Changing patterns of acute hematogenous osteomyelitis and septic arthritis: emergence of community-associated methicillin-resistant Staphylococcus aureus

J Pediatr Orthop. 2006 Nov-Dec;26(6):703-8. doi: 10.1097/01.bpo.0000242431.91489.b4.


Introduction: 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.

Publication types

  • Multicenter Study

MeSH terms

  • Acute Disease
  • Anti-Bacterial Agents / therapeutic use
  • Arthritis, Infectious / drug therapy
  • Arthritis, Infectious / epidemiology*
  • Arthritis, Infectious / microbiology
  • Child
  • Child, Preschool
  • Clindamycin / therapeutic use
  • Community-Acquired Infections / drug therapy
  • Community-Acquired Infections / epidemiology
  • Community-Acquired Infections / microbiology
  • Female
  • Humans
  • Incidence
  • Male
  • Methicillin Resistance*
  • Osteomyelitis / drug therapy
  • Osteomyelitis / epidemiology*
  • Osteomyelitis / microbiology
  • Prognosis
  • Retrospective Studies
  • Staphylococcus aureus / drug effects
  • Staphylococcus aureus / isolation & purification*
  • Tennessee / epidemiology


  • Anti-Bacterial Agents
  • Clindamycin