Arthritis, Infectious / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D002981:Clindamycin / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D016106:Methicillin Resistance; D010019:Osteomyelitis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D011379:Prognosis; D012189:Retrospective Studies; D013211:Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification*; D013714:Tennessee / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents; D002981:Clindamycin