Division of Pediatric Critical Care, Department of Pediatrics, University of Utah, Salt Lake City, Utah, United States of America.
Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Utah, Salt Lake City, Utah, United States of America.
PLoS One. 2020 Sep 18;15(9):e0238991. doi: 10.1371/journal.pone.0238991. eCollection 2020.
Invasive Staphylococcus aureus infections are a common cause of morbidity and mortality in children. In the early 2000's the proportion of infections due the methicillin-resistant S. aureus (MRSA) increased rapidly. We described the clinical and molecular epidemiology of invasive S. aureus disease in a pediatric population.
We prospectively identified children in Utah with invasive S. aureus infections. Medical records were reviewed to determine diagnosis and clinical characteristics. Isolates were genotyped using multi-locus sequence typing. The presence of genes encoding the Panton-Valentine leukocidin (PVL) was determined using polymerase chain reaction.
Over a 4-year period between January 2009 and December 2012, we identified 357 children, hospitalized at Primary Children's Hospital, with invasive S. aureus infections and isolates available for the study. Methicillin-susceptible S. aureus (MSSA) caused 79% of disease, while MRSA caused only 21% of disease. Mortality associated with invasive S. aureus infection was 3.6%. The most common diagnoses were osteoarticular infections (38%) followed by central line associated blood stream infections (19%) and pneumonia (12%). We identified 41 multi-locus sequence types. The majority of isolates belonged to 6 predominant clonal complexes (CC5, CC8, CC15, CC30, CC45, CC59). PVL was present in a minority (16%) of isolates, of which most were ST8 MRSA.
MSSA was the primary cause of invasive S. aureus infections at our institution throughout the study period. A limited number of predominant strains accounted for the majority of invasive disease. The classic virulence factor PVL was uncommon in MSSA isolates. Further study is needed to improve our understanding of S. aureus virulence and disease pathogenesis.
侵袭性金黄色葡萄球菌感染是儿童发病率和死亡率的常见原因。在 21 世纪初，耐甲氧西林金黄色葡萄球菌（MRSA）引起的感染比例迅速增加。我们描述了儿童侵袭性金黄色葡萄球菌病的临床和分子流行病学。
我们前瞻性地确定了犹他州患有侵袭性金黄色葡萄球菌感染的儿童。回顾病历以确定诊断和临床特征。使用多位点序列分型对分离株进行基因分型。使用聚合酶链反应确定是否存在编码杀白细胞素（PVL）的基因。
在 2009 年 1 月至 2012 年 12 月的 4 年期间，我们在 Primary Children's Hospital 确定了 357 名患有侵袭性金黄色葡萄球菌感染且分离株可供研究的儿童。耐甲氧西林金黄色葡萄球菌（MSSA）引起 79%的疾病，而耐甲氧西林金黄色葡萄球菌（MRSA）仅引起 21%的疾病。侵袭性金黄色葡萄球菌感染的死亡率为 3.6%。最常见的诊断是骨关节炎感染（38%），其次是中央静脉相关血流感染（19%）和肺炎（12%）。我们鉴定了 41 种多位点序列类型。大多数分离株属于 6 种主要克隆复合物（CC5、CC8、CC15、CC30、CC45、CC59）。少数（16%）分离株存在 PVL，其中大多数是 ST8-MRSA。
在整个研究期间，MSSA 是我们机构侵袭性金黄色葡萄球菌感染的主要原因。少数主要菌株导致了大多数侵袭性疾病。经典毒力因子 PVL 在 MSSA 分离株中并不常见。需要进一步研究以提高我们对金黄色葡萄球菌毒力和疾病发病机制的认识。
