USA300 is the predominant genotype causing staphylococcus aureus septic arthritis in children

Maria Carrillo-Marquez, Kristina G. Hulten, Wendy Hammerman, Edward O. Mason, Sheldon L. Kaplan

Research output: Contribution to journalArticle

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Abstract

Background: Staphylococcus aureus is the most common cause of septic arthritis (SA) in children. USA300 is the predominant community methicillin-resistant (MRSA) clone. Panton-Valentine leukocidin genes (pvl) have been associated with severe disease. Methods: Patients with S. aureus SA were identified from the Texas Children's Hospital surveillance study. Pulsed field gel electrophoresis and pvl polymerase chain reaction were performed on isolates. Results: Forty-five patients with S. aureus SA were identified between August 2001 and October 2008. Median age was 5.5 years (0.3-17.9 years); 69% were previously healthy. The most common joints affected were hip (40%) followed by knee (36%). Associated infection sites were osteomyelitis (n = 14), pyomyositis/myositis (n = 13), and cellulitis (n = 9). Bacteremia for 1 to 5 days occurred in 31% of the patients. Patients with associated osteomyelitis were more likely to be bacteremic (P = 0.001), have fever >2 days (P = 0.03), and to have C-reactive protein (CRP) ≥10 mg/dL (P = 0.01). Of 44 available isolates, 16 were MRSA; 13 of 16 were USA300 and 14 of 16 were pvl+. Twenty-eight isolates were MSSA; 8 of 28 were USA300 and 13 of 28 were pvl+. Infections caused by USA300 isolates were associated with longer duration of fever than non-USA300 isolates (median, [range]: 4 [0-15] days vs 1 [0-8] days) (P = 0.03). Overall, 61% of the isolates were pvl+. CRP ≥10 mg/dL was more likely in pvl+ infections than in pvl-infections (P = 0.05). Conclusions: S. aureus SA caused by USA300 isolates is associated with longer duration of fever. Empirical treatment of SA should include MRSA. CRP levels ≥10 mg/dL, fever >2 days, and bacteremia should raise suspicion for associated osteomyelitis.

Original languageEnglish (US)
Pages (from-to)1076-1080
Number of pages5
JournalPediatric Infectious Disease Journal
Volume28
Issue number12
DOIs
StatePublished - Jan 1 2009
Externally publishedYes

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Infectious Arthritis
Staphylococcus aureus
Genotype
Methicillin Resistance
Genes
Fever
Osteomyelitis
C-Reactive Protein
Bacteremia
Infection
Pyomyositis
Myositis
Cellulitis
Pulsed Field Gel Electrophoresis
Panton-Valentine leukocidin
Hip
Knee
Clone Cells
Joints
Polymerase Chain Reaction

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health
  • Microbiology (medical)
  • Infectious Diseases

Cite this

USA300 is the predominant genotype causing staphylococcus aureus septic arthritis in children. / Carrillo-Marquez, Maria; Hulten, Kristina G.; Hammerman, Wendy; Mason, Edward O.; Kaplan, Sheldon L.

In: Pediatric Infectious Disease Journal, Vol. 28, No. 12, 01.01.2009, p. 1076-1080.

Research output: Contribution to journalArticle

Carrillo-Marquez, Maria ; Hulten, Kristina G. ; Hammerman, Wendy ; Mason, Edward O. ; Kaplan, Sheldon L. / USA300 is the predominant genotype causing staphylococcus aureus septic arthritis in children. In: Pediatric Infectious Disease Journal. 2009 ; Vol. 28, No. 12. pp. 1076-1080.
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abstract = "Background: Staphylococcus aureus is the most common cause of septic arthritis (SA) in children. USA300 is the predominant community methicillin-resistant (MRSA) clone. Panton-Valentine leukocidin genes (pvl) have been associated with severe disease. Methods: Patients with S. aureus SA were identified from the Texas Children's Hospital surveillance study. Pulsed field gel electrophoresis and pvl polymerase chain reaction were performed on isolates. Results: Forty-five patients with S. aureus SA were identified between August 2001 and October 2008. Median age was 5.5 years (0.3-17.9 years); 69{\%} were previously healthy. The most common joints affected were hip (40{\%}) followed by knee (36{\%}). Associated infection sites were osteomyelitis (n = 14), pyomyositis/myositis (n = 13), and cellulitis (n = 9). Bacteremia for 1 to 5 days occurred in 31{\%} of the patients. Patients with associated osteomyelitis were more likely to be bacteremic (P = 0.001), have fever >2 days (P = 0.03), and to have C-reactive protein (CRP) ≥10 mg/dL (P = 0.01). Of 44 available isolates, 16 were MRSA; 13 of 16 were USA300 and 14 of 16 were pvl+. Twenty-eight isolates were MSSA; 8 of 28 were USA300 and 13 of 28 were pvl+. Infections caused by USA300 isolates were associated with longer duration of fever than non-USA300 isolates (median, [range]: 4 [0-15] days vs 1 [0-8] days) (P = 0.03). Overall, 61{\%} of the isolates were pvl+. CRP ≥10 mg/dL was more likely in pvl+ infections than in pvl-infections (P = 0.05). Conclusions: S. aureus SA caused by USA300 isolates is associated with longer duration of fever. Empirical treatment of SA should include MRSA. CRP levels ≥10 mg/dL, fever >2 days, and bacteremia should raise suspicion for associated osteomyelitis.",
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T1 - USA300 is the predominant genotype causing staphylococcus aureus septic arthritis in children

AU - Carrillo-Marquez, Maria

AU - Hulten, Kristina G.

AU - Hammerman, Wendy

AU - Mason, Edward O.

AU - Kaplan, Sheldon L.

PY - 2009/1/1

Y1 - 2009/1/1

N2 - Background: Staphylococcus aureus is the most common cause of septic arthritis (SA) in children. USA300 is the predominant community methicillin-resistant (MRSA) clone. Panton-Valentine leukocidin genes (pvl) have been associated with severe disease. Methods: Patients with S. aureus SA were identified from the Texas Children's Hospital surveillance study. Pulsed field gel electrophoresis and pvl polymerase chain reaction were performed on isolates. Results: Forty-five patients with S. aureus SA were identified between August 2001 and October 2008. Median age was 5.5 years (0.3-17.9 years); 69% were previously healthy. The most common joints affected were hip (40%) followed by knee (36%). Associated infection sites were osteomyelitis (n = 14), pyomyositis/myositis (n = 13), and cellulitis (n = 9). Bacteremia for 1 to 5 days occurred in 31% of the patients. Patients with associated osteomyelitis were more likely to be bacteremic (P = 0.001), have fever >2 days (P = 0.03), and to have C-reactive protein (CRP) ≥10 mg/dL (P = 0.01). Of 44 available isolates, 16 were MRSA; 13 of 16 were USA300 and 14 of 16 were pvl+. Twenty-eight isolates were MSSA; 8 of 28 were USA300 and 13 of 28 were pvl+. Infections caused by USA300 isolates were associated with longer duration of fever than non-USA300 isolates (median, [range]: 4 [0-15] days vs 1 [0-8] days) (P = 0.03). Overall, 61% of the isolates were pvl+. CRP ≥10 mg/dL was more likely in pvl+ infections than in pvl-infections (P = 0.05). Conclusions: S. aureus SA caused by USA300 isolates is associated with longer duration of fever. Empirical treatment of SA should include MRSA. CRP levels ≥10 mg/dL, fever >2 days, and bacteremia should raise suspicion for associated osteomyelitis.

AB - Background: Staphylococcus aureus is the most common cause of septic arthritis (SA) in children. USA300 is the predominant community methicillin-resistant (MRSA) clone. Panton-Valentine leukocidin genes (pvl) have been associated with severe disease. Methods: Patients with S. aureus SA were identified from the Texas Children's Hospital surveillance study. Pulsed field gel electrophoresis and pvl polymerase chain reaction were performed on isolates. Results: Forty-five patients with S. aureus SA were identified between August 2001 and October 2008. Median age was 5.5 years (0.3-17.9 years); 69% were previously healthy. The most common joints affected were hip (40%) followed by knee (36%). Associated infection sites were osteomyelitis (n = 14), pyomyositis/myositis (n = 13), and cellulitis (n = 9). Bacteremia for 1 to 5 days occurred in 31% of the patients. Patients with associated osteomyelitis were more likely to be bacteremic (P = 0.001), have fever >2 days (P = 0.03), and to have C-reactive protein (CRP) ≥10 mg/dL (P = 0.01). Of 44 available isolates, 16 were MRSA; 13 of 16 were USA300 and 14 of 16 were pvl+. Twenty-eight isolates were MSSA; 8 of 28 were USA300 and 13 of 28 were pvl+. Infections caused by USA300 isolates were associated with longer duration of fever than non-USA300 isolates (median, [range]: 4 [0-15] days vs 1 [0-8] days) (P = 0.03). Overall, 61% of the isolates were pvl+. CRP ≥10 mg/dL was more likely in pvl+ infections than in pvl-infections (P = 0.05). Conclusions: S. aureus SA caused by USA300 isolates is associated with longer duration of fever. Empirical treatment of SA should include MRSA. CRP levels ≥10 mg/dL, fever >2 days, and bacteremia should raise suspicion for associated osteomyelitis.

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