Bone infections in children are more often needing surgery

Methicillin-resistant Staphylococcus aureus (MRSA) is now the main cause of complications and long hospital stays in children with acute bone infection.

Acute osteomyelitis is an infection of the bone that affects children. It is usually caused by staphylococci and was traditionally treated with standard anti-staphylococcal antibiotics, but now many children have a more severe illness because the bacteria resist those antibiotics, so the child must stay in hospital for proper treatment.

"This study shows the shift from ordinary staphylococci to methicillin-resistant ones, which makes treatment harder and adds to the severity of the disease," says Dr Ramilo.

"MRSA isn't new," says Dr Mejias, "but the MRSA picked up in hospitals is a different strain from the MRSA picked up in the community. We now see children with osteomyelitis who have abscesses in the leg and form blood clots that travel to the lungs." She adds: "We don't want to frighten parents, but they should see a doctor if a child develops a limp, back pain and fever after a minor knock, because such knocks make it easier for staphylococci in the blood to reach the bone."

The study followed children admitted to the medical centre in Dallas between 1999 and 2003 with osteomyelitis. Their average age was 6 and 60% were boys; local pain, fever, swelling and limping were seen in more than half. The researchers split the patients into two periods (January 1999 to June 2001 and July 2001 to December 2003) to see when MRSA infections became more common and more severe, and compared MRSA osteomyelitis with other causes, including methicillin-sensitive Staphylococcus aureus (MSSA).

Although the signs at admission didn't change much between the two periods, children treated in the later period were worse off, probably because MRSA had become more common. In the second period:

Bone abscesses were seen in 69% of children with MRSA osteomyelitis, against 26% with MSSA.
Children with MRSA received antibiotics for 42 days, two weeks longer than those with MSSA.
78% of children with MRSA needed surgery, against 49% with MSSA.

So these infections must not be neglected: they need early treatment with the right antibiotics, and surgery when necessary.