title: Community-associated Staphylococcus aureus pneumonia among Greek children: epidemiology, molecular characteristics, treatment, and outcome.
abstract: Staphylococcus aureus is an infrequent cause of community-associated (CA-SA) pneumonia in children. The aim of this study was to evaluate the clinical, epidemiological, microbiological, and molecular characteristics of CA-SA pneumonia among children hospitalized in two large tertiary care referral centers during an 8-year period. Cases of CA-SA pneumonia admitted between 2007 and 2014 were retrospectively examined through medical record review. Molecular investigation was performed for available strains; mecA, Panton-Valentine leukocidin (PVL) (lukS-lukF-PV), and fibronectin binding protein A (fnbA) genes were detected by polymerase chain reaction (PCR). Clones were assigned by agr groups, pulsed-field gel electrophoresis (PFGE), SCCmec, and multilocus sequencing typing (MLST). In total, 41 cases were recorded (boys, 61 %), with a median age of 4.3 months (range, 1-175). Methicillin-resistant S. aureus (MRSA) accounted for 31 cases (75.6 %). Complications included empyema (25/41, 61 %), pneumatoceles (7/41, 17 %), and lung abscess (1/41, 2.5 %). Intensive care unit (ICU) admission was required in 58.5 %. Two deaths occurred (4.9 %). Definitive therapy was based on vancomycin with or without other antibiotics (55.9 %), followed by clindamycin and linezolid (26.5 % each). All isolates were susceptible to vancomycin (MIC90 2 mg/L, range 1-2), teicoplanin, and linezolid, whereas 26.8 % were resistant to clindamycin. Among the 25 studied strains, 20 were mecA-positive (MRSA), carrying also the fnbA gene. Of these, 90 % belonged to the ST80-IV/agr3/PVL-positive clone. Methicillin-susceptible S. aureus (MSSA) strains showed polyclonality, 3/5 were PVL-positive, and 3/5 were fnbA-positive. MRSA and particularly the ST80-IV clone predominated among staphylococcal pneumonia cases in children. Treatment provided was effective in all but two patients, despite the relatively high minimum inhibitory concentration (MIC) of vancomycin and a high resistance to clindamycin.
authors.affiliation: Department of Microbiology, "P. & A. Aglaia Kyriakou" Children's Hospital, Athens, Greece. tassosd@hotmail.com.
authors.forename: A G
authors.initials: AG
authors.lastname: Doudoulakakis
authors.affiliation: Department of Microbiology, "Aghia Sophia" Children's Hospital, Athens, Greece.
authors.forename: D
authors.initials: D
authors.lastname: Bouras
authors.affiliation: National Staphylococcal Reference Laboratory, Department of Microbiology, School of Medicine, University of Patras, Patras, Greece.
authors.forename: E
authors.initials: E
authors.lastname: Drougka
authors.affiliation: 1st Department of Paediatrics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: M
authors.initials: M
authors.lastname: Kazantzi
authors.affiliation: 1st Department of Paediatrics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: A
authors.initials: A
authors.lastname: Michos
authors.affiliation: Department of Microbiology, "Aghia Sophia" Children's Hospital, Athens, Greece.
authors.forename: A
authors.initials: A
authors.lastname: Charisiadou
authors.affiliation: National Staphylococcal Reference Laboratory, Department of Microbiology, School of Medicine, University of Patras, Patras, Greece.
authors.forename: I
authors.initials: I
authors.lastname: Spiliopoulou
authors.affiliation: Department of Microbiology, "P. & A. Aglaia Kyriakou" Children's Hospital, Athens, Greece.
authors.forename: E
authors.initials: E
authors.lastname: Lebessi
authors.affiliation: 2nd Department of Paediatrics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: M
authors.initials: M
authors.lastname: Tsolia
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology*; D015897:Comorbidity; D019468:Disease Management; D024881:Drug Resistance, Bacterial; D005260:Female; D005798:Genes, Bacterial; D006115:Greece / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008826:Microbial Sensitivity Tests; D058885:Multilocus Sequence Typing; D011023:Pneumonia, Staphylococcal / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology*; D013211:Staphylococcus aureus / Q000145:classification / Q000187:drug effects / Q000235:genetics*; D016896:Treatment Outcome; D037521:Virulence Factors / Q000235:genetics
chemical_list: D000900:Anti-Bacterial Agents; D037521:Virulence Factors