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Medicine (Baltimore). 2019 Sep;98(38):e17185. doi: 10.1097/MD.0000000000017185.

Severe infections of Panton-Valentine leukocidin positive Staphylococcus aureus in children.

Author information

1
Department of Pediatric Pneumology, Immunology and Intensive Care.
2
Department of Pediatric Hematology and Oncology.
3
Department of Pediatric Radiology.
4
Department of Neonatology.
5
Department of Medical Immunology.
6
Department of Dermatology, Venerology and Allergy.
7
Department of Pediatric Cardiology.
8
Institute of Hygiene and Environmental Medicine.
9
Department of Infectious Diseases and Respiratory Medicine.
10
Department of Pediatric Surgery, Charité - Universitätsmedizin Berlin.
11
Department of Immunology, Labor Berlin Charité-Vivantes GmbH.
12
Berlin-Brandenburg Center for Regenerative Therapies.
13
Department of Anesthesiology and Operative Intensive Care Medicine Campus Mitte and Campus-Virchow Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany.

Abstract

Infections caused by Panton-Valentine leukocidin-positive Staphylococcus aureus (PVL-SA) mostly present as recurrent skin abscesses and furunculosis. However, life-threatening infections (eg, necrotizing pneumonia, necrotizing fasciitis, and osteomyelitis) caused by PVL-SA have also been reported.We assessed the clinical phenotype, frequency, clinical implications (surgery, length of treatment in hospitals/intensive care units, and antibiotic treatments), and potential preventability of severe PVL-SA infections in children.Total, 75 children treated for PVL-SA infections in our in- and outpatient units from 2012 to 2017 were included in this retrospective study.Ten out of 75 children contracted severe infections (PVL-methicillin resistant S aureus n = 4) including necrotizing pneumonia (n = 4), necrotizing fasciitis (n = 2), pyomyositis (n = 2; including 1 patient who also had pneumonia), mastoiditis with cerebellitis (n = 1), preorbital cellulitis (n = 1), and recurrent deep furunculosis in an immunosuppressed patient (n = 1). Specific complications of PVL-SA infections were venous thrombosis (n = 2), sepsis (n = 5), respiratory failure (n = 5), and acute respiratory distress syndrome (n = 3). The median duration of hospital stay was 14 days (range 5-52 days). In 6 out of 10 patients a history suggestive for PVL-SA colonization in the patient or close family members before hospital admission was identified.PVL-SA causes severe to life-threatening infections requiring lengthy treatments in hospital in a substantial percentage of symptomatic PVL-SA colonized children. More than 50% of severe infections might be prevented by prompt testing for PVL-SA in individuals with a history of abscesses or furunculosis, followed by decolonization measures.

PMID:
31567961
DOI:
10.1097/MD.0000000000017185
[Indexed for MEDLINE]
Free PMC Article

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