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Safe, effective treatment is possible for children with S. aureus osteomyelitis
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SAN DIEGO — Hospital admissions rates for children with venous thromboembolism related to community-acquired Staphylococcus aureus osteomyelitis appear to be increasing, but results of a study presented here during ID Week 2012 indicated that these children can be treated with anticoagulants safely and effectively.
In a study of 227 children with community-acquired S. aureus osteomyelitis (OM), 31 of the children had deep vein thrombosis (DVT) and 22 had septic pulmonary emboli (PE); 19 of those 22 children with PE also had concomitant DVT, according to Sheldon Kaplan, MD, department of pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston, Texas, one of the study authors.
Sheldon Kaplan
“This is an important issue because of the circulating clones, especially of community-associated methicillin-resistant S. aureus (MRSA), we are seeing more venous thromboses,” Kaplan told Infectious Diseases in Children. “This was not an issue in the past with osteomyelitis, but now with these new circulating clones, it is something that occurs, and we really don’t understand why. Maybe this organism has some unique ability to turn on thrombosis mechanisms in the host is one thing that is suspected.”
DVT was adjacent to the OM site in 90% of the 31 children and 74% of those children had DVT in the lower extremities. Of the three children without DVT adjacent to the OM site, only one was associated with a central line, Kaplan, an Infectious Diseases in Children Board Member, said.
Of the children with DVT, MRSA was more common than methicillin-susceptible S. aureus (odds ratio 1.9; P=.11) and children with DVT were more likely to be admitted to the intensive care unit (OR 32.2; P=.0001) and have longer hospital stays (P<.0001).
Most patients (74%) had clot resolution and treated with unfractionated heparin and/or enoxaparin. The mean duration of anticoagulation was 85 days and overall survival rate was 99.6%; four patients were lost to follow up. There were two nonlife-threatening bleeding episodes, according to study findings.
“We think it is important for clinicians taking care of patients with S. aureus OM to be aware of this potential complication because it may lead to septic emboli to the lungs,” Kaplan explained. “At least in our experience, anticoagulanting these patients in preventing ongoing embolization and seems to be quite safe. It is certainly something that is done routinely in adults.”
ID Week 2012 is the first joint meeting of the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society of America, the Society for Healthcare Epidemiologists of America, and the HIV Medical Association.
For more information:
Patel K. Abstract #488. Presented at: ID Week 2012; October 17-21, 2012; San Diego.
Disclosure: Kaplan is a grant investigator and research grant recipient of Pfizer.