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Singh KB, London KI. 18F-FDG PET/CT in paediatric Staphylococcus aureus bacteraemia. J Paediatr Child Health 2024; 60:340. [PMID: 39039657 DOI: 10.1111/jpc.1_16560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 02/28/2024] [Accepted: 04/24/2024] [Indexed: 07/24/2024]
Affiliation(s)
- Karan Bir Singh
- Department of Nuclear Medicine, The Children's Hospital Westmead, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Kevin I London
- Department of Nuclear Medicine, The Children's Hospital Westmead, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Discipline of Medical Imaging Science, Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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Singh KB, London KI. 18F-FDG PET/CT in paediatric Staphylococcus aureus bacteraemia. J Paediatr Child Health 2024; 60:337. [PMID: 38700132 DOI: 10.1111/jpc.16560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 02/28/2024] [Accepted: 04/24/2024] [Indexed: 05/05/2024]
Affiliation(s)
- Karan Bir Singh
- Department of Nuclear Medicine, The Children's Hospital Westmead, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Kevin I London
- Department of Nuclear Medicine, The Children's Hospital Westmead, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Discipline of Medical Imaging Science, Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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El-Sobky T, Mahmoud S. Acute osteoarticular infections in children are frequently forgotten multidiscipline emergencies: beyond the technical skills. EFORT Open Rev 2021; 6:584-592. [PMID: 34377550 PMCID: PMC8335954 DOI: 10.1302/2058-5241.6.200155] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Acute osteoarticular infections (AOI) should be treated as top emergencies. The first few days following the inception of infection are ultra-critical to long-term prognosis.A comprehensive road map for management of childhood AOI is still lacking despite recent advances in microbiology and imaging (magnetic resonance imaging). The many faces of childhood AOI warrant a multidiscipline approach to management.Laboratory and imaging findings of are still debatable and should not overshadow or delay a management plan based on the experienced physician's clinical judgment.Ample evidence-based practice supports the use of a few days of intravenous antibiotic administration followed by oral therapy until correlative clinical and basic laboratory (acute phase reactants) results improve.The growing body of evidence on 'high-risk' children/neonates of AOI warrants continual clinical extra-vigilance in identifying these patient subsets.Open drainage and debridement remain the mainstay of treatment of septic hips, whereas for other joints the use of alternative surgical techniques should be individualized or on case-by-case basis.Because the consequences of misdiagnosis of AOI are usually grave and permanent, proactive treatment/overtreatment is justified in the event of unconfirmed but suspicious diagnosis. Cite this article: EFORT Open Rev 2021;6:584-592. DOI: 10.1302/2058-5241.6.200155.
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Affiliation(s)
- Tamer El-Sobky
- Division of Paediatric Orthopaedics, Department of Orthopaedic Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Shady Mahmoud
- Division of Paediatric Orthopaedics, Department of Orthopaedic Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Duguid RC, Al Reesi M, Bartlett AW, Palasanthiran P, McMullan BJ. Impact of Infectious Diseases Consultation on Management and Outcome of Staphylococcus aureus Bacteremia in Children. J Pediatric Infect Dis Soc 2021; 10:569-575. [PMID: 33355663 DOI: 10.1093/jpids/piaa155] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 11/25/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND To examine the impact of infectious diseases consultation (IDC) on the management and outcome of Staphylococcus aureus bacteremia (SAB) in children. METHODS A retrospective cohort study of children with SAB at a teritary pediatric hospital (January 2009-June 2015) identified by medical record review as to whether they received an IDC for SAB at the discretion of the admitting physician or surgeon was conducted. Differences in management and outcomes for those with and without IDC were evaluated, and multivariate regression analysis was used to determine factors associated with cure. RESULTS There were 100 patients included in the analysis. Fifty-five patients received IDC and 45 had no IDC (NIDC). Appropriate directed therapy within 24 hours (54/55 = 98.2% vs 34/45 = 75.6%, P < .01), choice (54/55 = 98.2% vs 37/45 = 82.2%, P < .01), dose (54/55 = 98.2% vs 36/45 = 80%, P < .01), and duration (52/55 = 94.5% vs 24/45 = 53.3%, P < .01) of directed antibiotic therapy were appropriate in more IDC group patients. Achievement of source control in indicated cases was also more common in the IDC group (28/32 = 87.5% vs 5/26 = 19.1%, P < .01). Appropriate investigation with repeat blood cultures and echocardiograms was not significantly different. All 55 patients in the IDC group had a complete response (cure) compared with 40 of the 45 (88.9%) patients in the NIDC group: 2 patients died and 3 patients had a relapse of infection with subsequent cure. In multivariate regression analysis, methicillin-susceptible SAB and IDC were factors independently associated with cure. CONCLUSIONS Children who received IDC for SAB in a tertiary pediatric setting were more likely to have appropriate investigations and management and had improved outcomes.
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Affiliation(s)
- Robert C Duguid
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Mohammed Al Reesi
- Infectious Diseases Unit, Paediatric Department, Suhar Hospital, Suhar, Oman
| | - Adam W Bartlett
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Pamela Palasanthiran
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Brendan J McMullan
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.,National Centre for Infections in Cancer, The University of Melbourne, Melbourne, Victoria, Australia
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5
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Del Rosal T, Méndez-Echevarría A, Garcia-Vera C, Escosa-Garcia L, Agud M, Chaves F, Román F, Gutierrez-Fernandez J, Ruiz de Gopegui E, Ruiz-Carrascoso G, Ruiz-Gallego MDC, Bernet A, Quevedo SM, Fernández-Verdugo AM, Díez-Sebastian J, Calvo C. Staphylococcus aureus Nasal Colonization in Spanish Children. The COSACO Nationwide Surveillance Study. Infect Drug Resist 2020; 13:4643-4651. [PMID: 33380814 PMCID: PMC7767716 DOI: 10.2147/idr.s282880] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 11/19/2020] [Indexed: 12/12/2022] Open
Abstract
Objective To assess the prevalence and risk factors for S. aureus and methicillin-resistant S. aureus (MRSA) nasal colonization in Spanish children. Methods Cross-sectional study of patients <14 years from primary care centers all over Spain. Clinical data and nasal aspirates were collected from March to July 2018. Results A total of 1876 patients were enrolled. Prevalence of S. aureus and MRSA colonization were 33% (95% CI 30.9–35.1) and 1.44% (95% CI 0.9–2), respectively. Thirty-three percent of the children (633/1876) presented chronic conditions, mainly atopic dermatitis, asthma and/or allergy (524/633). Factors associated with S. aureus colonization were age ≥5 years (OR 1.10, 95% CI 1.07–1.12), male sex (OR 1.43, 95% CI 1.17–1.76), urban setting (OR 1.46, 95% CI 1.08–1.97) and the presence of asthma, atopic dermatitis or allergies (OR 1.25; 95% CI: 1.093–1.43). Rural residence was the only factor associated with MRSA colonization (OR 3.62, 95% CI 1.57–8.36). MRSA was more frequently resistant than methicillin-susceptible S. aureus to ciprofloxacin [41.2% vs 2.6%; p<0.0001], clindamycin [26% vs 16.9%; p=0.39], and mupirocin [14.3% vs 6.7%; p=0.18]. None of the MRSA strains was resistant to tetracycline, fosfomycin, vancomycin or daptomycin. Conclusions The main risk factors for S. aureus colonization in Spanish children are being above five years of age, male gender, atopic dermatitis, asthma or allergy, and residence in urban areas. MRSA colonization is low, but higher than in other European countries and is associated with rural settings.
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Affiliation(s)
- Teresa Del Rosal
- Pediatric Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Madrid, Spain.,Translational Research Network in Pediatric Infectious Diseases (RITIP), Institute for Health Research IdiPAZ, Madrid, Spain
| | - Ana Méndez-Echevarría
- Pediatric Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Madrid, Spain.,Translational Research Network in Pediatric Infectious Diseases (RITIP), Institute for Health Research IdiPAZ, Madrid, Spain
| | - Cesar Garcia-Vera
- "José Ramón Muñoz Fernández" Health Care Center, Aragón Health Service, Zaragoza, Spain
| | - Luis Escosa-Garcia
- Pediatric Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Madrid, Spain.,Translational Research Network in Pediatric Infectious Diseases (RITIP), Institute for Health Research IdiPAZ, Madrid, Spain
| | - Martin Agud
- Pediatric Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Madrid, Spain
| | - Fernando Chaves
- Department of Clinical Microbiology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Federico Román
- Laboratory of Nosocomial Infections, Department of Bacteriology, CNM, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Enrique Ruiz de Gopegui
- Department of Clinical Microbiology, Hospital Universitari Son Espases. Servicio de Microbiología, Palma de Mallorca, Spain
| | | | | | - Albert Bernet
- Section of Microbiology, Arnau de Vilanova University Hospital, Lleida, Spain
| | - Sara Maria Quevedo
- Department of Microbiology, Hospital Universitario Severo Ochoa, Leganes, Spain
| | | | | | - Cristina Calvo
- Pediatric Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Madrid, Spain.,Translational Research Network in Pediatric Infectious Diseases (RITIP), Institute for Health Research IdiPAZ, Madrid, Spain
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Abstract
BACKGROUND Bloodstream infection (BSI) is one of the leading causes of morbidity and mortality in children. This study was done to assess the local epidemiology and outcome of BSIs managed at a large specialist pediatric hospital with a focus on community-onset BSI. METHODS We retrospectively reviewed laboratory-confirmed BSI in children (0-18 years) at The Children's Hospital at Westmead over a 3-year period (2014-2016). Laboratory data and patient medical records were used to determine BSI rates, blood culture contamination rates, patient demographics, isolate profile, antimicrobial resistance and mortality rate in this cohort. RESULTS In total, 47,368 blood cultures were collected; 1027 (2.2%) grew probable contaminants and 991 (2.1%) grew clinically significant isolates. Clinically significant bacteremia accounted for 4.8 per 1000 admissions, with 391 children managed for 465 culture-proven BSI episodes. One hundred thirty-one (28.2%) episodes were community-onset community-associated, and 334 (71.8%) were either community-onset healthcare-associated (HCA) (187; 40.2 %) or hospital-onset (147; 31.6%). Of the significant isolates, 243 (52.3%) were Gram-positive bacteria, 198 (42.6%) were Gram-negative bacteria, 6 (1.3%) were polymicrobial infections and 18 (3.9%) were yeast. Staphylococcus aureus (115; 24.7%) and Escherichia coli (54; 11.6%) were the most common organisms identified. Osteoarticular infection (44; 33.6%) and urosepsis (23; 17.6%) were the most frequent sites of infection associated with non-HCA BSI. Mortality at 30 days was reported in 15 (3.3%) children, all whom had preexisting comorbidities. CONCLUSIONS The majority of BSI episodes managed in our hospital were either community-onset HCA or hospital-onset infections. This highlights the considerable importance of infection control and central venous catheter device care initiatives. Among community-associated BSI, S. aureus in association with osteoarticular infection was predominant.
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Vogel AM, Borland A, van der Werf B, Morales A, Freeman J, Taylor S, Anderson P, Horsfall M, Drinkovic D, Lennon DR. Community-acquired invasive Staphylococcus aureus: Uncovering disparities and the burden of disease in Auckland children. J Paediatr Child Health 2020; 56:244-251. [PMID: 31355978 DOI: 10.1111/jpc.14573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 05/01/2019] [Accepted: 06/29/2019] [Indexed: 11/27/2022]
Abstract
AIM Staphylococcus aureus (SA) causes serious invasive disease in children. Large studies have measured the incidence of SA bacteraemia, but there is less information on the total burden of community-acquired invasive SA (iSA) in children. METHODS A retrospective, cross-sectional analysis of Auckland resident children aged 0-14 years who were hospitalised with iSA between 2011 and 2015 was performed. Laboratory databases and SA-related international classification of diseases 10 discharge codes were searched to identify community-onset cases with SA isolated from a normally sterile site. Clinical records and coroner's reports were reviewed to determine clinical syndromes and exclude nosocomial infections. RESULTS A total of 295 children with iSA were identified. The average annual incidence of iSA was 18.6 per 100 000 - for Pacific populations 44.3 per 100 000, Māori 24.3 per 100 000 and New Zealand European and other 8.8 per 100 000; 68% had bacteraemia. The incidence of iSA for Pacific infants was 10 times greater than non-Māori/non-Pacific (113.4/100 000 population vs. 11.8/100 000). Multivariate analysis found a higher risk of admission in Pacific children, males and those living in areas of high deprivation. Thirty-two patients (10.8%) were admitted to the intensive care unit; risk was higher in infants, Pacific children and those with respiratory infection (Relative Risk (RR) 12.2, 95% confidence interval (CI) 5.7-26.4) and multifocal (RR 6.9, 95% CI 3.4-13.8) and endovascular disease (RR 8.9, 95% CI 3.9-20.6). All deaths (n = 7) had respiratory infections, and four were patients <1 year of age. CONCLUSIONS Studies investigating SA bacteraemia alone significantly underestimate the total burden of iSA disease. There are marked ethnic and socio-economic disparities in iSA disease among Auckland children. Pacific infants are at the highest risk.
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Affiliation(s)
- Alison M Vogel
- Department of Paediatrics, University of Auckland, Auckland, New Zealand.,Kidz First, Counties Manukau District Health Board, Auckland, New Zealand
| | - Annie Borland
- Department of Paediatrics, University of Auckland, Auckland, New Zealand.,General Medicine, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Bert van der Werf
- Section of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Adrienne Morales
- Department of Paediatrics, University of Auckland, Auckland, New Zealand.,Medical Sciences, University of Otago, Dunedin, New Zealand
| | - Joshua Freeman
- Department of Microbiology, Auckland District Health Board, Auckland, New Zealand.,Department of Microbiology, Canterbury District Health Board, Christchurch, New Zealand
| | - Susan Taylor
- Department of Microbiology, Counties Manukau Health Board, Auckland, New Zealand
| | | | - Maraekura Horsfall
- Department of Paediatrics, Waitakere Hospital, Waitemata District Health Board, Auckland, New Zealand
| | - Dragana Drinkovic
- Department of Microbiology, North Shore Hospital, Waitemata District Health Board, Auckland, New Zealand
| | - Diana R Lennon
- Department of Paediatrics, University of Auckland, Auckland, New Zealand.,Kidz First, Counties Manukau District Health Board, Auckland, New Zealand.,Paediatric Infectious Diseases Department, Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand
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Riascos-Pinchao GA, Lozano-Triana C, Camacho Moreno G, Landínez-Millán G. Rare complications of Staphylococcus aureus infection in children: Case reports. REVISTA DE LA FACULTAD DE MEDICINA 2019. [DOI: 10.15446/revfacmed.v67n4.69053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Disseminated staphylococcal disease comprises a set of clinical manifestations secondary to multiple organ invasion that may range from cellulitis to sepsis. In pediatrics, the most common complications are osteoarticular and cutaneous infection; however, this article presents rare manifestations such as glomerulonephritis and thrombotic phenomena. This is the report of two cases of previously healthy adolescents: one presented with osteomyelitis and kidney injury, and the other, with lower limb cellulitis and respiratory deterioration with septic pulmonary embolism. The diagnostic process and additional management are described, highlighting the role of oxacillin in therapy. This article aims to highlight the importance of considering the rare manifestations of S. aureus infection, when the clinical evolution is abnormal, in order to initiate a timely treatment and get a better prognosis.
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Munro APS, Blyth CC, Campbell AJ, Bowen AC. Infection characteristics and treatment of Staphylococcus aureus bacteraemia at a tertiary children's hospital. BMC Infect Dis 2018; 18:387. [PMID: 30097020 PMCID: PMC6086073 DOI: 10.1186/s12879-018-3312-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 08/03/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Staphylococcus aureus bacteraemia (SAB) causes considerable morbidity and mortality in children. Despite this, its epidemiology and risk factors are poorly understood, with minimal paediatric clinical trial data available to guide clinicians in management. We conducted a pilot study to characterise SAB and validate a severity classification for use in future clinical trials. METHODS Patients with SAB were prospectively identified at Princess Margaret Hospital for Children (Perth, Western Australia) from May 2011 to December 2013. Retrospective data were collected from clinical and laboratory records. Cases were classified based on a priori defined criteria as simple (single or contiguous, peripheral site focus) or complex (multi-site, deep tissue, no focus or sepsis) and tested against risk factors and markers of severity of infection. RESULTS There were 49 cases of SAB (median age 7.7 years), with classification as simple (n = 30, 61%) and complex (n = 19, 39%) respectively. There were no deaths or relapses in our cohort. Only 10% of isolates were methicillin resistant S. aureus (MRSA), and none of these were healthcare-associated. Age, gender, Indigenous status, MRSA and healthcare-associated infections were not predictive of complex infection. Pre-existing malignancy was a risk factor for complex infection (p = 0.02). Complex infections were associated with a higher median maximum C reactive protein (216 mg/L vs 50 mg/L, p = < 0.001), longer median length of stay (42 vs 10 days, p = < 0.001) and longer duration of antibiotic therapy (43 vs 34 days, p = 0.03). DISCUSSION This is the first attempt to categorise paediatric SAB as simple versus complex, to guide clinicians in decision making. CONCLUSIONS There is a wide spectrum of disease severity in paediatric SAB, with maximum CRP, length of stay, and duration of therapy greater in those with complex disease. Distinct cohorts with simple and complex courses which may be a target for future clinical trials have been described.
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Affiliation(s)
- Alasdair P. S. Munro
- Department of Infectious Diseases, Perth Children’s Hospital, Hospital Ave, Nedlands, WA 6009 Australia
- Royal Hampshire County Hospital, Romsey Road, Winchester, Hampshire SO22 5DG UK
| | - Christopher C. Blyth
- Department of Infectious Diseases, Perth Children’s Hospital, Hospital Ave, Nedlands, WA 6009 Australia
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Roberts Road, Subiaco, WA 6008 Australia
- Department of Microbiology, PathWest Laboratory Medicine WA, Hospital Ave, Nedlands, WA 6009 Australia
- Centre for Child Health Research, School of Medicine, University of Western Australia, Nedlands, WA 6009 Australia
| | - Anita J. Campbell
- Department of Infectious Diseases, Perth Children’s Hospital, Hospital Ave, Nedlands, WA 6009 Australia
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Roberts Road, Subiaco, WA 6008 Australia
- Centre for Child Health Research, School of Medicine, University of Western Australia, Nedlands, WA 6009 Australia
| | - Asha C. Bowen
- Department of Infectious Diseases, Perth Children’s Hospital, Hospital Ave, Nedlands, WA 6009 Australia
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Roberts Road, Subiaco, WA 6008 Australia
- Centre for Child Health Research, School of Medicine, University of Western Australia, Nedlands, WA 6009 Australia
- Menzies School of Health Research, Charles Darwin University, Rocklands Drive, Tiwi, NT 0810 Australia
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Wang X, Liu Q, Zhang H, Li X, Huang W, Fu Q, Li M. Molecular Characteristics of Community-Associated Staphylococcus aureus Isolates From Pediatric Patients With Bloodstream Infections Between 2012 and 2017 in Shanghai, China. Front Microbiol 2018; 9:1211. [PMID: 29928269 PMCID: PMC5997952 DOI: 10.3389/fmicb.2018.01211] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Accepted: 05/17/2018] [Indexed: 11/13/2022] Open
Abstract
Staphylococcus aureus is known as an invasive human pathogen, resulting in significant morbidity and mortality worldwide; however, information on community-associated S. aureus (CA-SA) from bloodstream infections (BSI) in children in China remains scarce. This study aimed to investigate the molecular characteristics of 78 CA-SA isolates recovered from pediatric patients with BSI between 2012 and 2017 in Shanghai. All isolates including 51 (65.4%) methicillin-susceptible S. aureus (MSSA) and 27 (34.6%) methicillin-resistant S. aureus (MRSA) isolates were characterized based on antimicrobial resistance, virulence genes, multilocus sequence typing (MLST), spa, and SCCmec typing. A total of 18 distinct sequence types (STs) and 44 spa types were identified. ST188 and ST7 were the predominant MSSA clones and ST59-MRSA-SCCmecIV/V was the most common MRSA clone. Spa t189 (9.0%, 7/78) was the most common spa type. SCCmec types IV and V were observed at frequencies of 59.3 and 40.7%, respectively. Notably, 40 (51.3%) S. aureus BSI strains were multidrug resistant (MDR), and these were mostly resistant to penicillin, erythromycin, and clindamycin. MRSA strains were associated with substantially higher rates of resistance to multiple antibiotics than MSSA strains. Fifty (64.1%, 50/78) isolates, including 19 (70.3%) MRSA isolates, harbored ≥ 10 tested virulence genes, as evaluated in this study. Ten (37.0%) MRSA isolates and four (7.8%) MSSA isolates harbored the gene encoding Panton-Valentine leukocidin (PVL). Virulence genes analysis showed diversity in different clones; the seb-sek-seq genes were present in all ST59 strains, whereas the seg-sei-sem-sen-seo genes were present in different clones including ST5, ST20, ST22, ST25, ST26, ST30, ST121, and ST487 strains. In conclusion, this study revealed that community-associated S. aureus strains from BSI in children demonstrated considerable genetic diversity, and identified major genotypes of CA-MRSA and CA-MSSA, with a high prevalence of CA-MRSA. Furthermore, major genotypes were frequently associated with specific antimicrobial resistance and toxin gene profiles. Understanding the molecular characteristics of those strains might provide further insights regarding the spread of BSI S. aureus among children between communities in China.
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Affiliation(s)
- Xing Wang
- Department of Laboratory Medicine, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qian Liu
- Department of Laboratory Medicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - He Zhang
- Department of Emergency, Hebei Provincial Hospital of Traditional Chinese Medicine, Hebei, China
| | - Xia Li
- Department of Medical Microbiology and Immunology, University of California, Davis, Davis, CA, United States
| | - Weichun Huang
- Department of Laboratory Medicine, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qihua Fu
- Department of Laboratory Medicine, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Min Li
- Department of Laboratory Medicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Asgeirsson H, Thalme A, Weiland O. Staphylococcus aureus bacteraemia and endocarditis - epidemiology and outcome: a review. Infect Dis (Lond) 2017; 50:175-192. [PMID: 29105519 DOI: 10.1080/23744235.2017.1392039] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
PURPOSE To review the epidemiology of Staphylococcus aureus bacteraemia (SAB) and endocarditis (SAE), and discuss the short- and long-term outcome. Materials and methods: A literature review of the epidemiology of SAB and SAE. RESULTS The reported incidence of SAB in Western countries is 16-41/100,000 person-years. Increasing incidence has been observed in many regions, in Iceland by 27% during 1995-2008. The increase is believed to depend on changes in population risk factors and possibly better and more frequent utilization of diagnostic procedures. S. aureus is now the leading causes of infective endocarditis (IE) in many regions of the world. It accounts for 15-40% of all IE cases, and the majority of cases in people who inject drugs (PWID). Recently, the incidence of SAE in PWID in Stockholm, Sweden, was found to be 2.5/1000 person-years, with an in-hospital mortality of 2.5% in PWID as compared to 15% in non-drug users. The 30-day mortality associated with SAB amounts to 15-25% among adults in Western countries, but is lower in children (0-9%). Mortality associated with SAE is high (generally 20-30% in-hospital mortality), and symptomatic cerebral embolizations are common (12-35%). The 1-year mortality reported after SAB and SAE is 19-62% and reflects deaths from underlying diseases and complications caused by the infection. In a subset of SAE cases, valvular heart surgery is needed (15-45%), but active intravenous drug use seems to be a reason to refrain from surgery. Despite its importance, there are insufficient data on the optimal management of SAB and SAE, especially on the required duration of antibiotic therapy. Conclusions: The epidemiology of SAB and SAE has been changing in the past decades. They still carry a substantial morbidity and mortality. Intensified studies on treatment are warranted for improving patient outcome.
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Affiliation(s)
- Hilmir Asgeirsson
- a Department of Infectious Diseases , Karolinska University Hospital , Stockholm , Sweden.,b Unit of Infectious Diseases, Department of Medicine Huddinge , Karolinska Institutet , Stockholm , Sweden
| | - Anders Thalme
- a Department of Infectious Diseases , Karolinska University Hospital , Stockholm , Sweden
| | - Ola Weiland
- a Department of Infectious Diseases , Karolinska University Hospital , Stockholm , Sweden.,b Unit of Infectious Diseases, Department of Medicine Huddinge , Karolinska Institutet , Stockholm , Sweden
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