Severe Staphylococcal Sepsis in Adolescents in the Era of Community-Acquired Methicillin-Resistant Staphylococcus aureus
- 1 March 2005
- journal article
- case report
- Published by American Academy of Pediatrics (AAP)
- Vol. 115 (3), 642-648
- https://doi.org/10.1542/peds.2004-2300
Abstract
Objective. More than 70% of the community-acquired (CA) staphylococcal infections treated at Texas Children9s 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 Children9s Hospital since September 2002. CA MRSA and clonally related CA MSSA characterized as USA300 and sequence type 8 have been isolated from these patients.Keywords
This publication has 23 references indexed in Scilit:
- Community-Acquired, Methicillin-Resistant and Methicillin-Susceptible Staphylococcus aureus Musculoskeletal Infections in ChildrenThe Pediatric Infectious Disease Journal, 2004
- Pulsed-Field Gel Electrophoresis Typing of Oxacillin-Resistant Staphylococcus aureus Isolates from the United States: Establishing a National DatabaseJournal of Clinical Microbiology, 2003
- Severe Staphylococcus aureus Infections Caused by Clonally Related Community-Acquired Methicillin-Susceptible and Methicillin-Resistant IsolatesClinical Infectious Diseases, 2003
- Clindamycin treatment of invasive infections caused by community-acquired, methicillin-resistant and methicillin-susceptible Staphylococcus aureus in childrenThe Pediatric Infectious Disease Journal, 2003
- 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 StrainsJournal of Clinical Microbiology, 2003
- 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions ConferenceCritical Care Medicine, 2003
- Comparative Molecular Analysis of Community- or Hospital-Acquired Methicillin-Resistant Staphylococcus aureusAntimicrobial Agents and Chemotherapy, 2003
- Association between Staphylococcus aureus strains carrying gene for Panton-Valentine leukocidin and highly lethal necrotising pneumonia in young immunocompetent patientsThe Lancet, 2002
- Relationships between Staphylococcus aureus Genetic Background, Virulence Factors, agr Groups (Alleles), and Human DiseaseInfection and Immunity, 2002
- Pediatric risk of mortality (PRISM) scoreCritical Care Medicine, 1988