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 Table of Contents  
CLINICAL OBSERVATION
Year : 2017  |  Volume : 130  |  Issue : 23  |  Page : 2889-2890

Clinical and Molecular Epidemiology of Invasive Staphylococcus aureus Infections in Chinese Children: A Single-center Experience


1 Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
2 Bacteriology Laboratory, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
3 Ministry of Education Key Laboratory of Major Diseases in Children, National Key Discipline of Pediatrics (Capital Medical University), National Clinical Research Center for Respiratory Diseases, Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China

Date of Submission23-Jun-2017
Date of Web Publication24-Nov-2017

Correspondence Address:
Sun-Yun Qian
Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0366-6999.219158

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Keywords: Children; Clinical; Invasive Infection; Molecular; Staphylococcus aureus


How to cite this article:
Wang LJ, Dong F, Qian SY, Yao KH, Song WQ. Clinical and Molecular Epidemiology of Invasive Staphylococcus aureus Infections in Chinese Children: A Single-center Experience. Chin Med J 2017;130:2889-90

How to cite this URL:
Wang LJ, Dong F, Qian SY, Yao KH, Song WQ. Clinical and Molecular Epidemiology of Invasive Staphylococcus aureus Infections in Chinese Children: A Single-center Experience. Chin Med J [serial online] 2017 [cited 2017 Dec 12];130:2889-90. Available from: http://www.cmj.org/text.asp?2017/130/23/2889/219158



Staphylococcus aureus is associated with a variety of invasive infection; typically, these infections occur as sepsis, osteomyelitis, endocarditis, and arthritis. China has a relatively high incidence of invasive S. aureus disease in children.[1] The present study aimed to provide the demographics, clones, and the antimicrobial susceptibility of S. aureus that cause invasive infection in Chinese children.

Invasive S. aureus infection refers to S. aureus isolated from a normally sterile body site, including blood, pleural effusion, cerebrospinal fluid, joint effusion, and bone marrow, or a skin and soft tissue infection (SSTI) requiring hospital admission for surgical drainage/debridement under general anesthetic and/or intravenous antimicrobial therapy.[2] PCR amplification was used for multilocus sequence typing, agr typing, and spa typing. A total of 274 children (≤14 years old) between February 2016 and January 2017 in Beijing Children's Hospital had positive S. aureus clinical microbiology reports. Among these 274 children, 30 patients were classified as having invasive S. aureus infection; the incidence was 10.9% (30/274). Among these 30 patients, 8 patients were <1 month old, 11 patients between 2 months and 6 years, and 11 patients between 10 years and 14 years; 11 patients were infected by methicillin-resistant S. aureus (MRSA) and 19 by methicillin-susceptible S. aureus (MSSA); 8 patients suffered from single-site infection, 12 from two-site infection, and 10 from multi-site infection. Twenty-two (22/30) were hospitalized, and five (5/22) of them gave up for treatment, and one (1/5) died immediately.

As shown in [Table 1], MRSA was more likely to cause osteomyelitis than MSSA (P = 0.03). Three most common two-site infections were sepsis related to skin soft tissue or pneumonia or osteomyelitis. The multi-site infection was sepsis with osteomyelitis and arthritis, followed by sepsis with osteomyelitis and SSTI. Seven cases (7/30) had produced a total of 15 positive strains that had been collected at a different time or different aseptic sites, so we collected 38 isolates in total. Two agr types were detected, most isolates were agr 1 type (34/38), and 4 of them belonged to agr 2 type. A total of 10 STs were included, thirteen MRSA belonged to ST 59, four MRSA, and 7 MSSA belonged to ST22. The S. aureus strains displayed 18 spa types, among which t309 (12/38) was the most dominant clone (12/38, 4 MRSA, and 8 MSSA), following by t437 (8/38). Both the resistance rate of S. aureus to penicillin and erythromycin was 100%. All isolates resistant to ceffuxin are MRSA with a resistant rate of 47.1%. All isolates were susceptible to linezolid, tigecycline, fusidic acid, mupirocin, and vancomycin.
Table 1: Clinical characterization of patients with invasive S. aureus infections

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The invasive S. aureus infectious disease is relatively rare, however, it can be very serious and occasionally fatal.[3] In this study, we collected 30 cases within 1 year; the incidence was 10.9%. Eight of the patients were <1 month old, indicating that more than 25% of the invasive S. aureus infection in Chinese children are neonates. In this study, a higher proportion of MRSA osteomyelitis was observed compared with MSSA; and 22 patients suffered from two or multi-sites infection. When infection refers to multiple organs, invasive S. aureus infection should be considered. Empiric therapy like anti-MRSA antibiotics should be in consideration.[4] There were no isolates resistant to linezolid, tigecycline, fusidic acid, mupirocin, and vancomycin. In this study, the best way for patients with arthritis and/or osteomyelitis was vacuum sealing drainage.

Two MRSA strain types predominated (ST59 and ST22) and together accounted for all MRSA strains identified. This study showed that ST22 was present in both the invasive MRSA and MSSA isolates, so we should pay attention to this clone in case that it may be the replacement of ST59 clone. We found a diverse range of MSSA STs causing disease; the observed strain diversity indicated that host factors might be as important as the bacterial genetic profile in children.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patients have given consent for images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

This work was supported by grants from the National Natural Science Foundation of China (No. 81571948) and Beijing Natural Science Foundation (No. 7172075).

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Gu FF, Chen Y, Dong DP, Song Z, Guo XK, Ni YX, et al. Molecular epidemiology of Staphylococcus aureus among patients with skin and soft tissue infections in two Chinese hospitals. Chin Med J 2016;129:2319-24. doi: 10.4103/0366-6999.190673.  Back to cited text no. 1
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2.
Hamer DH, Darmstadt GL, Carlin JB, Zaidi AK, Yeboah-Antwi K, Saha SK, et al. Etiology of bacteremia in young infants in six countries. Pediatr Infect Dis J 2015;34:e1-8. doi: 10.1097/INF.0000000000000549.  Back to cited text no. 2
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3.
Romaniszyn D, Rózanska A, Wójkowska-Mach J, Chmielarczyk A, Pobiega M, Adamski P, et al. Epidemiology, antibiotic consumption and molecular characterisation of Staphylococcus aureus infections – Data from the Polish Neonatology Surveillance Network, 2009-2012. BMC Infect Dis 2015;15:169. doi: 10.1186/s12879-015-0890-3.  Back to cited text no. 3
    
4.
Cao G, Chen X, Wu S. Analysis of clinical efficacy of different initial antimicrobial treatment in healthcare associated pneumonia patients in emergency department. Chin Med J 2014;127:1814-9. doi: 10. 3760/cmaj. issn. 0366-6999. 20132885.  Back to cited text no. 4
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