Community-associated Staphylococcus aureus pneumonia among Greek children: epidemiology, molecular characteristics, treatment, and outcome

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 c...

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Published in:	European journal of clinical microbiology & infectious diseases Vol. 35; no. 7; pp. 1177 - 1185
Main Authors:	Doudoulakakis, A. G., Bouras, D., Drougka, E., Kazantzi, M., Michos, A., Charisiadou, A., Spiliopoulou, I., Lebessi, E., Tsolia, M.
Format:	Journal Article
Language:	English
Published:	Berlin/Heidelberg Springer Berlin Heidelberg 01-07-2016 Springer Nature B.V
Subjects:	Abscesses Anti-Bacterial Agents - pharmacology Anti-Bacterial Agents - therapeutic use Antibiotics Biomedical and Life Sciences Biomedicine Child Child, Preschool Children Cloning Community-Acquired Infections - diagnosis Community-Acquired Infections - drug therapy Community-Acquired Infections - epidemiology Community-Acquired Infections - microbiology Comorbidity Disease Management Drug Resistance, Bacterial Epidemiology Female Genes, Bacterial Greece - epidemiology Hospitalization Hospitals Humans Infant Infant, Newborn Internal Medicine Male Medical Microbiology Medical records Microbial Sensitivity Tests Microbiology Multilocus Sequence Typing Original Article Pathogens Pediatrics Pneumonia Pneumonia, Staphylococcal - diagnosis Pneumonia, Staphylococcal - drug therapy Pneumonia, Staphylococcal - epidemiology Pneumonia, Staphylococcal - microbiology Staphylococcus aureus Staphylococcus aureus - classification Staphylococcus aureus - drug effects Staphylococcus aureus - genetics Staphylococcus infections Treatment Outcome Virulence Factors - genetics Greece Athens Greece Europe Linezolid Respiratory Syncytial Virus Vancomycin Clindamycin Teicoplanin
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Summary:	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), SCC mec , 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 (MIC 90 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/ agr 3/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.
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ISSN:	0934-9723 1435-4373
DOI:	10.1007/s10096-016-2651-7