Complex bilateral methicillin-resistant Staphylococcus aureus renal and perirenal abscesses: a multidisciplinary approach and the use of C-reactive protein as an aid to management

Most of the anti-methicillin-resistant Staphylococcus aureus drugs available in Japan are administered intravenously, except for linezolid, which can also be administered orally. Here, we report a lupus patient with methicillin-resistant S. aureus–induced osteomyelitis. Linezolid had to be stopped due to severe anemia. In an effort to treat her on an outpatient basis, we planned to use a combination of minocycline and trimethoprim–sulfamethoxazole that exhibited in vitro sensitivity against the methicillin-resistant S. aureus detected, and rifampicin is used against methicillin-resistant S. aureus in certain cases. The use of rifampicin increased the level of C-reactive protein even though the prednisolone dose used was doubled, so we gave up using it. The combined application of oral minocycline and trimethoprim–sulfamethoxazole, however, controlled the inflammation, and the patient was able to be discharged. Fourteen months later, we discontinued the administration of both drugs and there has been no relapse more than a year. This combination of antibiotics may be useful, especially when patients want to be treated on an outpatient basis.

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Declining prevalence of Methicillin-resistant Staphylococcus aureus septic arthritis and osteomyelitis in children: implications for treatment

10.21203/rs.2.16049/v1 ◽

2019 ◽

Author(s):

Lindsay Weiss ◽

Amanda Lansell ◽

Janet Figueroa ◽

Parminder Suchdev ◽

Anjali Kirpalani

Keyword(s):

Staphylococcus Aureus ◽

Septic Arthritis ◽

Methicillin Resistant Staphylococcus Aureus ◽

Antibiotic Regimen ◽

Methicillin Resistant ◽

Reactive Protein ◽

Lengths Of Stay ◽

Ongoing Surveillance ◽

Relationship Of ◽

The Relationship

Abstract OBJECTIVES To assess clinical characteristics and differences in outcomes between children with Methicillin-resistant Staphylococcus aureus (MRSA) and Methicillin-sensitive Staphylococcus aureus (MSSA) osteomyelitis or septic arthritis and whether initial antibiotic regimen affects patient outcomes.STUDY DESIGN We analyzed records of children ages 15 days to 18 years admitted between 2009 and 2016 to two tertiary children’s hospitals who were diagnosed with an osteoarticular infection and had a microorganism identified. We compared the relationship of MRSA versus MSSA and initial antibiotic selection on patient outcomes including length of hospitalization and requiring a PICU transfer.RESULTS A total of 584 patients met inclusion criteria of which 365 (62.5%) had a microbiological diagnosis. MSSA was the most common pathogen identified (45.5%) followed by MRSA (31.2%). The percentage of MRSA cases decreased by 25.4% between 2009 and 2016, whereas MSSA infections increased by 18.6%. Compared to MSSA, patients with MRSA had a higher initial C-reactive protein (median 17.3 mg/dL vs 7.8 mg/dL, p<0.05) and a longer hospitalization (median 8.3 days vs 6.1 days, p<0.05). Patients whose initial antibiotic regimens included vancomycin were more likely to require a PICU transfer (15.0% vs 2.2%, p<0.05) and had a longer hospitalization (median 6.7 days vs 5.5 days, p<0.05) compared to those initiated on clindamycin without vancomycin.CONCLUSIONS While MRSA was associated with increased severity of osteoarticular infections compared to MSSA, the incidence of MRSA has been declining at our institution. Patients with longer lengths of stay and those requiring a PICU transfer were more likely to be on vancomycin. Clindamycin should be considered in the initial antibiotic regimen for osteomyelitis and septic arthritis with ongoing surveillance of local microbiology and outcomes.

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Declining Prevalence of Methicillin-Resistant Staphylococcus aureus Septic Arthritis and Osteomyelitis in Children: Implications for Treatment

Antibiotics ◽

10.3390/antibiotics9030101 ◽

2020 ◽

Vol 9 (3) ◽

pp. 101 ◽

Cited By ~ 2

Author(s):

Lindsay Weiss ◽

Amanda Lansell ◽

Janet Figueroa ◽

Parminder S. Suchdev ◽

Anjali Kirpalani

Keyword(s):

Staphylococcus Aureus ◽

Septic Arthritis ◽

Methicillin Resistant Staphylococcus Aureus ◽

Pediatric Intensive Care ◽

Antibiotic Regimen ◽

Osteoarticular Infection ◽

Methicillin Resistant ◽

Reactive Protein ◽

Lengths Of Stay ◽

Ongoing Surveillance

This study sought to assess clinical characteristics and differences in outcomes between children with Methicillin-resistant Staphylococcus aureus (MRSA) and Methicillin-sensitive Staphylococcus aureus (MSSA) osteomyelitis or septic arthritis and whether initial antibiotic regimen affects patient outcomes. We analyzed records of children ages 15 days to 18 years admitted between 2009 and 2016 to two tertiary children’s hospitals who were diagnosed with an osteoarticular infection and had a microorganism identified. A total of 584 patients met inclusion criteria, of which 365 (62.5%) had a microbiological diagnosis. MSSA was the most common pathogen identified (45.5%), followed by MRSA (31.2%). Compared to MSSA, patients with MRSA had a higher initial C-reactive protein and longer hospitalization. Patients whose initial antibiotic regimens included vancomycin had a longer hospitalization than those initiated on clindamycin without vancomycin, even after removing sicker patients admitted to the pediatric intensive care unit. While MRSA was associated with increased severity of osteoarticular infections compared to MSSA, the incidence of MRSA has been declining at our institution. Patients with longer lengths of stay were more likely to be on vancomycin. Clindamycin should be considered in the initial antibiotic regimen for osteomyelitis and septic arthritis with ongoing surveillance of local microbiology and outcomes.

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