Analysis of Invasive Community-Acquired Methicillin-Susceptible Staphylococcus aureus Infections During a Period of Declining Community Acquired Methicillin-Resistant Staphylococcus aureus Infections at a Large Children's Hospital. Issue 3 (March 2018)

• Record Type: Journal Article
• Authors: Hultén, Kristina G.; Mason, Edward O.; Lamberth, Linda B.; Forbes, Andrea R.; Revell, Paula A.; Kaplan, Sheldon L.
• Is Part Of: Pediatric infectious disease journal. Volume 37:Issue 3(2018)
• Publication Date: 2018-03
• Subjects: Staphylococcus aureus -- MSSA -- invasive -- pediatric -- USA300 -- Panton-Valentine leukocidin; Communicable diseases in children -- Periodicals; Infection in children -- Periodicals; 618.929
• DOI: 10.1097/INF.0000000000001753
• Languages: English
• ISSNs: 0891-3668

Abstract

Abstract : Background: The epidemiology of community acquired (CA) Staphylococcus aureus infections is changing in the United States. We investigated the current epidemiology of S. aureus infections at Texas Children's Hospital. Methods: Patients with CA- S. aureus skin and soft tissue and invasive infections were retrospectively identified from January 1, 2007 to December 31, 2014. Invasive CA-MSSA isolates were characterized by pulsed field gel electrophoresis, Spa typing, agr type and presence of lukSF -PV ( pvl ) genes. Medical records were reviewed. Statistical analyses included Fisher exact, χ 2 for trend and Wilcoxon tests. Results: CA-MRSA infections decreased by 60.4% (1461–578 infections) from 2007 to 2014 ( P < 0.0001), while CA-MSSA infections averaged 550 infections annually. Invasive CA-MRSA infections decreased by 67.2% from 61 to 20 infections ( P < 0.0001); invasive CA-MSSA averaged 44 infections annually. Among 296 invasive CA-MSSA isolates, 74 (25%) isolates were USA300 and 88 (30%) were pvl+. USA300 declined among invasive CA-MSSA over time ( P < 0.008). Musculoskeletal infections were most common (242/296, 82%); 52/242 (21.5%) isolates were USA300 and 62/242 (25.6%) pvl+. All 18 isolates from musculoskeletal infections with deep venous thrombosis and/or septic shock were pvl+ and 16/18 (88.9%) were USA300. Pneumonia isolates were mainly USA300 (8, 66.7%) and pvl+ (11, 91.7%). Conclusions: MSSA now cause the majority of invasive CA- S. aureus infections at our institution. Molecular analysis of invasive CA-MSSA isolates suggests strain diversity with USA300 on the decline and that disease presentations are to some extent strain specific. Changes in the CA- S. aureus epidemiology may, in part, be related to changes in immunity to the USA300 clone in the general population. Abstract : Supplemental Digital Content is available in the text.