Comparison of diagnosis and treatment of MSSA and MRSA osteomyelitis in children: a case-control study of 64 patients

BACKGROUND

We aimed to compare the clinical characteristics of acute osteomyelitis caused by methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive Staphylococcus aureus (MSSA) in children.

METHODS

We retrospectively analyzed the data of 64 children treated between September 2017 and June 2021. Based on the bacterial culture results, they were divided into MRSA and MSSA infection groups. Both groups were treated with debridement and vacuum-assisted closure for negative pressure drainage. Parameters including clinical manifestations, number of operations, length of hospital stay, inflammatory indicators, and concurrent arthritis were compared between the two groups.

RESULTS

In the MRSA infection group, there was one case each of residual joint stiffness and pathological fracture. Conversely, the MSSA group had two cases of residual joint stiffness. The MRSA infection group was more prone to high fever (t = 3.61, P = 0.001), white blood cell count elevation (t = 2.41, P = 0.022), arthritis (X² = 7.48, P = 0.013), metastatic abscess (X² = 4.78, P = 0.042), and a shorter length of progression from onset to admission (t = - 2.04, P = 0.046); however, it required more surgeries (t = 2.68, P = 0.009) and longer hospital stay (t = 2.04, P = 0.045).

CONCLUSIONS

Pediatric acute osteomyelitis caused by MRSA is more prone to cause high fever and markedly elevated of white blood cell count, and is often accompanied with suppurative infection of adjacent joints and metastatic abscesses, thus requiring more surgeries and longer hospital stay.

Biofilm Matrix Formation in Human: Clinical Significance, Diagnostic Techniques, and Therapeutic Drugs

Context: Some recent reports have indicated that almost 80% of clinical infections in humans have biofilm origin and impose additional healthcare costs. This study was an updated review of extracellular polymeric substance matrix (Biofilm) formation in humans and elaborated on its clinical significance, diagnosis, and therapeutic approaches. Evidence Acquisition: This narrative study reviewed the most recent information on the significance of microbial biofilm formation in clinical settings, common biofilm-producing bacterial species, its diagnosis, antibiotic drug resistance, and new approaches to the treatment of infections associated with biofilm formation. Results: Evidence indicated a permanent increase in the frequency of microbial biofilm in the central venous catheter, mechanical heart valve, and urinary catheter, as well as persistent infections. However, antimicrobial resistance induced by biofilms formation and the antimicrobial treatment of biofilms were problematic. Moreover, several assays and lab devices were described to evaluate biofilm formation. Furthermore, new attitudes towards anti-biofilm treatments were introduced in this paper. Conclusions: The number of different mechanisms were in accordance with the recent knowledge on how biofilms play a critical role in the disease pathogenesis. Biofilm strikes the treatment and surveillance of patients bearing infectious diseases under different conditions. The use of new methods in anti-biofilm treatments is effective for the recovery of infected patients.

Investigation of Antimicrobial Susceptibilities Among Bacteria Isolated from Blood Cultures in Hospitalized Patients, Tehran, Iran

Background: Bacteremia is the status, which is detected via a positive blood culture test with no contamination. Centers for Disease Control and Prevention (CDC) indicates that direct medical procedures and total costs are significantly high. Antibiotic resistance can play a major role in the costs, which are related to the long duration of treatment. Objectives: The aim of this study was to investigate the rate and profiles of antimicrobial susceptibility of blood culture isolates from Tehran, Iran. Methods: In the current cross-sectional study, a total of 5,000 blood culture samples were collected from patients hospitalized in the Loghman General Hospital, Tehran, Iran, with positive blood culture results from 2012 to 2013. Susceptibility to antimicrobial agents was analyzed using National Committee for Clinical Laboratory Standards guidelines. Results: Coagulase-negative staphylococci (38.8%), Staphylococcus aureus (20.5%), Acinetobacter (11.9%), and Escherichia coli (11.7%) were the most frequent bacteria isolated from the blood cultures, collectively accounting for > 80% of the isolates. Of isolated microorganisms, 63.75% and 36.24% belonged to Gram-positive and Gram-negative bacteria, respectively. Moreover, 88% of the isolates were MRSA (oxacillin-/methicillin-resistant), and 7% were VRE (vancomycin-resistant). Conclusions: The most frequent isolated organisms were Gram-positive bacteria, and the rate of MDR (multi-drug resistance) was high. The results of the current study obviously indicate the misuse of antibiotic in society. National surveillance studies in Iran will be useful for clinicians to choose the right empirical treatment and will help control and prevent infections caused by resistant organisms.