Role of Operative or Interventional Radiology-Guided Cultures for Osteomyelitis

McNeil, J. Chase; Forbes, Andrea; Vallejo, Jesús G.; Flores, Anthony R.; Hultén, Kristina G.; Mason, Edward O.; Kaplan, Sheldon L.

doi:10.1542/peds.2015-4616

Cited by 59 publications

(90 citation statements)

References 38 publications

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“…Acute hematogenous osteoarticular infections (AHOAIs), including both septic arthritis and osteomyelitis, are the most common manifestations of invasive staphylococcal disease in pediatrics (6). Similar to the work of others, we previously reported a decrease in the proportion of S. aureus AHOAIs caused by MRSA, contributing to only 32% of cases by 2014 (7). MRSA strains, particularly those belonging to the USA300 pulsotype and/or producing Panton-Valentine leucocidin (PVL, with such strains considered PVL positive), have previously been associated with negative clinical outcomes in AHOAI, including bone abscesses, prolonged fever, thromboses, and pathological fractures (8,9).…”

supporting

confidence: 81%

“…Patients with open or penetrating trauma, orthopedic hardware in place, osteomyelitis secondary to a contiguous focus, or osteomyelitis secondary to a surgical procedure (such as sternal osteomyelitis after cardiac surgery) were excluded. The clinical features of a subset of cases have been reported in previous publications (7,34,37). Antimicrobial treatment decisions were at the discretion of the infectious diseases physician of record.…”

Section: Methodsmentioning

confidence: 99%

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Association of Vancomycin MIC and Molecular Characteristics with Clinical Outcomes in Methicillin-Susceptible Staphylococcus aureus Acute Hematogenous Osteoarticular Infections in Children

Kok

Vallejo

Sommer

et al. 2018

Antimicrob Agents Chemother

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Strains of methicillin-resistant (MRSA), particularly those belonging to the USA300 pulsotype, have been well described to cause severe osteoarticular infections (OAIs). A vancomycin MIC of ≥1.5 μg/ml has been demonstrated to contribute to disease severity in adults with MRSA and even methicillin-susceptible (MSSA) bacteremia. Little data exist describing the outcomes of MSSA OAIs in terms of molecular characteristics and vancomycin MIC. All patients/isolates were chosen from a surveillance study at Texas Children's Hospital (TCH). OAI isolates were identified from 2011 to 2016 and subjected to vancomycin Etests, pulsed-field gel electrophoresis (PFGE), and PCR to determine Panton-Valentine leucocidin (PVL) production and group. Two hundred fifty-two cases of OAI were identified; 183 cases were MSSA (72.6%). During the study period, a decrease in the proportion of cases secondary to MRSA was observed, declining from 37.8% to 15.9% ( = 0.02). Of the MSSA isolates, 26.2% and 23.5% were USA300 and PVL positive, respectively. An increase in the proportion of MSSA isolates with a vancomycin MIC of ≥1.5 μg/ml occurred in the study period ( = 0.004). In MSSA, an elevated vancomycin MIC was associated with multiple surgical procedures and venous thromboses, even when adjusting for empirical β-lactam use. An increase in vancomycin MIC was noted among isolates belonging to group 4 during the study period. Methicillin resistance is declining among OAI isolates at TCH. Simultaneously, vancomycin Etest MICs are increasing among MSSA isolates. Vancomycin MICs of ≥2 μg/ml are associated with adverse clinical outcomes in MSSA irrespective of antibiotic choice, suggesting that this may be a surrogate for organism virulence.

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supporting

confidence: 81%

Section: Methodsmentioning

confidence: 99%

Association of Vancomycin MIC and Molecular Characteristics with Clinical Outcomes in Methicillin-Susceptible Staphylococcus aureus Acute Hematogenous Osteoarticular Infections in Children

Kok

Vallejo

Sommer

et al. 2018

Antimicrob Agents Chemother

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“…The frequency of positive blood culture in S. aureus OAI has varied in the literature and may be as high as 60%; 3 MRSA in particular may be associated with persistent bacteremia 2 as well as thrombotic complications. 4, 17 Concerns exist as to whether or not the presence of a positive blood culture for S. aureus should modify therapy in S. aureus OAI.…”

Section: Discussionmentioning

confidence: 99%

“…3, 14 Briefly, the consult database of the inpatient infectious diseases service at TCH Main Campus was reviewed from January 1, 2011- December 31, 2014 for patients with acute hematogenous osteomyelitis and/or septic arthritis. The inpatient infectious diseases service at TCH was staffed by 15 board certified pediatric infectious diseases physicians during the study period and was routinely consulted in cases of OAI.…”

Section: Methodsmentioning

confidence: 99%

“…S. aureus is overwhelmingly the most commonly identified etiology of these infections, accounting for >80% of culture positive cases 1, 2 ; a recent study at Texas Children’s Hospital (TCH) revealed that 31.7% of S. aureus causing osteomyelitis were methicillin-resistant. 3 S. aureus osteoarticular infections (OAI), particularly those caused by the USA300 pulsotype, are associated with a number of complications including venous thrombosis, septic pulmonary emboli, severe sepsis and pathologic fracture. 4, 5 Given the risks of complications in OAI, aggressive surgical and medical therapy is of importance.…”

Section: Introductionmentioning

confidence: 99%

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The Influence of the Route of Antibiotic Administration, Methicillin Susceptibility, Vancomycin Duration and Serum Trough Concentration on Outcomes of Pediatric Staphylococcus aureus Bacteremic Osteoarticular Infection

McNeil

Kaplan

Vallejo

2017

Pediatric Infectious Disease Journal

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Background Bacteremia is often one factor used in deciding the need for prolonged intravenous antimicrobial therapy in osteoarticular infections (OAI). We examined treatment practices and outcomes of bacteremic S. aureus osteoarticular infections (BOAI) evaluated at Texas Children’s Hospital (TCH). Methods Cases of acute hematogenous OAI in children with positive blood cultures for S. aureus at TCH from 2011–2014 were reviewed. Orthopedic complications included chronic osteomyelitis, growth arrest, pathologic fracture, avascular necrosis and chronic dislocation. Acute kidney injury (AKI) was defined as a doubling of the baseline creatinine. Results 192 cases of S. aureus OAI were identified with 102 cases of BOAI included (35 MRSA). 25 patients were discharged home on oral antibiotics. Patients discharged on oral antibiotics had a shorter duration of fever, a more rapid decline in C-reactive protein and were less likely to have MRSA. The frequency of orthopedic complications did not increase in patients who received early transition to oral antibiotics. For patients with MRSA bacteremia the rates of complications between those who received ≥ 7 days vs. < 7 days of vancomycin did not differ. Vancomycin serum troughs > 15 µg/ml were not associated with a decreased duration of fever, bacteremia or hospitalization, need for repeat operation or orthopedic complications but were associated with AKI. Conclusion Bacteremic S. aureus OAI are associated with substantial morbidity. Early transition to oral therapy may be a safe option for select patients with S. aureus BOAI, including those due to MRSA. Prolonged courses of vancomycin and vancomycin troughs > 15 µg/ml were not associated with improved outcomes for MRSA OAI.

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Clinical guideline highlights for the hospitalist: Diagnosis and management of acute hematogenous osteomyelitis in children

Palmer

Wang

2022

Journal of Hospital Medicine

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GUIDELINE TITLE Clinical practice guideline by the Pediatric Infectious Diseases Society and the Infectious Disease Society of America: 2021 Guideline on Diagnosis and Management of Acute Hematogenous Osteomyelitis in Children RELEASE DATE August 5, 2021 PRIOR VERSION(S) n/a DEVELOPER Pediatric Infectious Diseases Society (PIDS) and Infectious Disease Society of America (IDSA) FUNDING SOURCE PIDS and IDSA TARGET POPULATION Children with suspected or confirmed acute hematogenous osteomyelitis

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Role of Operative or Interventional Radiology-Guided Cultures for Osteomyelitis

Cited by 59 publications

References 38 publications

Association of Vancomycin MIC and Molecular Characteristics with Clinical Outcomes in Methicillin-Susceptible Staphylococcus aureus Acute Hematogenous Osteoarticular Infections in Children

Association of Vancomycin MIC and Molecular Characteristics with Clinical Outcomes in Methicillin-Susceptible Staphylococcus aureus Acute Hematogenous Osteoarticular Infections in Children

The Influence of the Route of Antibiotic Administration, Methicillin Susceptibility, Vancomycin Duration and Serum Trough Concentration on Outcomes of Pediatric Staphylococcus aureus Bacteremic Osteoarticular Infection

Clinical guideline highlights for the hospitalist: Diagnosis and management of acute hematogenous osteomyelitis in children

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