title: Community-acquired Methicillin-resistant Staphylococcus aureus Musculoskeletal Infections: Emerging Trends Over the Past Decade.
abstract: BACKGROUND
  The emergence of community-acquired methicillin-resistant Staphylococcus aureus (MRSA) has altered the management of pediatric musculoskeletal infections. Yet, institution-to-institution differences in MRSA virulence may exist, suggesting a need to carefully examine local epidemiological characteristics. The purpose of this study was to compare MRSA and methicillin-sensitive S. aureus (MSSA) musculoskeletal infections with respect to prevalence and complexity of clinical care over the past decade at a single children's hospital.
  
  
  METHODS
  We retrospectively reviewed a series of patients presenting to The Children's Hospital of Philadelphia with a diagnosis of osteomyelitis, septic arthritis, or both over a 10-year period. Inclusion criteria were S. aureus (SA) infections proven by positive culture of blood, bone, or joint aspirate. Exclusion criteria were non-SA infectious etiologies. Hospital-acquired infections were also not included to exclusively evaluate acute, community-acquired cases. Data related to hospital course, laboratory values, and number of surgical interventions were collected and compared between MRSA and MSSA cohorts.
  
  
  RESULTS
  In our series of pediatric patients, we identified 148 cases of acute, community-acquired musculoskeletal SA infections (MRSA, n=37 and MSSA, n=111). The prevalence of MRSA musculoskeletal infections increased from 11.8% in 2001 to 2002 to 34.8% in 2009 to 2010. Compared with MSSA, MRSA infections resulted in higher presenting C-reactive protein levels (10.4 vs. 7.8 mg/L, P=0.04), longer inpatient stays (10 vs. 5 d, P<0.01), multiple surgical procedures (n>1) (38% vs. 14%, P<0.01), increased sequelae (27% vs. 6%, P<0.01), and more frequent admissions to the intensive care unit (16% vs. 3%, P<0.01).
  
  
  CONCLUSIONS
  At our institution over the past decade, we found an approximate 3-fold rise in community-acquired pediatric MRSA musculoskeletal infections accompanied by an elevated risk for complications during inpatient management. Awareness of the epidemiological trends of MRSA within the local community may guide parental counseling and facilitate timely and accurate clinical diagnosis and treatment.
  
  
  METHODS
  Level II-prognostic retrospective study.
authors.affiliation: *Department of Orthopaedic Surgery, Stanford University Medical Center, Palo Alto, CA †Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD ‡Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA §Colorado Orthopedic Consultants, Aurora, CO.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Sarkissian
authors.forename: Itai
authors.initials: I
authors.lastname: Gans
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Gunderson
authors.forename: Stuart H
authors.initials: SH
authors.lastname: Myers
authors.forename: David A
authors.initials: DA
authors.lastname: Spiegel
authors.forename: John M
authors.initials: JM
authors.lastname: Flynn
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D001170:Arthritis, Infectious / Q000382:microbiology* / Q000601:surgery; D002097:C-Reactive Protein / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000382:microbiology / Q000601:surgery; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D010019:Osteomyelitis / Q000382:microbiology* / Q000601:surgery; D015143:Philadelphia / Q000453:epidemiology; D015995:Prevalence; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology* / Q000601:surgery
chemical_list: D002097:C-Reactive Protein