Clinical and molecular characteristics of invasive community-acquired Staphylococcus aureus infections in Chinese children.
BACKGROUND
This study aims to investigate the clinical features of invasive community-acquired Staphylococcus aureus (CA-SA) infection in Chinese children and analyze its molecular features.


METHODS
Clinical data and invasive CA-SA isolates were prospectively collected. Pediatric risk of mortality (PRISM) score was used for disease severity measurement. Molecular typing was then performed, followed by expression analysis for virulence genes.


RESULTS
Among 163 invasive CA-SA infection cases, 71 (43.6%) were methicillin-resistant SA (MRSA) infections and 92 (56.4%) were methicillin-susceptible SA (MSSA). A total of 105 (64.4%) children were younger than 1 year old, and 79.7% (129/163) were under 3 years age. Thirteen kinds of diseases were observed, in which bacteremia and pneumonia accounted for 65.6% (107/163) and 52.8% (86/163), respectively. A total of 112 (68.1%) patients had two or more infective sites simultaneously, and four cases (2.5%) died. CA-MSSA more frequently caused multi-sites infections, bacteremia, and musculoskeletal infection than MRSA. A total of 25 sequence types (STs) were detected. MRSA mainly comprised ST59 (49/71, 69%), whereas the most frequent clonotypes were ST88 (15/92, 16.3%), ST25 (13/92, 14.1%), ST7 (13/92, 14.1%), ST2155 (12/92, 13%), and ST188 (9/92, 9.8%) for MSSA. Seven STs were common to both MSSA and MRSA groups. No differences in clinical presentation or PRISM score were found between the two groups or among different ST. The expression levels of the four known virulence genes varied among the six main ST clones.


CONCLUSIONS
Invasive CA-SA infections were characterized by high incidence and multi-site infections in young children in China. The clinical manifestations of CA-MSSA were more frequently associated with multi-site infections, bacteremia and musculoskeletal infection than those of CA-MRSA. Isolated genotypes may be relevant to the expressions of virulence genes, but not to clinical manifestations.
Yanhong
Y
Qiao
Xue
X
Ning
Qiang
Q
Chen
Ruizhen
R
Zhao
Wenqi
W
Song
Yuejie
Y
Zheng
Fang
F
Dong
Shipeng
S
Li
Juan
J
Li
Lijuan
L
Wang
Ting
T
Zeng
Yanhong
Y
Dong
Kaihu
K
Yao
Sangjie
S
Yu
Yonghong
Y
Yang
Key Laboratory of Major Diseases in Children and National Key Discipline of Pediatrics, Ministry of Education, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Beijing, PR China. xuzhuangshen@163.com.
Xuzhuang
X
Shen
D000293:Adolescent; D016470:Bacteremia / Q000382:microbiology* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D017714:Community-Acquired Infections / Q000382:microbiology / Q000401:mortality; D005260:Female; D005798:Genes, Bacterial; D005838:Genotype; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000235:genetics; D058885:Multilocus Sequence Typing; D013203:Staphylococcal Infections / Q000382:microbiology* / Q000401:mortality; D037521:Virulence Factors / Q000235:genetics
D037521:Virulence Factors