Risk factors for the development of a DVT in children with osteomyelitis include surgical treatment, CRP > 6, MRSA, and age > 8 years. A fever of greater than 38.5 has NOT been found to be a risk factor.
Deep venous thrombosis is an uncommon complication in pediatric patients but is rising with the increasing incidence of MRSA. Some studies suggest that S. aureus exotoxins, such as the Panton-Valentine leukocidin, can cause leukocyte lysis and additional injury to endothelial surfaces. These events can cause microthrombosis and deep venous thrombosis.
Hollmig et al. did a retrospective evaluation of 212 pediatric patients hospitalized with osteomyelitis. Patients who were diagnosed with DVT were compared with those who did not develop a DVT. The authors identified risk factors for the development of DVT in pediatric patients with osteomyelitis including age greater than 8 years, CRP >6, methicillin-resistant staph aureus, and surgical treatment of the osteomyelitis.
Gonzalez et al, describes the increasing prevalence of methicillin-resistant staphylococcus aureus osteomyelitis and sepsis at Texas Children's Hospital. They identified 26 patients with staphylococcal sepsis. They were able to use DNA testing to isolate the specific strains responsible for infection noting both community acquired and nosocomial acquired organisms.
Illustration A suggests the possible mechanism by which Panton-Valentine leukocidin secreted by MRSA leads to endothelial cell damage. It suggests tissue necrosis could result from release of reactive oxygen species (ROS) from lysed PMNs rather than a direct necrotic effect on epithelial cells.
Hollmig ST, Copley LA, Browne RH, Grande LM, Wilson PL. Deep venous thrombosis associated with osteomyelitis in children. J Bone Joint Surg Am. 2007 Jul;89(7):1517-23. PubMed PMID: .
PMID:17606791 (Link to Abstract)
Gonzalez BE, Martinez-Aguilar G, Hulten KG, Hammerman WA, Coss-Bu J, Avalos-Mishaan A, Mason EO Jr, Kaplan SL. Severe Staphylococcal sepsis in adolescents in the era of community-acquired methicillin-resistant Staphylococcus aureus. Pediatrics. 2005 Mar;115(3):642-8.
PMID:15741366 (Link to Abstract)