Advertising Disclaimer
Published online March 1, 2005
PEDIATRICS Vol. 115 No. 3 March 2005, pp. 642-648 (doi:10.1542/peds.2004-2300)
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrowRequest Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Web of Science (115)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Gonzalez, B. E.
Right arrow Articles by Kaplan, S. L.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Gonzalez, B. E.
Right arrow Articles by Kaplan, S. L.
Related Collections
Right arrow Infectious Disease & Immunity
Right arrowRelated AAP Red Book topics:
Staphylococcal Infections
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Facebook   Add to Reddit   Add to Technorati   Add to Twitter  
What's this?

Severe Staphylococcal Sepsis in Adolescents in the Era of Community-Acquired Methicillin-Resistant Staphylococcus aureus

Blanca E. Gonzalez, MD*,{ddagger}, Gerardo Martinez-Aguilar, MD*,§, Kristina G. Hulten, PhD*,{ddagger}, Wendy A. Hammerman, RN*,{ddagger}, Jorge Coss-Bu, MD*,{ddagger}, Anna Avalos-Mishaan, MD*,{ddagger}, Edward O. Mason, Jr, PhD*,{ddagger}, Sheldon L. Kaplan, MD*,{ddagger}

* Department of Pediatrics, Baylor College of Medicine, Houston, Texas
{ddagger} Texas Children's Hospital, Houston, Texas
§ Medical Research Unit in Clinical Epidemiology, Mexican Social Security Institute, Durango, Mexico

Objective. More than 70% of the community-acquired (CA) staphylococcal infections treated at Texas Children's Hospital are caused by methicillin-resistant Staphylococcus aureus (MRSA). Since September 2002, an increase in the number of severely ill patients with S aureus infections has occurred. This study provides a clinical description of severely ill adolescent patients and an analysis of their isolates using molecular methods.

Methods. We identified adolescent patients meeting criteria for severe sepsis requiring admission to the PICU. Patient records were reviewed, and isolates were obtained for susceptibility testing and DNA extraction. Isolates were tested for the presence of virulence genes (cna, tst, lukS-PV, and lukF-PV) and enterotoxin genes (sea, seb, sec, sed, seh, and sej) by polymerase chain reaction. Genomic fingerprints were determined by repetitive-element polymorphism polymerase chain reaction and pulse-field gel electrophoresis. SCCmec cassette type was determined.

Results. Fourteen adolescents with severe CA S aureus infections were identified between August 2002 and January 2004. All were admitted to the PICU with sepsis and coagulopathy. Twelve patients had CA-MRSA infections; 2 had CA methicillin-susceptible Staphylococcus aureus (MSSA) infections. The mean age was 12.9 years (range: 10-15 years). Thirteen patients had pulmonary involvement and/or bone and joint infection; 10 patients had ≥2 bones or joints infected (range: 2-10); 4 patients developed vascular complications (deep venous thrombosis); and 3 patients died. All isolates were identical or closely related to the previously reported predominant clone in Houston, Texas (multilocus sequence type 8, USA300), and carried lukS-PV and lukF-PV genes as well as the SCCmec type IVa cassette (12 MRSA isolates) but did not contain cna or tst. Only 1 strain carried enterotoxin genes (sed and sej).

Conclusions. Severe staphylococcal infections in previously healthy adolescents without predisposing risk factors have presented more frequently at Texas Children's Hospital since September 2002. CA MRSA and clonally related CA MSSA characterized as USA300 and sequence type 8 have been isolated from these patients.

Key Words: community-acquired Staphylococcus aureus • methicillin-resistant • severe sepsis

Abbreviations: CA, community acquired • MRSA, methicillin-resistant Staphylococcus aureus • PVL, Panton-Valentine leukocidin • TCH, Texas Children's Hospital • PCR, polymerase chain reaction • REP-PCR, repetitive-element polymorphism polymerase chain reaction • PFGE, pulse-field gel electrophoresis • MSSA, methicillin-susceptible Staphylococcus aureus • ST, sequence type

Accepted Nov 23, 2004.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Facebook Facebook   Add to Reddit Reddit   Add to Technorati Technorati   Add to Twitter Twitter    What's this?


This article has been cited by other articles:


Home page
 J. Bacteriol.Home page
K. M. Daly, M. Upton, S. K. Sandiford, L. A. Draper, P. A. Wescombe, R. W. Jack, P. M. O'Connor, A. Rossney, F. Gotz, C. Hill, et al.
Production of the Bsa Lantibiotic by Community-Acquired Staphylococcus aureus Strains
J. Bacteriol., February 15, 2010; 192(4): 1131 - 1142.
[Abstract] [Full Text] [PDF]

Home page
 Eur Respir JHome page
A. Pantosti and M. Venditti
What is MRSA?
Eur. Respir. J., November 1, 2009; 34(5): 1190 - 1196.
[Abstract] [Full Text] [PDF]

Home page
 Eur Respir JHome page
K. Z. Vardakas, D. K. Matthaiou, and M. E. Falagas
Incidence, characteristics and outcomes of patients with severe community acquired-MRSA pneumonia
Eur. Respir. J., November 1, 2009; 34(5): 1148 - 1158.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
D. J. Elliott, T. E. Zaoutis, A. B. Troxel, A. Loh, and R. Keren
Empiric Antimicrobial Therapy for Pediatric Skin and Soft-Tissue Infections in the Era of Methicillin-Resistant Staphylococcus aureus
Pediatrics, June 1, 2009; 123(6): e959 - e966.
[Abstract] [Full Text] [PDF]

Home page
 Am J Crit CareHome page
A. S. Bruns and N. Sood
Community-Acquired Methicillin-Resistant Staphylococcus Aureus Epidural Abscess With Bacteremia and Multiple Lung Abscesses: Case Report
Am. J. Crit. Care., January 1, 2009; 18(1): 86 - 88.
[Abstract] [Full Text] [PDF]

Home page
 CVIHome page
E. L. Brown, M. G. Bowden, R. S. Bryson, K. G. Hulten, A. S. Bordt, A. Forbes, and S. L. Kaplan
Pediatric Antibody Response to Community-Acquired Staphylococcus aureus Infection Is Directed to Panton-Valentine Leukocidin
Clin. Vaccine Immunol., January 1, 2009; 16(1): 139 - 141.
[Abstract] [Full Text] [PDF]

Home page
 Antimicrob. Agents Chemother.Home page
G. Memmi, S. R. Filipe, M. G. Pinho, Z. Fu, and A. Cheung
Staphylococcus aureus PBP4 Is Essential for {beta}-Lactam Resistance in Community-Acquired Methicillin-Resistant Strains
Antimicrob. Agents Chemother., November 1, 2008; 52(11): 3955 - 3966.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
S. A. Fritz, J. Garbutt, A. Elward, W. Shannon, and G. A. Storch
Prevalence of and Risk Factors for Community-Acquired Methicillin-Resistant and Methicillin-Sensitive Staphylococcus aureus Colonization in Children Seen in a Practice-Based Research Network
Pediatrics, June 1, 2008; 121(6): 1090 - 1098.
[Abstract] [Full Text] [PDF]

Home page
 J. Clin. Microbiol.Home page
R. J. Olsen, K. M. Burns, L. Chen, B. N. Kreiswirth, and J. M. Musser
Severe Necrotizing Fasciitis in a Human Immunodeficiency Virus-Positive Patient Caused by Methicillin-Resistant Staphylococcus aureus
J. Clin. Microbiol., March 1, 2008; 46(3): 1144 - 1147.
[Abstract] [Full Text] [PDF]

Home page
 ANN INTERN MEDHome page
B. A. Diep, H. F. Chambers, C. J. Graber, J. D. Szumowski, L. G. Miller, L. L. Han, J. H. Chen, F. Lin, J. Lin, T. H. Phan, et al.
Emergence of Multidrug-Resistant, Community-Associated, Methicillin-Resistant Staphylococcus aureus Clone USA300 in Men Who Have Sex with Men
Ann Intern Med, February 19, 2008; 148(4): 249 - 257.
[Abstract] [Full Text] [PDF]

Home page
 Arch Pediatr Adolesc MedHome page
T. Q. Tan
The Truth About "The Superbug," Community-Associated Methicillin-Resistant Staphylococcus aureus: What the Practicing Clinician Needs to Know
Arch Pediatr Adolesc Med, February 1, 2008; 162(2): 183 - 184.
[Full Text] [PDF]

Home page
 J. Clin. Microbiol.Home page
Y.-C. Huang, K.-P. Hwang, P.-Y. Chen, C.-J. Chen, and T.-Y. Lin
Prevalence of Methicillin-Resistant Staphylococcus aureus Nasal Colonization among Taiwanese Children in 2005 and 2006
J. Clin. Microbiol., December 1, 2007; 45(12): 3992 - 3995.
[Abstract] [Full Text] [PDF]

Home page
 cfpHome page
C. Korownyk and G. M. Allan
Evidence-based approach to abscess management
Can Fam Physician, October 1, 2007; 53(10): 1680 - 1684.
[Abstract] [Full Text] [PDF]

Home page
 Antimicrob. Agents Chemother.Home page
M. W. Ellis, M. E. Griffith, D. P. Dooley, J. C. McLean, J. H. Jorgensen, J. E. Patterson, K. A. Davis, J. S. Hawley, J. A. Regules, R. G. Rivard, et al.
Targeted Intranasal Mupirocin To Prevent Colonization and Infection by Community-Associated Methicillin-Resistant Staphylococcus aureus Strains in Soldiers: a Cluster Randomized Controlled Trial
Antimicrob. Agents Chemother., October 1, 2007; 51(10): 3591 - 3598.
[Abstract] [Full Text] [PDF]

Home page
 J Bone Joint Surg BrHome page
P. D. Mitchell, D. M. Hunt, H. Lyall, M. Nolan, and G. Tudor-Williams
Panton-Valentine leukocidin-secreting Staphylococcus aureus causing severe musculoskeletal sepsis in children: A NEW THREAT
J Bone Joint Surg Br, September 1, 2007; 89-B(9): 1239 - 1242.
[Abstract] [Full Text] [PDF]

Home page
 The Annals of PharmacotherapyHome page
P. N Johnson, R. P Rapp, C. T Nelson, J. Butler, S. Overman, and R. J Kuhn
Characterization of Community-Acquired Staphylococcus aureus Infections in Children
Ann. Pharmacother., September 1, 2007; 41(9): 1361 - 1367.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
A. Elizur, R. C. Orscheln, T. W. Ferkol, J. J. Atkinson, W. M. Dunne Jr, R. S. Buller, J. R. Armstrong, E. R. Mardis, G. A. Storch, and C. L. Cannon
Panton-Valentine Leukocidin-Positive Methicillin-Resistant Staphylococcus aureus Lung Infection in Patients With Cystic Fibrosis
Chest, June 1, 2007; 131(6): 1718 - 1725.
[Abstract] [Full Text] [PDF]

Home page
 J. Immunol.Home page
X. Wang, X. Meng, J. R. Kuhlman, L. D. Nelin, K. K. Nicol, B. K. English, and Y. Liu
Knockout of Mkp-1 Enhances the Host Inflammatory Responses to Gram-Positive Bacteria
J. Immunol., April 15, 2007; 178(8): 5312 - 5320.
[Abstract] [Full Text] [PDF]

Home page
 J. Clin. Microbiol.Home page
K. K. Bonnstetter, D. J. Wolter, F. C. Tenover, L. K. McDougal, and R. V. Goering
Rapid Multiplex PCR Assay for Identification of USA300 Community-Associated Methicillin-Resistant Staphylococcus aureus Isolates
J. Clin. Microbiol., January 1, 2007; 45(1): 141 - 146.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
R. M. Fortunov, K. G. Hulten, W. A. Hammerman, E. O. Mason Jr, and S. L. Kaplan
Community-Acquired Staphylococcus aureus Infections in Term and Near-Term Previously Healthy Neonates
Pediatrics, September 1, 2006; 118(3): 874 - 881.
[Abstract] [Full Text] [PDF]

Home page
 NEJMHome page
G. J. Moran, A. Krishnadasan, R. J. Gorwitz, G. E. Fosheim, L. K. McDougal, R. B. Carey, D. A. Talan, and the EMERGEncy ID Net Study Group
Methicillin-Resistant S. aureus Infections among Patients in the Emergency Department.
N. Engl. J. Med., August 17, 2006; 355(7): 666 - 674.
[Abstract] [Full Text] [PDF]

Home page
 Antimicrob. Agents Chemother.Home page
B. K. English, E. M. Maryniw, A. J. Talati, and E. A. Meals
Diminished Macrophage Inflammatory Response to Staphylococcus aureus Isolates Exposed to Daptomycin versus Vancomycin or Oxacillin
Antimicrob. Agents Chemother., June 1, 2006; 50(6): 2225 - 2227.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
B. E. Gonzalez, J. Teruya, D. H. Mahoney Jr, K. G. Hulten, R. Edwards, L. B. Lamberth, W. A. Hammerman, E. O. Mason Jr, and S. L. Kaplan
Venous Thrombosis Associated With Staphylococcal Osteomyelitis in Children
Pediatrics, May 1, 2006; 117(5): 1673 - 1679.
[Abstract] [Full Text] [PDF]

Home page
 J. Clin. Microbiol.Home page
J.-A. McClure, J. M. Conly, V. Lau, S. Elsayed, T. Louie, W. Hutchins, and K. Zhang
Novel Multiplex PCR Assay for Detection of the Staphylococcal Virulence Marker Panton-Valentine Leukocidin Genes and Simultaneous Discrimination of Methicillin-Susceptible from -Resistant Staphylococci
J. Clin. Microbiol., March 1, 2006; 44(3): 1141 - 1144.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
C. E. Bocchini, K. G. Hulten, E. O. Mason Jr, B. E. Gonzalez, W. A. Hammerman, and S. L. Kaplan
Panton-Valentine Leukocidin Genes Are Associated With Enhanced Inflammatory Response and Local Disease in Acute Hematogenous Staphylococcus aureus Osteomyelitis in Children
Pediatrics, February 1, 2006; 117(2): 433 - 440.
[Abstract] [Full Text] [PDF]

Home page
 Pediatr. Rev.Home page
J. K. Todd
Staphylococcal Infections
Pediatr. Rev., December 1, 2005; 26(12): 444 - 450.
[Full Text] [PDF]

Home page
 Antimicrob. Agents Chemother.Home page
F. McAleese, E. Murphy, T. Babinchak, G. Singh, B. Said-Salim, B. Kreiswirth, P. Dunman, J. O'Connell, S. J. Projan, and P. A. Bradford
Use of Ribotyping To Retrospectively Identify Methicillin-Resistant Staphylococcus aureus Isolates from Phase 3 Clinical Trials for Tigecycline That Are Genotypically Related to Community-Associated Isolates
Antimicrob. Agents Chemother., November 1, 2005; 49(11): 4521 - 4529.
[Abstract] [Full Text] [PDF]

Home page
 NEJMHome page
A. L.N. Chapman, J. M. Greig, J. A. Innes, J. C. Hageman, R. Lynfield, S. K. Fridkin, L. G. Miller, F. Perdreau-Remington, and B. Spellberg
MRSA in the Community
N. Engl. J. Med., August 4, 2005; 353(5): 530 - 532.
[Full Text] [PDF]

Home page
 PediatricsHome page
L. L. Barton
Nonsteroidal Anti-inflammatory Drugs and Invasive Staphylococcal Infections: The Cart or the Horse?
Pediatrics, June 1, 2005; 115(6): 1790 - 1790.
[Full Text] [PDF]

Home page
 PediatricsHome page
B. E. Gonzalez, K. G. Hulten, W. A. Hammerman, J. Coss-Bu, A. Avalos-Mishaan, E. O. Mason, S. L. Kaplan, and G. Martinez-Aguilar
Nonsteroidal Anti-inflammatory Drugs and Invasive Staphylococcal Infections: The Cart or the Horse?: In Reply
Pediatrics, June 1, 2005; 115(6): 1791 - 1791.
[Full Text] [PDF]