PEDIATRICS Vol. 117 No. 2 February 2006, pp. 433-440 (doi:10.1542/10.1542/peds.2005-0566)
Panton-Valentine Leukocidin Genes Are Associated With Enhanced Inflammatory Response and Local Disease in Acute Hematogenous Staphylococcus aureus Osteomyelitis in Children
Department of Pediatrics, Baylor College of Medicine, Houston, Texas; Texas Children's Hospital, Houston, Texas
BACKGROUND. Staphylococcus aureus strains carrying the genes encoding Panton-Valentine leukocidin (pvl-positive [pvl+]) are associated with more febrile days and higher complication rates of osteomyelitis in children than are pvl-negative (pvl–) strains.
OBJECTIVES. Selected clinical, laboratory, and radiographic findings in children with osteomyelitis caused by pvl+ and pvl– S aureus strains were compared.
METHODS. The demographics, selected clinical features, laboratory values, and radiographic findings of children with community-acquired S aureus osteomyelitis prospectively identified at Texas Children's Hospital between August 2001 and July 2004 were reviewed. Polymerase chain reaction was performed to detect the genes for pvl (luk-S-PV and luk-F-PV) and fibronectin-binding protein (fnbB) in S aureus isolates. 
2, 2-sample t test, and multiple logistic regression were used for statistical analysis.
RESULTS. Methicillin-susceptible and methicillin-resistant S aureus (MSSA and MRSA, respectively) caused osteomyelitis in 33 and 56 children, respectively. Twenty-six isolates were pvl– (26 MSSA), 59 were pvl+ (3 MSSA, 56 MRSA), and 4 were not available for analysis (4 MSSA). On univariate analysis, patients with pvl+ S aureus isolates had significantly higher erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level both at presentation and as a maximum value during hospitalization and were more likely to have a blood culture positive for S aureus during their admission. Patients with pvl+ S aureus isolates were significantly more likely to have concomitant myositis or pyomyositis compared with patients with pvl– S aureus isolates on MRI. In a multivariate analysis pvl remained significantly associated with ESR and CRP levels at presentation and blood culture positive for S aureus. pvl+ status and younger age were associated with myositis on MRI.
CONCLUSIONS. Osteomyelitis caused by pvl+ S aureus strains were associated with more severe local disease and a greater systemic inflammatory response compared with osteomyelitis caused by pvl– S aureus.
Key Words: Staphylococcus aureus • Panton-Valentine leukocidin • osteomyelitis
Abbreviations: AHO—acute hematogenous osteomyelitis • MRSA—methicillin-resistant S aureus • CA—community acquired • MSSA—methicillin-susceptible S aureus • TCH—Texas Children's Hospital • PVL—Panton-Valentine leukocidin • ESR—erythrocyte sedimentation rate • CRP—C-reactive protein • WBC—white blood cell • ANC—absolute neutrophil count
Accepted Apr 20, 2005.
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