Factors associated with severity in invasive community-acquired Staphylococcus aureus infections in children: a prospective European multicentre study.
Staphylococcus aureus is the main pathogen responsible for bone and joint infections worldwide and is also capable of causing pneumonia and other invasive severe diseases. Panton-Valentine leukocidin (PVL) and methicillin-resistant S. aureus (MRSA) have been studied as factors related with severity in these infections. The aims of this study were to describe invasive community-acquired S. aureus (CA-SA) infections and to analyse factors related to severity of disease. Paediatric patients (aged 0-16 years) who had a CA-SA invasive infection were prospectively recruited from 13 centres in 7 European countries. Demographic, clinical and microbiological data were collected. Severe infection was defined as invasive infection leading to death or admission to intensive care due to haemodynamic instability or respiratory failure. A total of 152 children (88 boys) were included. The median age was 7.2 years (interquartile range, 1.3-11.9). Twenty-six (17%) of the 152 patients had a severe infection, including 3 deaths (2%). Prevalence of PVL-positive CA-SA infections was 18.6%, and 7.8% of the isolates were MRSA. The multivariate analysis identified pneumonia (adjusted odds ratio (aOR) 13.39 (95% confidence interval (CI) 4.11-43.56); p 0.008), leukopenia at admission (<3000/mm(3)) (aOR 18.3 (95% CI 1.3-259.9); p 0.03) and PVL-positive infections (aOR 4.69 (95% CI 1.39-15.81); p 0.01) as the only factors independently associated with severe outcome. There were no differences in MRSA prevalence between severe and nonsevere cases (aOR 4.30 (95% CI 0.68- 28.95); p 0.13). Our results show that in European children, PVL is associated with more severe infections, regardless of methicillin resistance.
Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain.
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Gijón
Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain.
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Bellusci
Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain.
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Petraitiene
Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain.
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Noguera-Julian
Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain.
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Zilinskaite
Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain.
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Sanchez Moreno
Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain.
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Saavedra-Lozano
Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain.
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Glikman
Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain.
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Daskalaki
Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain.
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Kaiser-Labusch
Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain.
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Falup-Pecurariu
Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain.
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Montagnani
Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain.
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Prieto
Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain.
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Gené
Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain.
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Trumpulyte
Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain.
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Kulecnikova
Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain.
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Lepe
Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain.
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Cercenado
Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain.
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Kudinsky
Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain.
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Makri
Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain.
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Huppertz
Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain.
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Bleotu
Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain.
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Cocchi
Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain.
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García-Hierro
Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain.
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Vitkauskiene
Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain.
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Fortuny
Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain.
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Zukovskaja
Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain.
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Neth
Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain.
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Santos
Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain.
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Rokney
Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain.
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Petra
Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain.
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Lixandru
Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain.
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Galli
Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain.
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Guillén
Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain.
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Chaves
Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain. Electronic address: pablorojoconejo@aim.com.
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Rojo Conejo
D001427:Bacterial Toxins / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000401:mortality / Q000473:pathology*; D003422:Critical Care; D005060:Europe / Q000453:epidemiology; D005098:Exotoxins / Q000032:analysis; D005260:Female; D006801:Humans; D007223:Infant; D007956:Leukocidins / Q000032:analysis; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000401:mortality / Q000473:pathology*; D013211:Staphylococcus aureus / Q000235:genetics / Q000302:isolation & purification* / Q000472:pathogenicity; D016019:Survival Analysis; D037521:Virulence Factors / Q000032:analysis
D001427:Bacterial Toxins; D005098:Exotoxins; D007956:Leukocidins; C078284:Panton-Valentine leukocidin; D037521:Virulence Factors
Children; Community-acquired Staphylococcus aureus; Methicillin resistance; Panton-Valentine leukocidin; Severe infections