title: Pediatric bone and joint infections caused by Panton-Valentine leukocidin-positive Staphylococcus aureus.
abstract: BACKGROUND
  Panton-Valentine leukocidin (PVL) is a necrotizing toxin secreted by Staphylococcus aureus. PVL-positive S. aureus osteomyelitis and arthritis have been described.
  
  
  METHODS
  We analyzed demographic, clinical, laboratory, microbiologic, and imaging data in a study group of 14 pediatric cases with PVL-positive S. aureus osteomyelitis and arthritis diagnosed between 2001 and 2005 and compared results with a control group of 17 pediatric cases of PVL-negative S. aureus osteomyelitis and arthritis treated in our institution during the same period. Treatments and outcome were studied.
  
  
  RESULTS
  The severity of PVL-positive S. aureus bone and joint infections was indicated by the presence of severe sepsis in all cases and of septic shock in 6 of the 14 patients. By comparison, severe sepsis was not noted in the control group (P = 0.004). On admission, the median C-reactive protein value was significantly higher in the study group (202.6 mg/L versus 83 mg/L in the control group; P = 0.001). Eleven patients with PVL-positive infection had local extension of the infection by magnetic resonance imaging and 7 patients had severe deep-seated infectious complications by computed tomography. By contrast only 1 patient in the control group presented with bone abscess without extension and none had deep-seated infection (P < 0.001). The median length of hospitalization was 45.5 days in the study group versus 13 days in the control group (P < 0.001). The median duration of intravenous antibacterial chemotherapy was 48 days versus 11.3 days in the control group (P < 0.001). Ten patients (71%) of the study group required surgical procedures with a mean of 3 procedures (range, 1-5) whereas 3 patients (17%) of the control group required 1 surgical drainage each (P = 0.002). All the patients survived, but only 2 patients of the study group were free of long-term complications, whereas there were no long-term complications noted in the control group.
  
  
  CONCLUSIONS
  PVL-positive S. aureus bone and joint infection is severe and requires prolonged treatment. Local complications are more frequent and often need repeated surgical drainage.
authors.affiliation: Services de Chirurgie Pédiatrique, Hôpital Edouard Herriot, Université Claude Bernard Lyon 1, Cedex, France. bruno.dohin@chu-lyon.fr
authors.forename: Bruno
authors.initials: B
authors.lastname: Dohin
authors.forename: Yves
authors.initials: Y
authors.lastname: Gillet
authors.forename: Rémi
authors.initials: R
authors.lastname: Kohler
authors.forename: Gérard
authors.initials: G
authors.lastname: Lina
authors.forename: François
authors.initials: F
authors.lastname: Vandenesch
authors.forename: Philippe
authors.initials: P
authors.lastname: Vanhems
authors.forename: Daniel
authors.initials: D
authors.lastname: Floret
authors.forename: Jerome
authors.initials: J
authors.lastname: Etienne
mesh_terms: D000293:Adolescent; D001170:Arthritis, Infectious / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000601:surgery; D001427:Bacterial Toxins / Q000235:genetics*; D005098:Exotoxins / Q000235:genetics*; D005260:Female; D006801:Humans; D007223:Infant; D007956:Leukocidins / Q000235:genetics*; D008279:Magnetic Resonance Imaging; D008297:Male; D010019:Osteomyelitis / Q000000981:diagnostic imaging / Q000382:microbiology / Q000503:physiopathology / Q000601:surgery; D011859:Radiography; D018805:Sepsis / Q000382:microbiology; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000382:microbiology; D013203:Staphylococcal Infections / Q000000981:diagnostic imaging / Q000382:microbiology / Q000503:physiopathology / Q000601:surgery; D013211:Staphylococcus aureus / Q000187:drug effects / Q000235:genetics
chemical_list: D001427:Bacterial Toxins; D005098:Exotoxins; D007956:Leukocidins; C078284:Panton-Valentine leukocidin