Clindamycin, cefazolin effective for osteoarticular infections caused by S. aureus

MEMPHIS, Tenn. — Non-nafcillin treatment regimens were efficacious and well tolerated among patients with methicillin-sensitive Staphylococcus aureus osteoarticular infections, according to results of a comparative efficacy study presented at the St. Jude/PIDS Pediatric Infectious Diseases Research Conference.

Perspective from C. Buddy Creech, MD, MPH

Although nafcillin is considered first-line therapy for invasive methicillin-susceptible S. aureus (MSSA), nafcillin has higher costs and complication rates compared with cefazolin or clindamycin.

Andrew Nuibe, MD, of the division of infectious diseases at the University of Utah School of Medicine, and colleagues analyzed data from 115 patients with MSSA osteoarticular infections who were admitted to Primary Children’s Hospital in Salt Lake City from 2008 to 2012.

Andrew Nuibe

Of the 115 patients, 75% had a diagnosis of MSSA bacteremia; 50% had osteomyelitis; 27% had septic arthritis; and 23% had both. Ninety-nine patients (86%) were treated with a nafcillin-containing regimen and 16 (14%) with a non-nafcillin regimen.

There were no significant differences in outcome measures when comparing nafcillin to non-nafcillin regimens, which included median length of stay; median number of surgical drainage procedures; number of readmissions; or complications (clot, infection or phlebitis).

“Larger studies are warranted to determine whether these regimens should be considered first-line therapy,” the study researchers concluded.

For more information:

Nuibe A. Abstract 201418. Presented at: St. Jude/PIDS Pediatric Infectious Diseases Research Conference; Feb. 21-22, 2014; Memphis, Tenn.

Disclosure: The researchers report no relevant financial disclosures.

Perspective

C. Buddy Creech, MD, MPH

It’s encouraging to see this study, which is focused on the treatment of methicillin-susceptible Staphylococcus aureus. While MRSA certainly has ruled the roost recently, methicillin-susceptible S. aureus (MSSA) continues to cause substantial morbidity and mortality in children, and therapy is surprisingly complicated. Many of us in pediatric ID have elected to use nafcillin or oxacillin preferentially; however, others use regimens such as cefazolin or clindamycin for these patients. No regimen is perfect, although from experience we know that nafcillin and oxacillin are often associated with dose-limiting changes in renal function and hepatic integrity and are extremely painful in the event of extravasation. Nuibe and colleagues suggest that a cheaper, less frequently administered antimicrobial such as cefazolin could be as effective, and certainly safer, than nafcillin or oxacillin. While their sample size is not sufficient to answer the question completely, it certainly informs future work, as we seek to understand the best treatment options for osteoarticular disease. Data such as these are important as the Pediatric Infectious Diseases Society drafts clinical practice guidelines for the treatment of osteoarticular infections in children.

C. Buddy Creech, MD, MPH

Infectious Diseases in Children Editorial Board Member

Disclosures: Creech reports no relevant financial disclosures.