Management of Pediatric Acute Hematogenous Osteomyelitis, Part II: A Focus on Methicillin‐Resistant Staphylococcus aureus, Current and Emerging Therapies

Abstract

Methicillin-resistant Staphylococcus aureus (MRSA) has become the most prevalent cause of acute hematogenous osteomyelitis (AHO) in pediatric patients. This increase in MRSA is due to the rise in community-acquired MRSA. Therefore, it is important that clinicians are aware of the various and upcoming therapies that cover this bacterium. A literature search of the Medline database was performed from creation through January 2018. Articles chosen for the review emphasize well-established MRSA treatment options for pediatric AHO, newer therapies on the horizon, and important pharmacokinetics and pharmacodynamic concepts for treatment. Traditional therapies, including vancomycin and clindamycin, remain effective for the treatment of pediatric AHO. When these agents cannot be used, evidence in AHO has been growing for daptomycin, linezolid, and ceftaroline. Further initial pediatric data with the long-acting lipoglycopeptides show promise and in the future may provide a role in AHO treatment in children.

Update on Acute Bone and Joint Infections in Paediatrics: A Narrative Review on the Most Recent Evidence-Based Recommendations and Appropriate Antinfective Therapy

“…Compared to other available antibiotics that are active against MRSA, the advantages of dalbavancin include a lower potential for drug interactions and the possibility of fewer required doses due to a longer half-life [ 59 ]. Another second-line drug after the failure of previous antibiotics may be daptomycin [ 60 , 61 ]. In complicated severe cases, when the involvement of PVL SA is suspected, antibiotic therapy should aim to inhibit toxin production.…”

A dual PMMA/calcium sulfate carrier of vancomycin is more effective than PMMA‐vancomycin at inhibiting Staphylococcus aureus growth in vitro

“…Vancomycin is one of glycol‐peptide antibiotics that are anti‐gram‐positive bacteria and is especially suitable for fight against methicillin‐resistant Staphylococcus aureus , which is the major pathogen of osteomyelitis [12]. In our previous clinical study, the composite drug delivery system of PMMA/calcium sulfate carried vancomycin could gain more effectively clinical anti‐infection for chronic osteomyelitis [3].…”

Acute osteoarticular infections in children are frequently forgotten multidiscipline emergencies: beyond the technical skills

“… 5 , 6 Hematogenous and/or spread from adjacent anatomic focus are the common modes of acquiring sepsis, with Staphylococcus aureus infections being the most common. 1 , 7 – 9 This is unlike fungal osteomyelitis, where the route of infection is basically exogenous. 10 Developing countries and impoverished populations of the developed world tend to have higher disease burden in terms of both incidence and severity of complications.…”

“… 17 Misdiagnosis, delayed diagnosis and consequent delay in institution of definitive treatment, late presentation, poor compliance with antibiotic regimes, high organism virulence and positive findings on joint ultrasound predict a poor long-term prognosis. 2 , 7 , 9 , 12 , 18 – 20 Empiric antibiotic therapy with or without surgical drainage and debridement are the goal standard for treatment. 7 , 9 Significant controversies exist as to the diagnostic role of acute phase reactants, synovial fluid analysis and culture, antimicrobial regimes and techniques of surgical drainage.…”

“… 2 , 7 , 9 , 12 , 18 – 20 Empiric antibiotic therapy with or without surgical drainage and debridement are the goal standard for treatment. 7 , 9 Significant controversies exist as to the diagnostic role of acute phase reactants, synovial fluid analysis and culture, antimicrobial regimes and techniques of surgical drainage. 7 , 9 , 13 , 18 …”