Etiology and clinical features of osteoarticular infections in children hospitalized at the Pediatric Hospital of the Pereira Rossell Health Care Center from 2003 through 2005
Presentación clínica y evolutiva observada en dos centros universitarios. Uruguay 2003-2007
Keywords:
COMMUNITY-ACQUIRED INFECTIONS, STAPHYLOCOCCUS AUREUS, METHICILLIN RESISTANCE, STAPHYLOCOCCAL INFECTIONSAbstract
Introduction: in Uruguay, since 2001, community acquired non-multiresistant methicillin-resistant staphylococcus aureus was defined as an emerging pathogen in child community acquired diseases. Between 2003 and 2004, the fast dissemination of infections caused by this germ resulted in several people dying and the uprising of a health alarm.
Objective: to describe the main clinical features and evolution in children hospitalized due to community acquired methicillin resistant staphylococcus aureus in two university medical centers between 2003 and 2007.
Method: the study was conducted in children with invasive community acquired methicillin resistant staphylococcus aureus infections, who were hospitalized in the Pediatric Hospital of the Pereira Rossell Health Care Center and in the Litoral de Paysandú Teaching Hospital between January 1, 2003 and December 31, 2007. We defined an infection as invasive when the germ was isolated in usually sterile sites. We analyzed age, sex, topography, complications and mortality.
Results: 78 children were hospitalized; average age was 5.4 years old. The most common clinical presentations were empyema (n=28), osteoarticular infection (n=27), bacteremia secondary to skin and soft tissue infections (n=9). Among children with empyemia, 5 evidenced sepsis or septic shock, or both; 27 required thorax drain, 11 of which evidenced abcess in the chest cavity, 6 of which evidenced costal osteomyelitis, one of which required partial neumonectomy.
Among the osteoarticular infection group, they all required drainage; 9 evidenced pandiaphystis, sepsis or septic sic, or both; 5 evidenced deep vein thrombosis, and 5 evolved to chronicity. Five children (6.4%) died; three of them with empyemia and two with osteoarticular infections.
Conclusions: a large proportion of children with invasive community acquired methicillin resistant staphylococcus aureus infections presented sequelae; mortality in this series was 6.4%. Learning about the different forms of clinical presentation and possible evolution is essential for early diagnosis and the appropriate empirical treatment. Genetic characterization of strains could contribute to improving control and treatment.
References
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(21) Mitchell P, Hunt DM, Lyall H, Nolan M, Tudor-Williams G. Panton- Valentine leukocidin-secreting Staphylococcus aureus causing severe musculoskeletal sepsis in children: a new threat. J Bone Joint Surg Br 2007; 89(9): 1239-42.
(22) Miles F, Voss L, Segedin E, Anderson BJ. Review of Staphylococcus aureus infections requiring admission to a paediatric intensive care unit. Arch Dis Child 2005; 90(12): 1274-8.
(23) Castaldo ET, Yang EY. Severe sepsis attributable to community-associated methicillin–resistant Staphylococcus aureus: an emerging fatal problem. Am Surg 2007; 73(7): 684-7.
(24) González BE, Martínez-Aguilar G, Hulten KG, Hammerman WA, Coss-Bu J, Avalos-Mishaan A, et al. Severe Staphylococcal sepsis in adolescents in the era of community-acquired methicillin-resistant staphylococcus aureus. Pediatrics 2005; 115(3): 642-8.
(25) Adem P, Montgomery C, Husain A, Koogler T, Arangelovich V, Humilier M, et al. Staphylococcus aureus sepsis and the Waterhouse-Friderichsen Syndrome in children. N Engl J Med 2005; 353(12): 1245-51.
(26) Martínez-Aguilar G, Avalos-Mishaan A, Hulten K, Hammerman W, Mason E, Kaplan S. Community-acquired, methicillin-resistant and methicillin-susceptible Staphylococcus aureus musculoskeletal infections in children. Pediatr Infect Dis J 2004; 23(8): 701-6.
(27) Sattler CA, Correa AG. Coagulase-positive Staphylococcal infections (Staphylococcus aureus). In: Feigin RD, Cherry JD, Demmler GJ, Kaplan SL Textbook of pediatrics infectious disease. 5 ed. Philadelphia: WB Saunders, 2004: 1099-129.
(28) Chartrand SA, MacCraken GH. Staphylococcal pneumonia in infants and children. Pediatr Infect Dis 1982; 1(1): 19-23.
(29) González B, Hulten K, Dishop M, Lamberth L, Hammerman W, Mason E, et al. Pulmonary manifestations in children with invasive community-acquired Staphylococcus aureus Infection. Clin Infect Dis 2005; 41(5): 583-90.
(30) Bradley S. Staphylococcus aureus pneumonia: emergence of MRSA in the community. Semin Respir Crit Care Med 2005; 26(6): 643-9.
(31) Guillet Y, Vanhems P, Lina G, Bes M, Vandenesch F, Floret D, et al. Factors predicting mortality in necrotizing community-acquired pneumonia caused by Staphylococcus aureus containing panton-valentine leukocidin. Clin Infect Dis 2007; 45(3): 315-21.
(32) Kallen A, Hageman J, Gorwitz R, Beekmann S, Polgreen P. Characteristics of Staphylococcus aureus community-acquired pneumonia during the 2006-2007 influenza season. Clin Infect Dis 2007; 45(12): 1655.
(33) Jupiter J, Erlich M, Novelline R, Leeds H, Keim D. The association of septic thrombophlebitis with subperiosteal abscesses in children. J Pediatr 1982; 101(5): 690-5.
(34) Horvath F, Brodeur A, Cherry J. Deep thrombophlebitis associated with acute osteomyelitis. J Pediatr 1971; 79(5): 815-8.
(35) González B, Teruya J, Mahoney D, Hulten K, Edwards R, Lamberth L, et al. Venous thrombosis associated with Staphylococcal osteomyelitis in children. Pediatrics 2006; 117(5): 1673-9.
(36) Cardozo N, Pomi F, Giachetto G, Giudice J, Pírez MC. Endocarditis infecciosa: características clínicas y evolutivas de niños hospitalizados entre 2000 y 2006 en dos centros asistenciales de referencia. Congreso Uruguayo de Pediatría, 26. Montevideo, 6-9 set 2007.
(37) Kaplan SL. Pyogenic liver abscess. In: Feigin RD, Cherry JD, Demmler GJ, Kaplan SL. TexbooK of pediatrics infectious disease. 5 ed. Philadelphia: WB Saunders, 2004: 679-82.
(38) Kaplan SL. Treatment of community-associated methicillin-resistant Staphylococcus aureus infections. Pediatr Infect Dis J 2005; 24(5): 457-8.
(39) Fergie J, Purcell K. The treatment of community-acquired methicillin-resistant Staphylococcus aureus Infections. Pediatr Infect Dis J 2008; 27(1): 67-8.
(2) Gorwitz R. A review of community-associated methicillin-resistant Staphylococcus aureus skin and soft tissue infections. Pediatr Infect Dis J 2008; 27(1): 1-7.
(3) Ribeiro A, Días C, Silva-Carvalho MC, Berquó L, Ferreira F, Santos RN, et al. First report of infection with community-acquired methicillin resistant staphylococcus aureus in South America. J Clin Microbiol 2005; 43(4): 1985-8.
(4) Ma X, Galiana A, Pedreira W, Mowszowicz M, Christophersen I, Machiavello S, et al. Community-acquired methicillin-resistant staphylococcus aureus, Uruguay. Emerg Infect Dis 2005; 11(6): 973-6.
(5) Galiana A. Infección por Staphylococcus aureus meticilino resistente adquirido en la comunidad. Arch Pediatr Urug 2003; 74(1): 26-9.
(6) Pedreira W, Anzalone L, Galiana A, Blanco LJ, Seijas V, Andújar M, et al. Infecciones de piel y partes blandas. Biomedicina 2006; 2(3): 240-5.
(7) Prego J, Galiana A, Pujadas M, Almada K, Boulay M, Carugatti MJ. Infecciones de piel y partes blandas en pacientes ambulatorios. Arch Pediatr Urug 2004; (4): 300-6.
(8) Bonino A, Gnesetti A, Pujadas M, Broggi A. Infecciones por Staphylococcus aureus meticilino resistente adquirido en la comunidad: análisis de una población pediátrica asistida en el Hospital Policial de Uruguay 2004. Arch Pediatr Urug 2007; 78(1): 41-7.
(9) Parodi V, Aldao J, Bustos R. Estafilococo meticilino resistente en la maternidad del Centro Hospitalario Pereira Rossell. Arch Pediatr Urug 2007; 78(1): 5-10.
(10) Amorín B, Machi A, Long A, Mareque G, Reyes M, Martínez L. Infecciones invasivas a Staphylococcus aureus. Servicio de Pediatría. Hospital de Paysandú 2003-2006. Congreso Uruguayo de Pediatría, 26. Montevideo, 6-9 set 2007.
(11) Uruguay. Universidad de la República. Facultad de Medicina. Hospital de Clínicas Dr. Manuel Quintela. Departamento Clínico de Medicina. Pautas institucionales: Staphylococcus aureus meticilino resistente comunitario (SAMR- com). Agosto, 2004. Obtenido de: http://www.infectologia.edu.uy/UserFiles/File/PautaSAMR_com.pdf (Consulta: 17 mar 2008).
(12) Pirez C, Montano A, Rubio I, Bello O. Impétigo, abscesos y forúnculos. In: Atención pediátrica: pautas de diagnóstico, tratamiento y prevención. 6 ed. Montevideo: Oficina del Libro-AEM, 2007: 301-18.
(13) Mishaan AM, Mason EO Jr, Martinez-Aguilar G, Hammerman W, Propst JJ, Lupski JR, et al. Emergence of a predominant clone of community –acquired staphylococcus aureus among Children in Houston, Texas. Pediatr Infect Dis J 2005; 24(3): 201-6.
(14) Kaplan S. Community acquired methicillin resistant staphylococcus aureus infection in children. Semin Pediatr Infect Dis 2006; 17:113-9.
(15) Lina G, Piemont Y, Godail-Gamot F, Bes M, Peter M, Gaudochon V. Involmement of Panton-Valentine leukocidin-producing Staphylococcus aureus in primary skin infections and pneumonia. Clin Infect Dis 1999; 29(1): 1128-32.
(16) Pardo L, Macedo M, Castro M, Sandín D, Mateos S, Pérez S, et al. Infecciones por Staphylococcus aureus adquiridas en la comunidad en una población pediátrica: características clínicas y microbiológicas. Congreso Uruguayo de Pediatría, 26. Montevideo, 6-9 set 2007.
(17) Kaplan S, Hulten K, Gonzalez B, Hammerman W, Lamberth L, Versalovic J. Three–year surveillance of community –acquired Staphylococcus aureus infections in children. Clin Infect Dis 2005; 40(12): 1785-91.
(18) Martínez-Aguilar G, Hammerman WA, Mason E, Kaplan S. Clindamycin treatment of invasive infections caused by community-acquired, methicillin-resistant and methicillin-susceptible Staphylococcus aureus in children. Pediatr Infect Dis J 2003; 22(7): 593-8.
(19) Knapp C, Moody JA. Tests to assess bactericidal activity. Time-kill assay. In: Isenberg HD, ed. Clinical microbiology procedures handbook. Washington: American Society of Microbiology; 1992: 5.16.1-5.
(20) National Committee for Clinical Laboratory Standards. Performance standards for antimicrobial susceptibility testing; 14th informational supplement. Wayne: NCCLS, 2004. (Document M100-S14).
(21) Mitchell P, Hunt DM, Lyall H, Nolan M, Tudor-Williams G. Panton- Valentine leukocidin-secreting Staphylococcus aureus causing severe musculoskeletal sepsis in children: a new threat. J Bone Joint Surg Br 2007; 89(9): 1239-42.
(22) Miles F, Voss L, Segedin E, Anderson BJ. Review of Staphylococcus aureus infections requiring admission to a paediatric intensive care unit. Arch Dis Child 2005; 90(12): 1274-8.
(23) Castaldo ET, Yang EY. Severe sepsis attributable to community-associated methicillin–resistant Staphylococcus aureus: an emerging fatal problem. Am Surg 2007; 73(7): 684-7.
(24) González BE, Martínez-Aguilar G, Hulten KG, Hammerman WA, Coss-Bu J, Avalos-Mishaan A, et al. Severe Staphylococcal sepsis in adolescents in the era of community-acquired methicillin-resistant staphylococcus aureus. Pediatrics 2005; 115(3): 642-8.
(25) Adem P, Montgomery C, Husain A, Koogler T, Arangelovich V, Humilier M, et al. Staphylococcus aureus sepsis and the Waterhouse-Friderichsen Syndrome in children. N Engl J Med 2005; 353(12): 1245-51.
(26) Martínez-Aguilar G, Avalos-Mishaan A, Hulten K, Hammerman W, Mason E, Kaplan S. Community-acquired, methicillin-resistant and methicillin-susceptible Staphylococcus aureus musculoskeletal infections in children. Pediatr Infect Dis J 2004; 23(8): 701-6.
(27) Sattler CA, Correa AG. Coagulase-positive Staphylococcal infections (Staphylococcus aureus). In: Feigin RD, Cherry JD, Demmler GJ, Kaplan SL Textbook of pediatrics infectious disease. 5 ed. Philadelphia: WB Saunders, 2004: 1099-129.
(28) Chartrand SA, MacCraken GH. Staphylococcal pneumonia in infants and children. Pediatr Infect Dis 1982; 1(1): 19-23.
(29) González B, Hulten K, Dishop M, Lamberth L, Hammerman W, Mason E, et al. Pulmonary manifestations in children with invasive community-acquired Staphylococcus aureus Infection. Clin Infect Dis 2005; 41(5): 583-90.
(30) Bradley S. Staphylococcus aureus pneumonia: emergence of MRSA in the community. Semin Respir Crit Care Med 2005; 26(6): 643-9.
(31) Guillet Y, Vanhems P, Lina G, Bes M, Vandenesch F, Floret D, et al. Factors predicting mortality in necrotizing community-acquired pneumonia caused by Staphylococcus aureus containing panton-valentine leukocidin. Clin Infect Dis 2007; 45(3): 315-21.
(32) Kallen A, Hageman J, Gorwitz R, Beekmann S, Polgreen P. Characteristics of Staphylococcus aureus community-acquired pneumonia during the 2006-2007 influenza season. Clin Infect Dis 2007; 45(12): 1655.
(33) Jupiter J, Erlich M, Novelline R, Leeds H, Keim D. The association of septic thrombophlebitis with subperiosteal abscesses in children. J Pediatr 1982; 101(5): 690-5.
(34) Horvath F, Brodeur A, Cherry J. Deep thrombophlebitis associated with acute osteomyelitis. J Pediatr 1971; 79(5): 815-8.
(35) González B, Teruya J, Mahoney D, Hulten K, Edwards R, Lamberth L, et al. Venous thrombosis associated with Staphylococcal osteomyelitis in children. Pediatrics 2006; 117(5): 1673-9.
(36) Cardozo N, Pomi F, Giachetto G, Giudice J, Pírez MC. Endocarditis infecciosa: características clínicas y evolutivas de niños hospitalizados entre 2000 y 2006 en dos centros asistenciales de referencia. Congreso Uruguayo de Pediatría, 26. Montevideo, 6-9 set 2007.
(37) Kaplan SL. Pyogenic liver abscess. In: Feigin RD, Cherry JD, Demmler GJ, Kaplan SL. TexbooK of pediatrics infectious disease. 5 ed. Philadelphia: WB Saunders, 2004: 679-82.
(38) Kaplan SL. Treatment of community-associated methicillin-resistant Staphylococcus aureus infections. Pediatr Infect Dis J 2005; 24(5): 457-8.
(39) Fergie J, Purcell K. The treatment of community-acquired methicillin-resistant Staphylococcus aureus Infections. Pediatr Infect Dis J 2008; 27(1): 67-8.
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2008-12-31
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Amorín MB, Castro M, Sandín D, Chamorro F, Romero C, Giachetto G, et al. Etiology and clinical features of osteoarticular infections in children hospitalized at the Pediatric Hospital of the Pereira Rossell Health Care Center from 2003 through 2005: Presentación clínica y evolutiva observada en dos centros universitarios. Uruguay 2003-2007. Rev. Méd. Urug. [Internet]. 2008 Dec. 31 [cited 2024 Nov. 21];24(4):230-7. Available from: https://revista.rmu.org.uy/index.php/rmu/article/view/513
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