Pediatric Bone and Joint Infections Caused by Panton-Valentine Leukocidin-Positive Staphylococcus aureus

• Published in: The Pediatric infectious disease journal Vol. 26; no. 11; pp. 1042 - 1048
• Main Authors: Dohin, Bruno, Gillet, Yves, Kohler, Rémi, Lina, Gérard, Vandenesch, François, Vanhems, Philippe, Floret, Daniel, Etienne, Jerome
• Format: Journal Article
• Language: English
• Published: Baltimore, MD Lippincott Williams & Wilkins, Inc 01-11-2007; Philadelphia, PA Lippincott; Hagerstown, MD
• Subjects: Adolescent; Arthritis, Infectious - diagnostic imaging; Arthritis, Infectious - microbiology; Arthritis, Infectious - surgery; Bacterial arthritis and osteitis; Bacterial diseases; Bacterial Toxins - genetics; Biological and medical sciences; Diseases of the osteoarticular system; Exotoxins - genetics; Female; Human bacterial diseases; Humans; Infant; Infectious diseases; Leukocidins - genetics; Magnetic Resonance Imaging; Male; Medical sciences; Miscellaneous. Osteoarticular involvement in other diseases; Osteomyelitis - diagnostic imaging; Osteomyelitis - microbiology; Osteomyelitis - physiopathology; Osteomyelitis - surgery; Radiography; Sepsis - microbiology; Severity of Illness Index; Shock, Septic - microbiology; Staphylococcal Infections - diagnostic imaging; Staphylococcal Infections - microbiology; Staphylococcal Infections - physiopathology; Staphylococcal Infections - surgery; Staphylococcal infections, streptococcal infections, pneumococcal infections; Staphylococcus aureus - drug effects; Staphylococcus aureus - genetics; Human; Pediatrics; Cytokine; Diseases of the osteoarticular system; bone and joint infection; Arthritis; Infection; Panton-Valentine leukocidin; osteomyelitis; Osteitis; Bacteriosis; Bacteria; Micrococcales; Micrococcaceae; Bone; Staphylococcal infection; Child; Staphylococcus aureus
• ISSN: 0891-3668; 1532-0987
• DOI: 10.1097/INF.0b013e318133a85e

BACKGROUND:Panton-Valentine leukocidin (PVL) is a necrotizing toxin secreted by Staphylococcus aureus. PVL-positive S. aureus osteomyelitis and arthritis have been described.
METHODS:We analyzed demographic, clinical, laboratory, microbiologic, and imaging data in a study group of 14 pediatric cases with PVL-positive S. aureus osteomyelitis and arthritis diagnosed between 2001 and 2005 and compared results with a control group of 17 pediatric cases of PVL-negative S. aureus osteomyelitis and arthritis treated in our institution during the same period. Treatments and outcome were studied.
RESULTS:The severity of PVL-positive S. aureus bone and joint infections was indicated by the presence of severe sepsis in all cases and of septic shock in 6 of the 14 patients. By comparison, severe sepsis was not noted in the control group (P = 0.004). On admission, the median C-reactive protein value was significantly higher in the study group (202.6 mg/L versus 83 mg/L in the control group; P = 0.001). Eleven patients with PVL-positive infection had local extension of the infection by magnetic resonance imaging and 7 patients had severe deep-seated infectious complications by computed tomography. By contrast only 1 patient in the control group presented with bone abscess without extension and none had deep-seated infection (P < 0.001). The median length of hospitalization was 45.5 days in the study group versus 13 days in the control group (P < 0.001). The median duration of intravenous antibacterial chemotherapy was 48 days versus 11.3 days in the control group (P < 0.001). Ten patients (71%) of the study group required surgical procedures with a mean of 3 procedures (range, 1–5) whereas 3 patients (17%) of the control group required 1 surgical drainage each (P = 0.002). All the patients survived, but only 2 patients of the study group were free of long-term complications, whereas there were no long-term complications noted in the control group.
CONCLUSION:PVL-positive S. aureus bone and joint infection is severe and requires prolonged treatment. Local complications are more frequent and often need repeated surgical drainage.