TY - JOUR
TI - Community-associated Staphylococcus aureus pneumonia among Greek children: epidemiology, molecular characteristics, treatment, and outcome
AU - Doudoulakakis, A.G.
AU - Bouras, D.
AU - Drougka, E.
AU - Kazantzi, M.
AU - Michos, A.
AU - Charisiadou, A.
AU - Spiliopoulou, I.
AU - Lebessi, E.
AU - Tsolia, M.
JO - European Journal of Clinical Microbiology and Infectious Diseases
PY - 2016
VL - 35
TODO - 7
SP - 1177-1185
PB - Springer-Verlag
SN - null
TODO - 10.1007/s10096-016-2651-7
TODO - antibiotic agent;  beta lactam antibiotic;  clindamycin;  fibronectin binding protein;  fibronectin binding protein A;  linezolid;  Panton Valentine leukocidin;  penicillin binding protein 2a;  teicoplanin;  unclassified drug;  vancomycin;  antiinfective agent;  virulence factor, antibiotic resistance;  antibiotic sensitivity;  antibiotic therapy;  Article;  child;  clinical article;  community acquired pneumonia;  death;  drug efficacy;  empyema;  female;  Greek (people);  hospitalized child;  human;  infant;  intensive care;  lung abscess;  male;  methicillin resistant Staphylococcus aureus infection;  minimum inhibitory concentration;  molecular cloning;  multilocus sequence typing;  nonhuman;  outcome assessment;  pneumatocele;  priority journal;  protein analysis;  retrospective study;  treatment indication;  bacterial gene;  classification;  Community-Acquired Infections;  comorbidity;  disease management;  drug effects;  genetics;  Greece;  microbial sensitivity test;  microbiology;  newborn;  Pneumonia, Staphylococcal;  preschool child;  Staphylococcus aureus;  treatment outcome, Anti-Bacterial Agents;  Child;  Child, Preschool;  Community-Acquired Infections;  Comorbidity;  Disease Management;  Drug Resistance, Bacterial;  Female;  Genes, Bacterial;  Greece;  Humans;  Infant;  Infant, Newborn;  Male;  Microbial Sensitivity Tests;  Multilocus Sequence Typing;  Pneumonia, Staphylococcal;  Staphylococcus aureus;  Treatment Outcome;  Virulence Factors
TODO - 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. © 2016, Springer-Verlag Berlin Heidelberg.
ER -