Τίτλος:
Community-associated Staphylococcus aureus pneumonia among Greek children: epidemiology, molecular characteristics, treatment, and outcome
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
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.
Συγγραφείς:
Doudoulakakis, A.G.
Bouras, D.
Drougka, E.
Kazantzi, M.
Michos, A.
Charisiadou, A.
Spiliopoulou, I.
Lebessi, E.
Tsolia, M.
Περιοδικό:
European Journal of Clinical Microbiology and Infectious Diseases
Λέξεις-κλειδιά:
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
DOI:
10.1007/s10096-016-2651-7
