BACKGROUND: Staphylococcus aureus is the most common cause of septic arthritis (SA) in children. USA300 is the predominant community methicillin-resistant (MRSA) clone. Panton-Valentine leukocidin genes (pvl) have been associated with severe disease. METHODS: Patients with S. aureus SA were identified from the Texas Children's Hospital surveillance study. Pulsed field gel electrophoresis and pvl polymerase chain reaction were performed on isolates. RESULTS: Forty-five patients with S. aureus SA were identified between August 2001 and October 2008. Median age was 5.5 years (0.3-17.9 years); 69% were previously healthy. The most common joints affected were hip (40%) followed by knee (36%). Associated infection sites were osteomyelitis (n = 14), pyomyositis/myositis (n = 13), and cellulitis (n = 9). Bacteremia for 1 to 5 days occurred in 31% of the patients. Patients with associated osteomyelitis were more likely to be bacteremic (P = 0.001), have fever >2 days (P = 0.03), and to have C-reactive protein (CRP) > or = 10 mg/dL (P = 0.01). Of 44 available isolates, 16 were MRSA; 13 of 16 were USA300 and 14 of 16 were pvl+. Twenty-eight isolates were MSSA; 8 of 28 were USA300 and 13 of 28 were pvl+. Infections caused by USA300 isolates were associated with longer duration of fever than non-USA300 isolates (median, [range]: 4 [0-15] days vs 1 [0-8] days) (P = 0.03). Overall, 61% of the isolates were pvl+. CRP > or = 10 mg/dL was more likely in pvl+ infections than in pvl- infections (P = 0.05). CONCLUSIONS: S. aureus SA caused by USA300 isolates is associated with longer duration of fever. Empirical treatment of SA should include MRSA. CRP levels > or = 10 mg/dL, fever >2 days, and bacteremia should raise suspicion for associated osteomyelitis.
BACKGROUND:Staphylococcus aureus is the most common cause of septic arthritis (SA) in children. USA300 is the predominant community methicillin-resistant (MRSA) clone. Panton-Valentine leukocidin genes (pvl) have been associated with severe disease. METHODS:Patients with S. aureus SA were identified from the Texas Children's Hospital surveillance study. Pulsed field gel electrophoresis and pvl polymerase chain reaction were performed on isolates. RESULTS: Forty-five patients with S. aureus SA were identified between August 2001 and October 2008. Median age was 5.5 years (0.3-17.9 years); 69% were previously healthy. The most common joints affected were hip (40%) followed by knee (36%). Associated infection sites were osteomyelitis (n = 14), pyomyositis/myositis (n = 13), and cellulitis (n = 9). Bacteremia for 1 to 5 days occurred in 31% of the patients. Patients with associated osteomyelitis were more likely to be bacteremic (P = 0.001), have fever >2 days (P = 0.03), and to have C-reactive protein (CRP) > or = 10 mg/dL (P = 0.01). Of 44 available isolates, 16 were MRSA; 13 of 16 were USA300 and 14 of 16 were pvl+. Twenty-eight isolates were MSSA; 8 of 28 were USA300 and 13 of 28 were pvl+. Infections caused by USA300 isolates were associated with longer duration of fever than non-USA300 isolates (median, [range]: 4 [0-15] days vs 1 [0-8] days) (P = 0.03). Overall, 61% of the isolates were pvl+. CRP > or = 10 mg/dL was more likely in pvl+ infections than in pvl- infections (P = 0.05). CONCLUSIONS:S. aureus SA caused by USA300 isolates is associated with longer duration of fever. Empirical treatment of SA should include MRSA. CRP levels > or = 10 mg/dL, fever >2 days, and bacteremia should raise suspicion for associated osteomyelitis.
Authors: Malgorzata Miller; Stefanie Donat; Sonja Rakette; Thilo Stehle; Thijs R H M Kouwen; Sander H Diks; Annette Dreisbach; Ewoud Reilman; Katrin Gronau; Dörte Becher; Maikel P Peppelenbosch; Jan Maarten van Dijl; Knut Ohlsen Journal: PLoS One Date: 2010-02-04 Impact factor: 3.240
Authors: K Z Vardakas; I Kontopidis; I D Gkegkes; P I Rafailidis; M E Falagas Journal: Eur J Clin Microbiol Infect Dis Date: 2013-01-20 Impact factor: 3.267
Authors: James E Cassat; Neal D Hammer; J Preston Campbell; Meredith A Benson; Daniel S Perrien; Lara N Mrak; Mark S Smeltzer; Victor J Torres; Eric P Skaar Journal: Cell Host Microbe Date: 2013-06-12 Impact factor: 21.023
Authors: C Lemaître; A Ferroni; C Doit; H Vu-Thien; C Glorion; J Raymond; P Mary; P Wicart; E Bingen; B Ilharreborde; M Lorrot Journal: Eur J Clin Microbiol Infect Dis Date: 2012-05-09 Impact factor: 3.267