Association of Antibiotic Route and Outcomes in Children with Methicillin-Resistant Staphylococcus aureus Bacteremic Osteomyelitis
Abstract Introduction There remains uncertainty about whether transitioning to oral antibiotic therapy is appropriate for the management of children with methicillin-resistant Staphylococcus aureus (MRSA) bacteremic osteomyelitis. We compared clinical outcomes for children with MRSA osteomyelitis wi...
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Adis, Springer Healthcare
2024-11-01
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| Series: | Infectious Diseases and Therapy |
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| Online Access: | https://doi.org/10.1007/s40121-024-01074-2 |
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| author | Jared Olson Rana F. Hamdy Alice J. Hsu Pranita D. Tamma Jeffrey S. Gerber Nora F. Fino Adam L. Hersh |
| author_facet | Jared Olson Rana F. Hamdy Alice J. Hsu Pranita D. Tamma Jeffrey S. Gerber Nora F. Fino Adam L. Hersh |
| author_sort | Jared Olson |
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| description | Abstract Introduction There remains uncertainty about whether transitioning to oral antibiotic therapy is appropriate for the management of children with methicillin-resistant Staphylococcus aureus (MRSA) bacteremic osteomyelitis. We compared clinical outcomes for children with MRSA osteomyelitis with associated bacteremia who were transitioned to discharge oral antibiotic therapy to those discharged on outpatient parenteral antibiotic therapy (OPAT). Methods We performed a retrospective, multicenter, cohort study of children ≤ 18 years hospitalized with MRSA bacteremic osteomyelitis across four children’s hospitals from 2007 to 2018 discharged on oral antibiotic therapy versus OPAT. The primary outcome was treatment failure within 6 months of discharge, defined as any of the following: diagnosis of chronic osteomyelitis, conversion from oral to IV antibiotic route, an operative procedure after the index hospitalization (abscess drainage, bone biopsy, arthrocentesis, or pathologic fracture) and/or recrudescence of MRSA bacteremia. Outcomes were analyzed in an inverse propensity score weighted (IPW) cohort. Results A total of 106 cases of MRSA bacteremic osteomyelitis were included; 44 (42%) were discharged in the oral antibiotic therapy group and 62 (59%) patients were discharged in the OPAT group. In the IPW cohort, treatment failure within 6 months of discharge occurred in 3.4% of children in the discharge oral therapy group and 16.3% in the OPAT group (P = 0.03). The odds of 6-month composite treatment failure between discharge oral therapy and OPAT were 0.18 (95% CI 0.05–0.61). Conclusions Discharge oral therapy was not associated with higher rates of treatment failure compared to OPAT for children with MRSA bacteremic osteomyelitis. |
| format | Article |
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| institution | Kabale University |
| issn | 2193-8229 2193-6382 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | Adis, Springer Healthcare |
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| series | Infectious Diseases and Therapy |
| spelling | doaj-art-e833600654a742cd992e7d75e7bc4a002025-02-02T12:35:15ZengAdis, Springer HealthcareInfectious Diseases and Therapy2193-82292193-63822024-11-01141819010.1007/s40121-024-01074-2Association of Antibiotic Route and Outcomes in Children with Methicillin-Resistant Staphylococcus aureus Bacteremic OsteomyelitisJared Olson0Rana F. Hamdy1Alice J. Hsu2Pranita D. Tamma3Jeffrey S. Gerber4Nora F. Fino5Adam L. Hersh6Department of Pharmacy, Primary Children’s HospitalDepartment of Pediatrics, Children’s National HospitalDepartment of Pharmacy, The Johns Hopkins HospitalDepartment of Pediatrics, The Johns Hopkins University School of MedicineDepartment of Pediatrics, Children’s Hospital of PhiladelphiaDivision of Epidemiology, Department of Internal Medicine, University of UtahDivision of Infectious Diseases, Department of Pediatrics, University of UtahAbstract Introduction There remains uncertainty about whether transitioning to oral antibiotic therapy is appropriate for the management of children with methicillin-resistant Staphylococcus aureus (MRSA) bacteremic osteomyelitis. We compared clinical outcomes for children with MRSA osteomyelitis with associated bacteremia who were transitioned to discharge oral antibiotic therapy to those discharged on outpatient parenteral antibiotic therapy (OPAT). Methods We performed a retrospective, multicenter, cohort study of children ≤ 18 years hospitalized with MRSA bacteremic osteomyelitis across four children’s hospitals from 2007 to 2018 discharged on oral antibiotic therapy versus OPAT. The primary outcome was treatment failure within 6 months of discharge, defined as any of the following: diagnosis of chronic osteomyelitis, conversion from oral to IV antibiotic route, an operative procedure after the index hospitalization (abscess drainage, bone biopsy, arthrocentesis, or pathologic fracture) and/or recrudescence of MRSA bacteremia. Outcomes were analyzed in an inverse propensity score weighted (IPW) cohort. Results A total of 106 cases of MRSA bacteremic osteomyelitis were included; 44 (42%) were discharged in the oral antibiotic therapy group and 62 (59%) patients were discharged in the OPAT group. In the IPW cohort, treatment failure within 6 months of discharge occurred in 3.4% of children in the discharge oral therapy group and 16.3% in the OPAT group (P = 0.03). The odds of 6-month composite treatment failure between discharge oral therapy and OPAT were 0.18 (95% CI 0.05–0.61). Conclusions Discharge oral therapy was not associated with higher rates of treatment failure compared to OPAT for children with MRSA bacteremic osteomyelitis.https://doi.org/10.1007/s40121-024-01074-2Acute osteomyelitisMethicillin-resistant Staphylococcus aureusBacteremia |
| spellingShingle | Jared Olson Rana F. Hamdy Alice J. Hsu Pranita D. Tamma Jeffrey S. Gerber Nora F. Fino Adam L. Hersh Association of Antibiotic Route and Outcomes in Children with Methicillin-Resistant Staphylococcus aureus Bacteremic Osteomyelitis Infectious Diseases and Therapy Acute osteomyelitis Methicillin-resistant Staphylococcus aureus Bacteremia |
| title | Association of Antibiotic Route and Outcomes in Children with Methicillin-Resistant Staphylococcus aureus Bacteremic Osteomyelitis |
| title_full | Association of Antibiotic Route and Outcomes in Children with Methicillin-Resistant Staphylococcus aureus Bacteremic Osteomyelitis |
| title_fullStr | Association of Antibiotic Route and Outcomes in Children with Methicillin-Resistant Staphylococcus aureus Bacteremic Osteomyelitis |
| title_full_unstemmed | Association of Antibiotic Route and Outcomes in Children with Methicillin-Resistant Staphylococcus aureus Bacteremic Osteomyelitis |
| title_short | Association of Antibiotic Route and Outcomes in Children with Methicillin-Resistant Staphylococcus aureus Bacteremic Osteomyelitis |
| title_sort | association of antibiotic route and outcomes in children with methicillin resistant staphylococcus aureus bacteremic osteomyelitis |
| topic | Acute osteomyelitis Methicillin-resistant Staphylococcus aureus Bacteremia |
| url | https://doi.org/10.1007/s40121-024-01074-2 |
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