Severe Staphylococcal Sepsis in Adolescents in the Era of Community-Acquired Methicillin-Resistant Staphylococcus aureus

American Academy of Pediatrics (AAP) - Tập 115 Số 3 - Trang 642-648 - 2005
Blanca E. Gonzalez1,2, Gerardo Martínez‐Aguilar3,4, Kristina G. Hultén3,2, Wendy A. Hammerman3,2, Jorge Coss‐Bu3,2, Anna Avalos-Mishaan3,2, Edward O. Mason3,2, Sheldon L. Kaplan3,2
1Department of Pediatrics, Baylor College of Medicine, Houston, Texas USA
2Texas Children's Hospital, Houston, Texas
3Department of Pediatrics, Baylor College of Medicine, Houston, Texas
4Medical Research Unit in Clinical Epidemiology, Mexican Social Security Institute, Durango, Mexico

Tóm tắt

Objective. More than 70% of the community-acquired (CA) staphylococcal infections treated at Texas Children's Hospital are caused by methicillin-resistant Staphylococcus aureus (MRSA). Since September 2002, an increase in the number of severely ill patients with S aureus infections has occurred. This study provides a clinical description of severely ill adolescent patients and an analysis of their isolates using molecular methods. Methods. We identified adolescent patients meeting criteria for severe sepsis requiring admission to the PICU. Patient records were reviewed, and isolates were obtained for susceptibility testing and DNA extraction. Isolates were tested for the presence of virulence genes (cna, tst, lukS-PV, and lukF-PV) and enterotoxin genes (sea, seb, sec, sed, seh, and sej) by polymerase chain reaction. Genomic fingerprints were determined by repetitive-element polymorphism polymerase chain reaction and pulse-field gel electrophoresis. SCCmec cassette type was determined. Results. Fourteen adolescents with severe CA S aureus infections were identified between August 2002 and January 2004. All were admitted to the PICU with sepsis and coagulopathy. Twelve patients had CA-MRSA infections; 2 had CA methicillin-susceptible Staphylococcus aureus (MSSA) infections. The mean age was 12.9 years (range: 10-15 years). Thirteen patients had pulmonary involvement and/or bone and joint infection; 10 patients had ≥2 bones or joints infected (range: 2-10); 4 patients developed vascular complications (deep venous thrombosis); and 3 patients died. All isolates were identical or closely related to the previously reported predominant clone in Houston, Texas (multilocus sequence type 8, USA300), and carried lukS-PV and lukF-PV genes as well as the SCCmec type IVa cassette (12 MRSA isolates) but did not contain cna or tst. Only 1 strain carried enterotoxin genes (sed and sej). Conclusions. Severe staphylococcal infections in previously healthy adolescents without predisposing risk factors have presented more frequently at Texas Children's Hospital since September 2002. CA MRSA and clonally related CA MSSA characterized as USA300 and sequence type 8 have been isolated from these patients.

Từ khóa


Tài liệu tham khảo

Sattler CV, Correa AG. Coagulase-positive staphylococcal infections (Staphylococcus aureus). In: Feigin RD, Cherry JD, Demmler GJ, Kaplan SL, eds. Textbook of Pediatric Infectious Diseases. 5th ed. Philadelphia, PA: Saunders; 2004:1099–1129

Caksen H, Uzum K, Yuksel S. Prognostic factors in children with Staphylococcus aureus sepsis. J Emerg Med. 2003;25:199–201

Martinez-Aguilar G, Hammerman WA, Mason EO Jr, Kaplan SL. Clindamycin treatment of invasive infections caused by community-acquired, methicillin-resistant and methicillin-susceptible Staphylococcus aureus in children. Pediatr Infect Dis J. 2003;22:593–598

Mongkolrattanothai K, Boyle S, Kahana MD, Daum RS. Severe Staphylococcus aureus infections caused by clonally related community-acquired methicillin-susceptible and methicillin-resistant isolates. Clin Infect Dis. 2003;15;37:1050–1058

Centers for Disease Control and Prevention. Four pediatric deaths from community-acquired methicillin-resistant Staphylococcus aureus—Minnesota and North Dakota, 1997–1999. JAMA. 1999;282:1123–1125

Fey PD, Said-Salim B, Rupp ME, et al. Comparative molecular analysis of community- or hospital-acquired methicillin-resistant Staphylococcus aureus. Antimicrob Agents Chemother. 2003;47:196–203

Dufour P, Gillet Y, Bes M, et al. Community-acquired methicillin-resistant Staphylococcus aureus infections in France: emergence of a single clone that produces Panton-Valentine leukocidin. Clin Infect Dis. 2002;35:819–824

Gillet Y, Issartel B, Vanhems P, et al. Association between Staphylococcus aureus strains carrying gene for Panton-Valentine leukocidin and highly lethal necrotising pneumonia in young immunocompetent patients. Lancet. 2002;359:753–759

Lowy FD. Staphylococcus aureus infections. N Engl J Med. 1998;339:520–532

Shulman ST, Ayoub EM. Severe staphylococcal sepsis in adolescents. Pediatrics. 1976;58:59–66

National Committee for Clinical Laboratory Standards. Performance Standards for Antimicrobial Susceptibility Testing. Fourteenth Informational Supplement (Aerobic Dilution). M100-S14 (M7). Wayne, PA: National Committee for Clinical Laboratory Standards; 2003

Levy MM, Fink MP, Marshall JC, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med. 2003;31:1250–1256

Despond O, Proulx F, Carcillo JA, Lacroix J. Pediatric sepsis and multiple organ dysfunction syndrome. Curr Opin Pediatr. 2001;13:247–253

Young LS. Sepsis syndrome. In: Mandell GL, Bennett JC, Dolin R, eds. Mandell, Douglas and Bennett's Principles and Practice of Infectious Diseases. 5th ed. Philadelphia, PA: Churchill Livingstone; 2000:806–819

Pollack MM, Ruttimann UE, Getson PR. Pediatric risk of mortality (PRISM) score. Crit Care Med. 1988;16:1110–1116

National Committee for Clinical Laboratory Standards. Performance Standards for Antimicrobial Susceptibility Testing. Fourteenth Informational Supplement (Aerobic Dilution). M100-S14 (M7). Table 2C: MIC interpretive standards (μg/mL) for Staphylococcus aureus. Wayne, PA: National Committee for Clinical Laboratory Standards; 2003

Murchan S, Kaufmann ME, Deplano A, et al. Harmonization of pulsed-field gel electrophoresis protocols for epidemiological typing of strains of methicillin-resistant Staphylococcus aureus: a single approach developed by consensus in 10 European laboratories and its application for tracing the spread of related strains. J Clin Microbiol. 2003;41:1574–1585

Tenover FC, Arbeit RD, Goering RV, et al. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol. 1995;33:2233–2239

Okuma K, Iwakawa K, Turnidge JD, et al. Dissemination of new methicillin-resistant Staphylococcus aureus clones in the community. J Clin Microbiol. 2002;40:4289–4294

Jarraud S, Mougel C, Thioulouse J, et al. Relationships between Staphylococcus aureus genetic background, virulence factors, agr groups (alleles), and human disease. Infect Immun. 2002;70:631–641

Avalos Mishaan AM, Mason EO Jr, Martinez-Aguilar G, et al. Emergence of a predominant clone of community acquired Staphylococcus aureus among children in Houston, Texas. Pediatr Infect Dis J. 2005; In press

Fadahunsi HO. Severe staphylococcal sepsis in Nigerian children: a report of 27 cases. Ann Trop Paediatr. 1988;8:22–25

Naimi TS, LeDell KH, Boxrud DJ, et al. Epidemiology and clonality of community-acquired methicillin-resistant Staphylococcus aureus in Minnesota, 1996–1998. Clin Infect Dis. 2001;33:990–996

American Academy of Pediatrics. Toxic shock syndrome. In: Pickering LK, ed. Red Book 2003 Report of the Committee on Infectious Diseases. 26th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2003:624–630

Said-Salim B, Mathema B, Kreiswirth BN. Community-acquired methicillin-resistant Staphylococcus aureus: an emerging pathogen. Infect Control Hosp Epidemiol. 2003;24:451–455

Groom AV, Wolsey DH, Naimi TS, et al. Community-acquired methicillin-resistant Staphylococcus aureus in a rural American Indian community. JAMA. 2001;286:1201–1205

Vandenesch F, Naimi T, Enright MC, et al. Community-acquired methicillin-resistant Staphylococcus aureus carrying Panton-Valentine leukocidin genes: worldwide emergence. Emerg Infect Dis. 2003;9:978–984

Baba T, Takeuchi F, Kuroda M, et al. Genome and virulence determinants of high virulence community-acquired MRSA. Lancet. 2002;359:1819–1827

McDougal LK, Steward CD, Killgore GE, et al. Pulsed-field gel electrophoresis typing of oxacillin-resistant Staphylococcus aureus isolates from the United States: establishing a national database. J Clin Microbiol. 2003;41:5113–5120

Buckingham SC, McDougal LK, Cathey LD, et al. Emergence of community-associated methicillin-resistant Staphylococcus aureus at a Memphis, Tennessee children's hospital. Pediatr Infect Dis J. 2004;23:619–624

Centers for Disease Control and Prevention. Methicillin-resistant Staphylococcus aureus infections in correctional facilities—Georgia, California, and Texas, 2001–2003. MMWR Morb Mortal Wkly Rep. 2003;52:992–996

Martinez-Aguilar G, Avalos-Mishaan A, Hulten K, et al. Community-acquired, methicillin-resistant and methicillin-susceptible Staphylococcus aureus musculoskeletal infections in children. Pediatr Infect Dis J. 2004;23:701–706

Thông tin
Thông tin xuất bản

American Academy of Pediatrics (AAP)

Tập 115 Số 3

642-648

Thông tin tác giả