Staphylococcus aureus clones causing osteomyelitis; a literature review (2000-2020).

Abstract Objectives Staphylococcus aureus is the most common causative organism of osteomyelitis (OM). Nevertheless, the molecular epidemiology of S. aureus causing OM remains ill-defined. This study aims to address the global epidemiology of S. aureus clones from OM patients. Methods Literature databases were searched for studies reporting the molecular typing of S. aureus involved in OM, published between January 1, 2000 and July 29, 2020. Data from 32 articles that fulfilled inclusion criteria were analyzed for year of publication, country of patients, methicillin-susceptibility, and genotypic characteristics of S. aureus isolates. Results Pandemic clones CC5, CC8, CC22, CC30 and CC45 were the most common in OM. The distribution of clones greatly differed among studies due to the local epidemiology of S. aureus and to the MSSA heterogeneity. PVL-positive MRSA clones belonging to ST80/CC80 and ST8/CC8/USA300 were the most common among paediatric patients in Europe and USA; greater variability was observed in the adult population. In Europe, MRSA belonged to PVL-negative CC5, CC8 and CC22 indicating a nosocomial origin of infections; in Asia the PVL-positive ST59/CC59 MRSA was the most frequent. PVL-positive clones were often detected in hematogenous OM in children and adults. Although MSSA were polyclonal, the PVL-negative ST398/CC398 MSSA was the most prevalent clone in diabetic foot OM. Conclusions All major S. aureus clones circulating in both hospital and community settings appear to be capable of causing OM. Future studies reporting molecular typing and genomic data will provide more insights into the epidemiology and pathobiology of S. aureus clones causing OM.