Factors associated with severity in invasive community-acquired Staphylococcus aureus infections in children: a prospective European multicentre study

Abstract

Staphylococcus aureus is the main pathogen responsible for bone and joint infections worldwide and is also capable of causing pneumonia and other invasive severe diseases. Panton-Valentine leukocidin (PVL) and methicillin-resistant S. aureus (MRSA) have been studied as factors related with severity in these infections. The aims of this study were to describe invasive community-acquired S. aureus (CA-SA) infections and to analyse factors related to severity of disease. Paediatric patients (aged 0-16 years) who had a CA-SA invasive infection were prospectively recruited from 13 centres in 7 European countries. Demographic, clinical and microbiological data were collected. Severe infection was defined as invasive infection leading to death or admission to intensive care due to haemodynamic instability or respiratory failure. A total of 152 children (88 boys) were included. The median age was 7.2 years (interquartile range, 1.3-11.9). Twenty-six (17%) of the 152 patients had a severe infection, including 3 deaths (2%). Prevalence of PVL-positive CA-SA infections was 18.6%, and 7.8% of the isolates were MRSA. The multivariate analysis identified pneumonia (adjusted odds ratio (aOR) 13.39 (95% confidence interval (CI) 4.11-43.56); p 0.008), leukopenia at admission (<3000/mm(3)) (aOR 18.3 (95% CI 1.3-259.9); p 0.03) and PVL-positive infections (aOR 4.69 (95% CI 1.39-15.81); p 0.01) as the only factors independently associated with severe outcome. There were no differences in MRSA prevalence between severe and nonsevere cases (aOR 4.30 (95% CI 0.68- 28.95); p 0.13). Our results show that in European children, PVL is associated with more severe infections, regardless of methicillin resistance.

Epidemiology and Antibacterial Treatment of Acute Hematogenous Osteomyelitis in Patients Hospitalized at Children’s Clinical University Hospital in Riga, Latvia

“…More studies are necessary to investigate the role of PVL toxin in the outcome of AHO at our study site. Similarly to other European countries, the prevalence of MRSA bacteraemia amongst those of S. aureus origin has decreased from 26.6% in 2004 to 9% in 2009 (9). The prevalence of MRSA in AHO patients from our study sample was even lower, 1.4%, which must be considered when prescribing antibacterial treatment.…”

“…aureus (MRSA), and the possible acquisition of Panton-Valentine leukocidin (PVL) gene, a virulence factor associated with increased speed of propagation, severity of inflammation, and higher complication rate (6,13). According to latest studies, the prevalence of MRSA amongst invasive infections caused by Staphylococcus aureus is approximately 8% in Europe (9), whereas in USA it is the causative agent of AHO in up to 40% to 50% of cases (7). Another microorganism with a significant role in pathogenesis of AHO is Kingella kingae, a species of Gram-negative aerobic coccobacilli.…”

Methicillin-sensible Staphylococcus aureus causing endocarditis, with cerebral and orthopaedic complications, in a 17-month-old child with no risk factor

“…A recent European prospective study described factors associated with severity in invasive community-acquired S. aureus infections in children, it also shows an association with predisposal condition (30%), as intravascular device, chronic or acute predisposing diseases, oncological diseases or neonates 8. They found that the presence of valentine panton leucocidin (VPL), pneumonia and leucopenia are independently associated with severe S. aureus infection in children; our child did not show any of those factors.…”

A Cross-Sectional Study of Colonization Rates with Methicillin-Resistant Staphylococcus aureus (MRSA) and Extended-Spectrum Beta-Lactamase (ESBL) and Carbapenemase-Producing Enterobacteriaceae in Four Swiss Refugee Centres

“…We used whole genome sequencing (WGS) to assess the relatedness of isolates and provided evidence for a suspected MRSA-transmission event in one refugee centre. In addition, we determined the rate of Panton-Valentine leukocidin (PVL)-positive MRSA strains from WGS data, as this toxin is a major virulence factor for pathogen transmission and more severe clinical infections [7]. …”