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Vo-Pham-Minh T, Tran-Cong D, Phan-Viet H, Dinh-Chi T, Nguyen-Thi-Hong T, Cao-Thi-My T, Nguyen-Thi-Dieu H, Vo-Thai D, Nguyen-Thien V, Duong-Quy S. Staphylococcus aureus Pneumonia in Can Tho, Vietnam: Clinical Characteristics, Antimicrobial Resistance Profile and Risk Factors of Mortality. Pulm Ther 2024; 10:193-205. [PMID: 38446335 PMCID: PMC11282013 DOI: 10.1007/s41030-024-00254-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 02/05/2024] [Indexed: 03/07/2024] Open
Abstract
INTRODUCTION Staphylococcus aureus (S. aureus) is an important pathogen in both community-acquired and hospital-acquired pneumonia. S. aureus pneumonia has a high mortality rate and serious complications. Resistance to multiple antibiotics is a major challenge in the treatment of S. aureus pneumonia. Understanding the antibiotic resistance profile of S. aureus and the risk factors for mortality can help optimize antibiotic regimens and improve patient outcomes in S. aureus pneumonia. METHODS A prospective cohort study of 118 patients diagnosed with S. aureus pneumonia between May 2021 and June 2023 was conducted, with a 30-day follow-up period. Demographic information, comorbidities, Charlson Comorbidity Index, clinical characteristics, outcomes, and complications were collected for each enrolled case. The data were processed and analyzed using R version 3.6.2. RESULTS S. aureus pneumonia has a 30-day mortality rate of approximately 50%, with complication rates of 22% for acute respiratory distress syndrome (ARDS), 26.3% for septic shock, and 14.4% for acute kidney injury (AKI). Among patients with methicillin-resistant S. aureus (MRSA) pneumonia treated with vancomycin (n = 40), those with a vancomycin minimum inhibitory concentration (MIC) ≤ 1 had significantly higher cumulative survival at day 30 compared to those with MIC ≥ 2 (log-rank test p = 0.04). The prevalence of MRSA among S. aureus isolates was 84.7%. Hemoptysis, methicillin resistance, acidosis (pH < 7.35), and meeting the Infectious Diseases Society of America/American Thoracic Society (IDSA/ATS) criteria for severe pneumonia were significantly associated with mortality in a multivariate Cox regression model based on the adaptive least absolute shrinkage and selection operator (LASSO). CONCLUSIONS S. aureus pneumonia is a severe clinical condition with high mortality and complication rates. MRSA has a high prevalence in Can Tho City, Vietnam. Hemoptysis, methicillin resistance, acidosis (pH < 7.35), and meeting the IDSA/ATS criteria for severe pneumonia are risk factors for mortality in S. aureus pneumonia.
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Affiliation(s)
- Thu Vo-Pham-Minh
- Department of Internal Medicine, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho City, 94000, Vietnam
| | - Dang Tran-Cong
- Department of Internal Medicine, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho City, 94000, Vietnam
| | - Hung Phan-Viet
- Department of Internal Medicine, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho City, 94000, Vietnam
| | - Thien Dinh-Chi
- Department of Internal Medicine, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho City, 94000, Vietnam
| | - Tran Nguyen-Thi-Hong
- Department of Internal Medicine, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho City, 94000, Vietnam
| | - Thuy Cao-Thi-My
- Respiratory Department, Can Tho Central General Hospital, Can Tho City, 94000, Vietnam
| | - Hien Nguyen-Thi-Dieu
- Microbiological Department, Can Tho Central General Hospital, Can Tho City, 94000, Vietnam
| | - Duong Vo-Thai
- Microbiological Department, Can Tho Central General Hospital, Can Tho City, 94000, Vietnam
| | - Vu Nguyen-Thien
- Pharmacy Department, Can Tho University of Medicine and Pharmacy Hospital, Can Tho City, 94000, Vietnam
| | - Sy Duong-Quy
- Bio-Medical Research Centre, Lam Dong Medical College, Da Lat, Vietnam.
- Penn State Medical College, Hershey Medical Center, Hershey, PA, 117033, USA.
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Luo Y, Wang Y. Development of a Nomogram for Predicting Massive Necrotizing Pneumonia in Children. Infect Drug Resist 2023; 16:1829-1838. [PMID: 37016631 PMCID: PMC10066889 DOI: 10.2147/idr.s408198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 03/17/2023] [Indexed: 03/31/2023] Open
Abstract
Objective This study aimed to develop a nomogram model for predicting massive necrotizing pneumonia (NP) in children. Methods A total of 282 children with NP admitted to Kunming Children's Hospital from January 2014 to November 2022 were enrolled. The children with NP were divided into massive necrotizing pneumonia (MNP) group and non-MNP group according to the severity of the lung necrosis. The clinical data of the children were collected, and least absolute shrinkage and selection operator (LASSO) regression and multivariate logistic regression models were used to analyze the influencing factors of MNP. A nomogram model was constructed, and its predictive efficacy was evaluated. Results The predictors selected by LASSO regression analysis were: haematogenous spread, white blood cell (WBC), hemoglobin (Hb), C-reactive protein (CRP), lactate dehydrogenase (LDH), and activated partial thromboplastin time (APTT) (P < 0.05). Based on the above independent influencing factors, a nomogram model for MNP was constructed. The bootstrap method was used to repeat sampling 1000 times. The results showed that the consistency index of the nomogram model in predicting MNP was 0.833 in the training set and 0.810 in the validation set. The results of ROC curve analysis showed that the area under the receiver-operating-characteristic curve (AUC) of the nomogram model for predicting MNP was 0.889 [95% CI (0.818, 0.959)] in the training set and 0.814 [95% CI (0.754, 0.874)] in the validation set. The calibration curve of the nomogram predicting MNP was basically close to the actual curve. The decision curve showed that the nomogram had good clinical utility. Conclusion We developed a nomogram for predicting MNP, which can help clinicians identify the severity of lung necrosis early.
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Affiliation(s)
- Yonghan Luo
- Second Department of Infectious Disease, Kunming Children’s Hospital, Kunming, Yunnan, People’s Republic of China
| | - Yanchun Wang
- Second Department of Infectious Disease, Kunming Children’s Hospital, Kunming, Yunnan, People’s Republic of China
- Correspondence: Yanchun Wang, Second Department of Infectious Disease, Kunming Children’s Hospital, Kunming, Yunnan, 650000, People’s Republic of China, Email
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Li Q, Zhang X, Chen B, Ji Y, Chen W, Cai S, Xu M, Yu M, Bao Q, Li C, Zhang H. Early predictors of lung necrosis severity in children with community-acquired necrotizing pneumonia. Pediatr Pulmonol 2022; 57:2172-2179. [PMID: 35686616 DOI: 10.1002/ppul.26020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 05/17/2022] [Accepted: 05/29/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To analyze baseline clinical and laboratory characteristics and explore the possible predictors of lung necrosis severity in children with community-acquired necrotizing pneumonia (NP). METHODOLOGY This retrospective observational study was performed in a tertiary referral center. A total of 104 patients aged <15 years with community-acquired pneumonia and radiologically confirmed NP by computed tomography (CT) were included. Patients were classified into the mild, moderate, or massive necrosis groups. RESULTS Among them, 29, 41, and 34 patients had mild, moderate, and massive necrosis, respectively. Moreover, 34.6% of the patients were admitted to pediatric intensive care unit. Massive necrosis was more likely to occur during winter (p < 0.05) and was associated with more severe clinical outcomes, such as longer duration of fever, longer hospitalization, increased mortality, and a higher risk of subsequent surgical intervention (p < 0.05). Multivariate analysis demonstrated that the following were independent risk factors for massive necrosis in this study: C-reactive protein (CRP) (p = 0.036), serum albumin (p = 0.009), and immunoglobulin M (IgM) (p = 0.022). Receiver operating characteristic analysis showed that when the cut-off value for CRP, serum albumin, and IgM were set at 122 mg/L, 30.8 g/L, and 95.7 mg/dl, respectively, they showed good diagnostic performance for differentiating patients with massive necrosis from all patients with NP. CONCLUSION NP is a potentially severe complication of pediatric community-acquired pneumonia. Different severities of lung necrosis can lead to different clinical outcomes. CRP, serum albumin, and IgM levels are independent predictors of the degree of lung necrosis.
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Affiliation(s)
- Qiaoling Li
- Department of Pediatric Respiratory Disease, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China.,Institute of Biomedical Informatics, School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, China
| | - Xueya Zhang
- Department of Pediatric Respiratory Disease, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China.,Institute of Biomedical Informatics, School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, China
| | - Bo Chen
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Yongan Ji
- Department of Clinical Laboratory, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Wei Chen
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Shujing Cai
- Department of Pediatric Respiratory Disease, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Ming Xu
- Department of Pediatric Respiratory Disease, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Mingwei Yu
- Department of Pediatric Respiratory Disease, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Qiyu Bao
- Institute of Biomedical Informatics, School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, China.,Key Laboratory of Medical Genetics of Zhejiang Province, Key Laboratory of Laboratory Medicine, Ministry of Education of China, School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, China.,Department of Laboratory Sciences, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Changchong Li
- Department of Pediatric Respiratory Disease, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Hailin Zhang
- Department of Pediatric Respiratory Disease, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China.,Institute of Biomedical Informatics, School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, China
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SARS-CoV-2 with Panton-Valentine leukocidin-producing Staphylococcus aureus healthcare-associated pneumonia in the Indian Ocean. Heliyon 2022; 8:e10422. [PMID: 36091947 PMCID: PMC9444300 DOI: 10.1016/j.heliyon.2022.e10422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 07/04/2022] [Accepted: 08/18/2022] [Indexed: 11/21/2022] Open
Abstract
At this time, the literature reports only one case of superinfection with Panton-Valentine leukocidin (PVL)-producing Staphylococcus aureus in a patient with severe acute respiratory distress syndrome secondary to coronavirus 2 (SARS-CoV-2) pneumonia. Here we report the first two cases of PVL-producing S. aureus healthcare-associated pneumonia in patients hospitalized for SARS-CoV-2 pneumonia in the Indian Ocean region. The two isolated strains of S. aureus were found to belong to the ST152/t355 clone, a known PVL-producing S. aureus clone that circulates in Africa and is responsible for infections imported into Europe. Our two cases reinforce the hypothesis that SARS-CoV-2 infection favors the occurrence of PVL-producing S. aureus pneumonia. Production of PVL should be searched in patients returning from the Indian Ocean region who present with severe SARS-CoV-2 pneumonia complicated by superinfection with S. aureus even in the case of late onset healthcare-associated pneumonia
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Blot M, Zeggay A, Aho-Glele LS, Laborde C, Le Moing V, Chirouze C, Bouiller K, Piroth L. Is blood lymphocyte count a prognostic biomarker in Staphylococcus aureus bacteremia? J Investig Med 2022; 70:1549-1552. [DOI: 10.1136/jim-2022-002356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2022] [Indexed: 11/04/2022]
Abstract
Lymphopenia is common in patients with sepsis and associated with mortality. Immune-stimulatory therapies likely to restore T-cells count and function are under investigation in sepsis. Our study aimed to assess whether lymphopenia is a reliable prognostic biomarker in Staphylococcus aureus bacteremia. We conducted an ancillary study of the prospective VIRSTA Study including 574 patients with S. aureus bacteremia in two tertiary care centers. Neither lymphocyte count at the onset nor lymphocyte change during the first 4 days was associated with 12-week mortality. These results highlight the importance of characterizing the immune profile of patients with sepsis according to the cause before investigating immunostimulatory therapies to restore lymphocyte proliferation and function.
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Pichon M, Micaelo M, Rasoanandrasana S, Menn AM. Molecular characterization of Staphylococcus aureus isolates derived from severe pneumonia: a retrospective monocentre study. Infect Dis (Lond) 2021; 53:811-819. [PMID: 34382901 DOI: 10.1080/23744235.2021.1963472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Staphylococcus aureus is endowed with a repertoire of virulence factors potentially implicated in its pathogenicity and ability to cause invasive disease. The main objective of this study was to describe the bacterial genotype, including virulence genes and affiliation to clonal complexes (CCs), encountered in severe pneumonia. METHODS DNA microarray was used to analyse 18 S. aureus isolates from patients hospitalized with severe pneumonia between 2017 and 2019. RESULTS Among 18 S. aureus isolates, 14 were methicillin-susceptible S. aureus (MSSA), and 4 methicillin-resistant S. aureus (MRSA). There were 14 community-acquired, 3 healthcare-associated, and 1 hospital-acquired infections. Different radiological presentations were observed: necrotizing pneumonia (n = 8, 44%), alveolar consolidation (n = 7, 39%), alveolar-interstitial infiltrates (n = 3, 17%). Sixteen patients (89%) required ICU hospitalization, 13 (72%) an invasive mechanical ventilation, and 12 (67%) a vasopressor support. Mortality affected 6 patients (33%). Panton-Valentine leukocidin (PVL), staphylococcal enterotoxins, toxic shock syndrome toxine-1 (TSST-1) encoding genes were documented in nine (50%), 12 (67%), one (6%) of the isolates, respectively. Accessory regulator gene group I was the most reported (n = 9, 50%) and was found in five deaths. The majority of isolates were affiliated to CC152 (n = 6), followed by CC15 (n = 3), CC45 (n = 2), CC30 (n = 2), CC1 (n = 2), CC8 (n = 1), CC9 (n = 1), and CC25 (n = 1). All the CC152 isolates were PVL-positive. CONCLUSION CC152-PVL positive S. aureus strains were the most prevalent in severe pneumonia. Other virulence gene profiles were found coupled to additional clonal lineages. A genotyping strategy contributes to describe the current circulating strains and bacterial genetic backgrounds.
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Affiliation(s)
- Maud Pichon
- Service de Médecine Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil, France
| | - Maïte Micaelo
- Service de Microbiologie, Centre Hospitalier Victor Dupouy, Argenteuil, France
| | | | - Anne-Marie Menn
- Service de Médecine Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil, France
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Raineri EJM, Altulea D, van Dijl JM. Staphylococcal trafficking and infection - from 'nose to gut' and back. FEMS Microbiol Rev 2021; 46:6321165. [PMID: 34259843 PMCID: PMC8767451 DOI: 10.1093/femsre/fuab041] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 07/11/2021] [Indexed: 12/12/2022] Open
Abstract
Staphylococcus aureus is an opportunistic human pathogen, which is a leading cause of infections worldwide. The challenge in treating S. aureus infection is linked to the development of multidrug-resistant strains and the mechanisms employed by this pathogen to evade the human immune defenses. In addition, S. aureus can hide asymptomatically in particular ‘protective’ niches of the human body for prolonged periods of time. In the present review, we highlight recently gained insights in the role of the human gut as an endogenous S. aureus reservoir next to the nasopharynx and oral cavity. In addition, we address the contribution of these ecological niches to staphylococcal transmission, including the roles of particular triggers as modulators of the bacterial dissemination. In this context, we present recent advances concerning the interactions between S. aureus and immune cells to understand their possible roles as vehicles of dissemination from the gut to other body sites. Lastly, we discuss the factors that contribute to the switch from colonization to infection. Altogether, we conclude that an important key to uncovering the pathogenesis of S. aureus infection lies hidden in the endogenous staphylococcal reservoirs, the trafficking of this bacterium through the human body and the subsequent immune responses.
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Affiliation(s)
- Elisa J M Raineri
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Dania Altulea
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jan Maarten van Dijl
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Cilloniz C, Dominedò C, Gabarrús A, Garcia-Vidal C, Becerril J, Tovar D, Moreno E, Pericás JM, Vargas CR, Torres A. Methicillin-susceptible staphylococcus aureus in community-acquired pneumonia: Risk factors and outcomes. J Infect 2020; 82:76-83. [PMID: 33144192 DOI: 10.1016/j.jinf.2020.10.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 01/21/2023]
Abstract
OBJECTIVES We aimed to describe the prevalence, risk factors and outcomes of Methicillin-susceptible S. aureus (MSSA) community-acquired pneumonia (CAP) and compare them with those associated with CAP due to Streptococcus pneumoniae, the most frequent causative microorganism, in a large cohort of patients. METHODS This was an observational study of prospectively collected data of consecutive adults with CAP and a definitive etiology enrolled between 2004 and 2018. Patients were divided into MSSA CAP and pneumococcal CAP groups for analysis. RESULTS A microbial etiology was established in 1,548 (33%) cases: S. aureus caused 6% of microbiologically-confirmed CAP cases. In the latter, 52 were due to MSSA (60% of S. aureus CAP cases, and 3% of microbiologically-confirmed CAP cases) and 34 were due to MRSA (40% of S. aureus CAP cases, and 2% of microbiologically-confirmed CAP cases). S. pneumoniae was identified in 734 (47%) microbiologically-confirmed CAP cases. The presence of fever was independently associated with a lower risk of MSSA CAP (OR 0.53; 95% CI, 0.28-0.99). Patients with MSSA CAP had higher 30-day mortality than patients with pneumococcal CAP, both before and after adjustment for potential confounders (21% vs 7%, p = 0.002). MSSA was independently associated with 30-day mortality in the overall population. CONCLUSION MSSA CAP was associated with worse outcomes than pneumococcal CAP in our cohort. MSSA was an independent factor of mortality.
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Affiliation(s)
- Catia Cilloniz
- Department of Pneumology, Hospital Clinic of Barcelona, August Pi i Sunyer Biomedical Research Institute - IDIBAPS, University of Barcelona, Biomedical Research Networking Centers in Respiratory Diseases (CIBERES) Barcelona, C/ Villarroel 170, 08036 Barcelona, Spain
| | - Cristina Dominedò
- Department of Shock e Trauma, San Camillo Forlanini Hospital, Rome, Italy
| | - Albert Gabarrús
- Department of Pneumology, Hospital Clinic of Barcelona, August Pi i Sunyer Biomedical Research Institute - IDIBAPS, University of Barcelona, Biomedical Research Networking Centers in Respiratory Diseases (CIBERES) Barcelona, C/ Villarroel 170, 08036 Barcelona, Spain
| | | | - José Becerril
- National Polytechnic Institute, Ciudad de México, México
| | - Diego Tovar
- National Polytechnic Institute, Ciudad de México, México
| | - Estela Moreno
- Department of Infectious Diseases, Hospital Clinic of Barcelona, Spain
| | - Juan M Pericás
- Clinical Direction of Infectious Diseases and Microbiology, IRBLleida, Universitat de Lleida, Lleida, Spain
| | - Carmen Rosa Vargas
- Department of Pneumology, Hospital Clinic of Barcelona, August Pi i Sunyer Biomedical Research Institute - IDIBAPS, University of Barcelona, Biomedical Research Networking Centers in Respiratory Diseases (CIBERES) Barcelona, C/ Villarroel 170, 08036 Barcelona, Spain
| | - Antoni Torres
- Department of Pneumology, Hospital Clinic of Barcelona, August Pi i Sunyer Biomedical Research Institute - IDIBAPS, University of Barcelona, Biomedical Research Networking Centers in Respiratory Diseases (CIBERES) Barcelona, C/ Villarroel 170, 08036 Barcelona, Spain; Catalan Institution for Research and Advanced Studies (ICREA), Spain.
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Huang J, Zhang T, Zou X, Wu S, Zhu J. Panton-valentine leucocidin carrying Staphylococcus aureus causing necrotizing pneumonia inactivates the JAK/STAT signaling pathway and increases the expression of inflammatory cytokines. INFECTION GENETICS AND EVOLUTION 2020; 86:104582. [PMID: 33017689 DOI: 10.1016/j.meegid.2020.104582] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/13/2020] [Accepted: 10/01/2020] [Indexed: 11/17/2022]
Abstract
PURPOSE Methicillin-resistant Staphylococcus aureus (MRSA) carrying Panton-Valentine leukocidin, a pore-forming toxin, is a common cause of necrotizing pneumonia. However, the early pulmonary inflammatory response following PVL(+) MRSA infection is unknown. The purpose of this study was to use a murine model to determine the effect of PVL(+) MRSA on lung tissues and the expression of cytokines and JAK and STAT mRNA and protein. METHODS Mice were randomly divided into 3 groups and intra-nasally treated with PBS (control group), recombinant PVL (rPVL group), and PVL(+) MRSA (PVL group). At 24 and 48 h after inoculation, bronchoalveolar lavage fluid (BALF) was tested for cytokine levels, and lung tissues were tested for JAK and STAT mRNA and protein expression, and examined after hematoxylin and eosin staining. RESULTS Mice infected with the PVL(+) strain became ill, characterized by impaired mobility, hunched posture, ruffled fur, and labored breathing. Lung tissue exhibited tissue necrosis and hemorrhage. BALF levels of IL-8, TNF-α, IFN-γ, IL-12, sICAM-1, and sVCAM-1 were increased in the rPVL or PVL groups, while levels of IL-10 and IL-4 levels were similar among the groups. JAK1 and STAT1 mRNA expression and protein levels were increased in lung tissue from mice infected with PVL(+) MRSA and rPVL. CONCLUSIONS PVL is a significant S. aureus virulence factor, and upregulates the expression of proinflammatory cytokines but does not affect the expression of anti-inflammatory cytokines. The effect of PVL may be due to JAK/STAT pathway activation. Blockade of the JAK/STAT pathway may decrease the severity of PVL(+) MRSA pneumonia.
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Affiliation(s)
- Jing Huang
- Department of Pulmonary and Critical Care Medicine, the Third Affiliated Hospital of Sun Yat-Sen University, No. 600 Tianhe Road, Guangzhou, Guangdong, China.
| | - Tiantuo Zhang
- Department of Pulmonary and Critical Care Medicine, the Third Affiliated Hospital of Sun Yat-Sen University, No. 600 Tianhe Road, Guangzhou, Guangdong, China
| | - Xiaoling Zou
- Department of Pulmonary and Critical Care Medicine, the Third Affiliated Hospital of Sun Yat-Sen University, No. 600 Tianhe Road, Guangzhou, Guangdong, China
| | - Shaozhu Wu
- Department of Pulmonary and Critical Care Medicine, the Third Affiliated Hospital of Sun Yat-Sen University, No. 600 Tianhe Road, Guangzhou, Guangdong, China
| | - Jiaxin Zhu
- Department of Pulmonary and Critical Care Medicine, the Third Affiliated Hospital of Sun Yat-Sen University, No. 600 Tianhe Road, Guangzhou, Guangdong, China
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Clinical Manifestations in Children with Staphylococcal Bacteremia Positive for Panton-Valentine Leucocidin: A Nationwide Survey in a Low Methicillin-Resistance Setting. Pediatr Infect Dis J 2020; 39:e274-e276. [PMID: 32496412 DOI: 10.1097/inf.0000000000002722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A total of 714 pediatric cases of Staphylococcus aureus bacteremia were identified from 2008 to 2015 in Denmark; 98% were methicillin-susceptible S. aureus (MSSA). Fifteen isolates (2,1%) were Panton-Valentine leucocidin positive (0.17/100,000 children/year) and 87% MSSA. Eight cases (53%) were severe, including all pneumonia cases. Panton-Valentine leucocidin positive Staphylococcus aureus bacteremia is rare in our setting with high MSSA-prevalence. Half of the cases were uncomplicated.
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Martínez-Camblor P, Pardo-Fernández JC. The Youden Index in the Generalized Receiver Operating Characteristic Curve Context. Int J Biostat 2019; 15:/j/ijb.ahead-of-print/ijb-2018-0060/ijb-2018-0060.xml. [PMID: 30943172 DOI: 10.1515/ijb-2018-0060] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 03/13/2019] [Indexed: 12/22/2022]
Abstract
The receiver operating characteristic (ROC) curve and their associated summary indices, such as the Youden index, are statistical tools commonly used to analyze the discrimination ability of a (bio)marker to distinguish between two populations. This paper presents the concept of Youden index in the context of the generalized ROC (gROC) curve for non-monotone relationships. The interval estimation of the Youden index and the associated cutoff points in a parametric (binormal) and a non-parametric setting is considered. Monte Carlo simulations and a real-world application illustrate the proposed methodology.
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Affiliation(s)
- Pablo Martínez-Camblor
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, 7 Lebanon Street, Suite 309, Hinman Box 7251, Hanover, NH 03755, USA
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Retrospective study of pneumonia due to Panton-Valentine leukocidin-producing Staphylococcus aureus in Reunion. Med Mal Infect 2019; 49:534-539. [PMID: 30765285 DOI: 10.1016/j.medmal.2019.01.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 04/19/2018] [Accepted: 01/23/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Panton-Valentine leukocidin-producing Staphylococcus aureus necrotizing pneumonia is an unusual cause of community-acquired pneumonia, although associated with a high case fatality. This infection mainly affects young individuals, without any history, and is most often preceded by flu-like symptoms. METHOD We focused on patients presenting with Staphylococcus aureus necrotizing pneumonia in Reunion (Indian Ocean) admitted to the emergency department. We performed a retrospective study based on data collected from laboratory registers and medical files of patients presenting with Staphylococcus aureus necrotizing pneumonia in Reunion between December 2014 and December 2017. RESULTS A total of 16 patients were recruited for this study, with a median age of 40.5 years. More than half of patients had previously been admitted to the emergency department for acute respiratory distress syndrome or severe sepsis. Fourteen patients were admitted to the intensive care unit and six patients died (five premature deaths). CONCLUSION Physicians should be aware of this infection during the flu season and quickly adapt the specific antibiotic treatment, including a drug inhibiting toxin production. As methicillin-resistant Staphylococcus aureus is very rarely observed in Reunion, physicians can still adapt the empirical treatment, without glycopeptides.
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TNF-α increases Staphylococcus aureus-induced death of human alveolar epithelial cell line A549 associated with RIP3-mediated necroptosis. Life Sci 2018; 195:81-86. [DOI: 10.1016/j.lfs.2018.01.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 01/07/2018] [Accepted: 01/08/2018] [Indexed: 01/01/2023]
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Martínez-Camblor P, Corral N, Rey C, Pascual J, Cernuda-Morollón E. Receiver operating characteristic curve generalization for non-monotone relationships. Stat Methods Med Res 2016; 26:113-123. [DOI: 10.1177/0962280214541095] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The receiver operating characteristic curve is a popular graphical method frequently used in order to study the diagnostic capacity of continuous markers. It represents in a plot true-positive rates against the false-positive ones. Both the practical and theoretical aspects of the receiver operating characteristic curve have been extensively studied. Conventionally, it is assumed that the considered marker has a monotone relationship with the studied characteristic; i.e., the upper (lower) values of the (bio)marker are associated with a higher probability of a positive result. However, there exist real situations where both the lower and the upper values of the marker are associated with higher probability of a positive result. We propose a receiver operating characteristic curve generalization, [Formula: see text], useful in this context. All pairs of possible cut-off points, one for the lower and another one for the upper marker values, are taken into account and the best of them are selected. The natural empirical estimator for the [Formula: see text] curve is considered and its uniform consistency and asymptotic distribution are derived. Finally, two real-world applications are studied.
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Affiliation(s)
- Pablo Martínez-Camblor
- Oficina de Investigación Biosanitaria de Asturias (OIB-FICYT)
- Universidad Autonoma de Chile, Chile
| | | | - Corsino Rey
- Universidad de Oviedo
- UCI Pediátrica, Departamento de Pediatría, Hospital Universitario Central de Asturias (HUCA)
| | - Julio Pascual
- Universidad de Oviedo
- Área de Neurociencias, Servicio de Neurología, Hospital Universitario Central de Asturias (HUCA)
| | - Eva Cernuda-Morollón
- Universidad de Oviedo
- Área de Neurociencias, Servicio de Neurología, Hospital Universitario Central de Asturias (HUCA)
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15
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Community-associated Staphylococcus aureus pneumonia among Greek children: epidemiology, molecular characteristics, treatment, and outcome. Eur J Clin Microbiol Infect Dis 2016; 35:1177-85. [PMID: 27140201 DOI: 10.1007/s10096-016-2651-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 04/15/2016] [Indexed: 10/21/2022]
Abstract
Staphylococcus aureus is an infrequent cause of community-associated (CA-SA) pneumonia in children. The aim of this study was to evaluate the clinical, epidemiological, microbiological, and molecular characteristics of CA-SA pneumonia among children hospitalized in two large tertiary care referral centers during an 8-year period. Cases of CA-SA pneumonia admitted between 2007 and 2014 were retrospectively examined through medical record review. Molecular investigation was performed for available strains; mecA, Panton-Valentine leukocidin (PVL) (lukS-lukF-PV), and fibronectin binding protein A (fnbA) genes were detected by polymerase chain reaction (PCR). Clones were assigned by agr groups, pulsed-field gel electrophoresis (PFGE), SCCmec, and multilocus sequencing typing (MLST). In total, 41 cases were recorded (boys, 61 %), with a median age of 4.3 months (range, 1-175). Methicillin-resistant S. aureus (MRSA) accounted for 31 cases (75.6 %). Complications included empyema (25/41, 61 %), pneumatoceles (7/41, 17 %), and lung abscess (1/41, 2.5 %). Intensive care unit (ICU) admission was required in 58.5 %. Two deaths occurred (4.9 %). Definitive therapy was based on vancomycin with or without other antibiotics (55.9 %), followed by clindamycin and linezolid (26.5 % each). All isolates were susceptible to vancomycin (MIC90 2 mg/L, range 1-2), teicoplanin, and linezolid, whereas 26.8 % were resistant to clindamycin. Among the 25 studied strains, 20 were mecA-positive (MRSA), carrying also the fnbA gene. Of these, 90 % belonged to the ST80-IV/agr3/PVL-positive clone. Methicillin-susceptible S. aureus (MSSA) strains showed polyclonality, 3/5 were PVL-positive, and 3/5 were fnbA-positive. MRSA and particularly the ST80-IV clone predominated among staphylococcal pneumonia cases in children. Treatment provided was effective in all but two patients, despite the relatively high minimum inhibitory concentration (MIC) of vancomycin and a high resistance to clindamycin.
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16
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Gijón M, Bellusci M, Petraitiene B, Noguera-Julian A, Zilinskaite V, Sanchez Moreno P, Saavedra-Lozano J, Glikman D, Daskalaki M, Kaiser-Labusch P, Falup-Pecurariu O, Montagnani C, Prieto L, Gené A, Trumpulyte G, Kulecnikova I, Lepe JA, Cercenado E, Kudinsky R, Makri A, Huppertz HI, Bleotu L, Cocchi P, García-Hierro P, Vitkauskiene A, Fortuny C, Zukovskaja V, Neth O, Santos M, Rokney A, Petra M, Lixandru R, Galli L, Guillén S, Chaves F, Rojo Conejo P. Factors associated with severity in invasive community-acquired Staphylococcus aureus infections in children: a prospective European multicentre study. Clin Microbiol Infect 2016; 22:643.e1-6. [PMID: 27107685 DOI: 10.1016/j.cmi.2016.04.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 03/17/2016] [Accepted: 04/05/2016] [Indexed: 11/30/2022]
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.
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Affiliation(s)
- M Gijón
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - M Bellusci
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - B Petraitiene
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - A Noguera-Julian
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - V Zilinskaite
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - P Sanchez Moreno
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - J Saavedra-Lozano
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - D Glikman
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - M Daskalaki
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - P Kaiser-Labusch
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - O Falup-Pecurariu
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - C Montagnani
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - L Prieto
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - A Gené
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - G Trumpulyte
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - I Kulecnikova
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - J A Lepe
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - E Cercenado
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - R Kudinsky
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - A Makri
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - H I Huppertz
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - L Bleotu
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - P Cocchi
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - P García-Hierro
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - A Vitkauskiene
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - C Fortuny
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - V Zukovskaja
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - O Neth
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - M Santos
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - A Rokney
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - M Petra
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - R Lixandru
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - L Galli
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - S Guillén
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - F Chaves
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - P Rojo Conejo
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain.
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17
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Ravishankar S, Chapin K, Alexander-Scott N, Wills H, Merritt C, Jacobson M, Kleris R, Alhinai Z, Sediva I, Muratore C, Mermel L, Mangray S. Enterovirus D68 and Panton-Valentine Leukocidin-Positive Staphylococcus aureus Respiratory Coinfection with Fatal Outcome. Pediatr Dev Pathol 2016; 19:80-5. [PMID: 26367063 DOI: 10.2350/15-06-1652-cr.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A previously healthy 10-year-old girl with a 2-day history of upper respiratory illness and fever rapidly developed respiratory failure and sepsis with leukopenia, and expired despite attempts at resuscitation. Postmortem examination revealed bilateral necrotizing pneumonia and evidence of disseminated intravascular coagulation. Nasopharyngeal swabs and lung tissue submitted to the Centers for Disease Control and Prevention (CDC) were positive for Enterovirus D68 (EV-D68). Blood and lung cultures were positive for methicillin-resistant Staphylococcus aureus (MRSA). The isolates were submitted to the CDC and were found to be positive for the toxin Panton-Valentine leukocidin. We describe a fatality related to invasive toxin-mediated MRSA associated with EV-D68 coinfection, along with the clinical, laboratory, and autopsy findings, which provided important clues, prompting further investigation at the CDC to arrive at the correct diagnosis.
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Affiliation(s)
- Sanjita Ravishankar
- 1 Department of Pathology and Laboratory Medicine, Lifespan Academic Medical Center & Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Kimberle Chapin
- 1 Department of Pathology and Laboratory Medicine, Lifespan Academic Medical Center & Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Nicole Alexander-Scott
- 2 Department of Infectious Diseases, Lifespan Academic Medical Center & Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Hale Wills
- 3 Department of Pediatric Surgery, Lifespan Academic Medical Center & Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Christopher Merritt
- 4 Department of Emergency Medicine, Lifespan Academic Medical Center & Alpert Medical School of Brown University, Providence, RI 02903, USA.,5 Department of Pediatrics, Lifespan Academic Medical Center & Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Melanie Jacobson
- 5 Department of Pediatrics, Lifespan Academic Medical Center & Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Renee Kleris
- 5 Department of Pediatrics, Lifespan Academic Medical Center & Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Zaid Alhinai
- 2 Department of Infectious Diseases, Lifespan Academic Medical Center & Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Ivona Sediva
- 5 Department of Pediatrics, Lifespan Academic Medical Center & Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Christopher Muratore
- 3 Department of Pediatric Surgery, Lifespan Academic Medical Center & Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Leonard Mermel
- 2 Department of Infectious Diseases, Lifespan Academic Medical Center & Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Shamlal Mangray
- 1 Department of Pathology and Laboratory Medicine, Lifespan Academic Medical Center & Alpert Medical School of Brown University, Providence, RI 02903, USA
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Necrotizing pneumonia due to clonally diverse Staphylococcus aureus strains producing Panton-Valentine leukocidin: the Czech experience. Epidemiol Infect 2015. [PMID: 26201459 DOI: 10.1017/s0950268815001521] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
A prospective study (2007-2013) was undertaken to investigate clinical features and prognostic factors of necrotizing pneumonia caused by Staphylococcus aureus producing Panton-Valentine leukocidin (PVL) in the Czech Republic. Twelve cases of necrotizing pneumonia were detected in 12 patients (median age 25 years) without severe underlying disease. Eight cases occurred in December and January and the accumulation of cases in the winter months preceding the influenza season was statistically significant (P < 0·001). The course of pneumonia was very rapid, leading to early sepsis and/or septic shock in all but one patient. Seven patients died and mortality was fourfold higher in those patients presenting with primary pneumonia than with pneumonia complicating other staphylococcal/pyogenic infection elsewhere in the body. The S. aureus isolates displayed considerable genetic variability and were assigned to five lineages CC8 (n = 3), CC15 (n = 2), CC30 (n = 2), CC80 (n = 1), and CC121 (n = 3) and one was a singleton of ST154 (n = 1), all were reported to be associated with community-acquired infection. Four strains were methicillin resistant. The high case-fatality rate can only be reduced by improving the speed of diagnosis and a rapid test to detect S. aureus in the airways is needed.
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Sheikh HQ, Aqil A, Kirby A, Hossain FS. Panton-Valentine leukocidin osteomyelitis in children: a growing threat. Br J Hosp Med (Lond) 2015; 76:18-24. [PMID: 25585179 DOI: 10.12968/hmed.2015.76.1.18] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Panton-Valentine leukocidin-producing Staphylococcus aureus osteomyelitis is associated with multiple complications including multiple abscesses, deep vein thrombosis and fulminant sepsis. This article reviews the literature concerning this emerging threat which is currently under-recognized.
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Affiliation(s)
- Hassaan Q Sheikh
- Specialty Registrar in the Department of Trauma and Orthopaedics
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20
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Atwa ZTH. Usefulness of gender and abnormal blood count for predicting pneumonia outcome in children. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2015. [DOI: 10.1016/j.ejcdt.2014.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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21
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Blot M, Croisier D, Péchinot A, Vagner A, Putot A, Fillion A, Baudouin N, Quenot JP, Charles PE, Bonniaud P, Chavanet P, Piroth L. A leukocyte score to improve clinical outcome predictions in bacteremic pneumococcal pneumonia in adults. Open Forum Infect Dis 2014; 1:ofu075. [PMID: 25734145 PMCID: PMC4281790 DOI: 10.1093/ofid/ofu075] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 07/24/2014] [Indexed: 12/02/2022] Open
Abstract
In multivariate analysis, a leukocyte score that adds 1 point each for neutropenia, lymphopenia and monocytopenia was associated with 30-day mortality in 192 patients with bacteremic pneumococcal pneumonia. By reflecting immunoparalysis, this score could improve clinical outcome predictions in BPP. Background Bacteremic pneumococcal pneumonia (BPP) is associated with high and early mortality. A simple procedure to predict mortality is crucial. Methods All adult patients with BPP admitted from 2005 through 2013 to the University Hospital of Dijon, France, were enrolled to study 30-day mortality and associated factors, particularly leukocyte counts. A simple leukocyte score was created by adding 1 point each for neutropenia (<1500 cells/mm3), lymphopenia (<400), and monocytopenia (<200). Results One hundred and ninety-two adult patients (mean age, 69 years; standard deviation [SD], 19 years) who had developed and were hospitalized for BPP (58% community-acquired) were included. The 30-day crude mortality rate was 21%. The mean Pneumonia Severity Index score was high at 127.3 (SD = 41.3). Among the 182 patients who had a white blood cell count, 34 (19%) had a high leukocyte score (≥2). Multivariate analysis revealed that mortality was significantly associated with a high leukocyte score (odds ratio, 6.28; 95% confidence interval, 2.35–16.78), a high respiratory rate, a low serum bicarbonate level, and an altered mental status (all P < .05). The leukocyte score was not significantly dependent on the previous state of immunosuppression, alcoholism, or viral coinfection, but it did correlate with an acute respiratory distress syndrome and a low serum bicarbonate level. Conclusions This new leukocyte score, in combination with the well known predictive factors, seems of interest in predicting the risk of death in BPP. A high score correlated with organ dysfunction and probably reflects the level of immunoparalysis. Its predictive value has to be confirmed in other cohorts.
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Affiliation(s)
| | | | - André Péchinot
- Laboratoire de Bactériologie, Plateau Technique de Biologie ; Observatoire Régional du Pneumocoque, Bourgogne
| | | | | | | | | | - Jean-Pierre Quenot
- Service de Réanimation Médicale ; Centre d'Investigation Clinique-Epidémiologie Clinique/Essais Cliniques , Centre Hospitalier Universitaire , Dijon , France ; Institut National de la Santé et de la Recherche Médicale, Dijon , France
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