Clinical characteristics and outcomes of community-acquired methicillin-resistant Staphylococcus aureus septic arthritis
Objective: We investigated the clinical characteristics, treatment patterns and outcomes of community-acquired methicillin resistant Staphylococcus aureus (CA-MRSA) septic arthritis.
Methods: This was a retrospective chart review of CA-MRSA septic arthritis in a tertiary care hospital from 2000-2013. We compared CA-MRSA septic arthritis cases with HA-MRSA septic arthritis cases to identify important differences between the two groups.
Results: We identified 11 cases of CA-MRSA septic arthritis and 34 cases of hospital-acquired methicillin-resistant SA (HA-MRSA) septic arthritis. Community-acquired methicillin-resistant Staphylococcus aureus caused 25% of the MRSA septic arthritis cases. Community-acquired methicillin-resistant Staphylococcus aureus septic arthritis occurred in younger patients with fewer comorbidities or risk factors. There was no difference in initial presentation between CA-MRSA and HA-MRSA. Community-acquired methicillin-resistant Staphylococcus aureus patients were less likely to be treated with appropriate antibiotics initially. Community-acquired methicillin-resistant Staphylococcus aureus septic arthritis was associated with increased morbidity with a high percentage of patients developing poor joint outcomes or osteomyelitis complications. Community-acquired methicillin-resistant Staphylococcus aureus septic arthritis was also associated with increased utilization of health care resources due to long hospital stays, high readmissions rates, and increased requirements for rehabilitation facility placement and home health support. There was no difference in mortality, poor joint outcome, readmissions, and osteomyelitis complications between CA-MRSA septic arthritis and HA-MRSA septic arthritis.
Conclusions: Community-acquired methicillin-resistant Staphylococcus aureus septic arthritis is associated with increased morbidity and health care resource utilization. Increased awareness into CA-MRSA as a cause of septic arthritis in younger patients with no risk factors is important, especially when considering empiric treatment.
Salgado CD, Farr BM, Calfee DP. Community-acquired methicillin-resistant Staphylococcus aureus: a meta-analysis of prevalence and risk factors. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2003;36(2):131-9.
Huang H, Flynn NM, King JH, Monchaud C, Morita M, Cohen SH. Comparisons of community-associated methicillin-resistant Staphylococcus aureus (MRSA) and hospital-associated MSRA infections in Sacramento, California. Journal of clinical microbiology. 2006;44(7):2423-7.
Naimi TS, LeDell KH, Como-Sabetti K, Borchardt SM, Boxrud DJ, Etienne J, et al. Comparison of community- and health care-associated methicillin-resistant Staphylococcus aureus infection. JAMA. 2003;290(22):2976-84.
David MZ, Daum RS. Community-associated methicillin-resistant Staphylococcus aureus: epidemiology and clinical consequences of an emerging epidemic. Clinical microbiology reviews. 2010;23(3):616-87.
Frazee BW, Fee C, Lambert L. How common is MRSA in adult septic arthritis? Annals of emergency medicine. 2009;54(5):695-700.
Ross JJ, Davidson L. Methicillin-resistant Staphylococcus aureus septic arthritis: an emerging clinical syndrome. Rheumatology (Oxford). 2005;44(9):1197-8.
Sharff KA, Richards EP, Townes JM. Clinical management of septic arthritis. Current rheumatology reports. 2013;15(6):332.
Byrne PA, Hosein IK, Camilleri J. Methicillin-resistant Staphylococcus aureus septic arthritis: urgent and emergent. Clinical rheumatology. 1998;17(5):407-8.
Lodise TP, McKinnon PS, Swiderski L, Rybak MJ. Outcomes analysis of delayed antibiotic treatment for hospital-acquired Staphylococcus aureus bacteremia. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2003;36(11):1418-23.
Kessler CS, Kane K, Dev S, Smiley JL. Inadequate postgraduate training of skin and soft tissue infections in an era of community-associated methicillin-resistant Staphylococcus aureus. Journal of investigative medicine : the official publication of the American Federation for Clinical Research. 2013;61(6):1026-9.
Vonk J, Shackelford TK, editors. The Oxford handbook of comparative evolutionary psychology. New York: Oxford University Press; 2012.
David MZ, Crawford SE, Boyle-Vavra S, Hostetler MA, Kim DC, Daum RS. Contrasting pediatric and adult methicillin-resistant Staphylococcus aureus isolates. Emerging infectious diseases. 2006;12(4):631-7.
Charlebois ED, Bangsberg DR, Moss NJ, Moore MR, Moss AR, Chambers HF, et al. Population-based community prevalence of methicillin-resistant Staphylococcus aureus in the urban poor of San Francisco. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2002;34(4):425-33.
Baggett HC, Hennessy TW, Leman R, Hamlin C, Bruden D, Reasonover A, et al. An outbreak of community-onset methicillin-resistant Staphylococcus aureus skin infections in southwestern Alaska. Infection control and hospital epidemiology : the official journal of the Society of Hospital Epidemiologists of America. 2003;24(6):397-402.
Wang WY, Lee SY, Chiueh TS, Lu JJ. Molecular and phenotypic characteristics of methicillin-resistant and vancomycin-intermediate Staphylococcus aureus isolates from patients with septic arthritis. Journal of clinical microbiology. 2009;47(11):3617-23.
- There are currently no refbacks.