High frequency of methicillin-susceptible and methicillin-resistant <i>Staphylococcus aureus</i> in children under 1 year old with skin and soft tissue infections

Salazar-Ospina, Lorena; Jiménez, Judy Natalia

doi:10.1016/j.jped.2017.06.020

Acessibilidade / Reportar erro

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original articles • J. Pediatr. (Rio J.) 94 (4) • Jul-Aug 2018 • https://doi.org/10.1016/j.jped.2017.06.020 copy

High frequency of methicillin-susceptible and methicillin-resistant Staphylococcus aureus in children under 1 year old with skin and soft tissue infections^☆ ☆ Please cite this article as: Salazar-Ospina L, Jiménez JN. High frequency of methicillin-susceptible and methicillin-resistant Staphylococcus aureus in children under 1 year old with skin and soft tissue infections. J Pediatr (Rio J). 2018;94:380-9.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

Staphylococcus aureus is responsible for a large number of infections in pediatric population; however, information about the behavior of such infections in this population is limited. The aim of the study was to describe the clinical, epidemiological, and molecular characteristics of infections caused by methicillin-susceptible and resistant S. aureus (MSSA-MRSA) in a pediatric population.

Method:

A cross-sectional descriptive study in patients from birth to 14 years of age from three high-complexity institutions was conducted (2008-2010). All patients infected with methicillin-resistant S. aureus and a representative sample of patients infected with methicillin-susceptible S. aureus were included. Clinical and epidemiological information was obtained from medical records and molecular characterization included spa typing, pulsed-field gel electrophoresis (PFGE), and multilocus sequence typing (MLST). In addition, staphylococcal cassette chromosome mec (SCCmec) and virulence factor genes were detected.

Results:

A total of 182 patients, 65 with methicillin-susceptible S. aureus infections and 117 with methicillin-resistant S. aureus infections, were included in the study; 41.4% of the patients being under 1 year. The most frequent infections were of the skin and soft tissues. Backgrounds such as having stayed in day care centers and previous use of antibiotics were more common in patients with methicillin-resistant S. aureus infections (p ≤ 0.05). Sixteen clonal complexes were identified and methicillin-susceptible S. aureus strains were more diverse. The most common cassette was staphylococcal cassette chromosomemec IVc (70.8%), which was linked to Panton-Valentine leukocidin (pvl).

Conclusions:

In contrast with other locations, a prevalence of infections in children under 1 year of age in the city could be observed; this emphasizes the importance of epidemiological knowledge at the local level.

KEYWORDS
Staphylococcus aureus; MSSA; MRSA; Pediatric; Epidemiology; Molecular biology

	POA-I (n = 101) n (%)			HAI (n = 60) n (%)			Total (n = 182) n (%)
	MSSA n = 37 (36.6)	MRSA n = 64 (63.4)	p-Value	MSSA n = 18 (30.0)	MRSA n = 42 (70.0)	p-Value	MSSA n = 65	MRSA n = 117	p-Value
Gender
Male	25 (67.6)	41 (64.1)	0.721	11 (61.1)	32 (76.2)	0.235	43 (66.2)	78 (66.7)	0.944
Female	12 (32.4)	23 (35.9)	0.721	7 (38.9)	10 (23.8)	0.235	22 (33.8)	39 (33.3)	0.944

Age (years)
Median	4	4	0.534^b b Mann–Whitney U-test.	3.5	1	0.141^b b Mann–Whitney U-test.	3	2	0.330^b b Mann–Whitney U-test.
Range	0–14	0–14	0.534^b b Mann–Whitney U-test.	0–12	0–14	0.141^b b Mann–Whitney U-test.	0–14	0–14	0.330^b b Mann–Whitney U-test.
≤ 1years	10 (27.0)	21 (32.8)	0.601	5 (27.8)	22 (52.4)	0.130	23 (35.4)	52 (44.5)	0.826
2–4 years	12 (32.4)	16 (25.0)		5 (27.8)	10 (23.8)		18 (27.7)	27 (23.1)
5–8 years	3 (8.1)	8 (12.5)		3 (16.7)	2 (4.8)		7 (10.8)	11 (9.5)
9–12 years	7 (18.9)	15 (23.4)		5 (27.8)	5 (11.9)		12 (18.5)	20 (17.1)
13–14 years	5 (13.5)	4 (6.3)		0 (0)	3 (7.1)		5 (7.7)	7 (6.0)

Previous history
Hospitalization in the past year	21 (56.8)	29 (45.3)	0.268	5 (27.8)	23 (54.8)	0.055	33 (50.8)	61 (52.1)	0.860
Stay in ICU in the past year	3 (8.1)	1 (1.6)	0.138 ^a a Fisher's exact test.	0 (0)	9 (21.4)	0.047 ^a a Fisher's exact test.	5 (7.7)	14 (12.0)	0.366
Surgery in the past year	11 (29.7)	11 (17.2)	0.141	4 (22.2)	14 (33.3)	0.389	25 (38.5)	36 (30.8)	0.292
Dialysis in the past year	4 (10.8)	1 (1.6)	0.059 ^a a Fisher's exact test.	1 (5.6)	4 (9.5)	1.000	5 (7.7)	5 (4.3)	0.333 ^a a Fisher's exact test.
MRSA isolation in the past year	1 (2.7)	2 (3.1)	1.000 ^a a Fisher's exact test.	0 (0)	4 (9.5)	0.306 ^a a Fisher's exact test.	1 (1.5)	7 (6.0)	0.262 ^a a Fisher's exact test.
Antimicrobials use in past six months	11 (31.4)	27 (45.8)	0.171	5 (29.4)	25 (64.1)	0.017	20 (32.8)	60 (55.0)	0.005
Trauma in past six months	9 (24.3)	10 (15.6)	0.281	7 (38.9)	8 (19.0)	0.118 ^a a Fisher's exact test.	16 (24.6)	19 (16.2)	0.169
Stay in a children's day care centers in the past year	1 (2.7)	6 (9.4)	0.418^a a Fisher's exact test.	0 (0)	5 (11.9)	0.309 ^a a Fisher's exact test.	1 (1.5)	13 (11.1)	0.020
Family infection in the past year	5 (21.7)	10 (21.7)	1.000	2 (15.4)	7 (19.4)	1.000 ^a a Fisher's exact test.	9 (21.4%)	17 (18.3)	0.668
Sports participation in the past year	8 (27.6)	16 (32.7)	0.639	2 (14.3)	3 (7.9)	0.602 ^a a Fisher's exact test.	10 (19.6)	20 (20.4)	0.908

Hospital stay (days)
Median	0	0	0.098 ^b b Mann–Whitney U-test.	5.50	14	0.038 ^b b Mann–Whitney U-test.	0	0	0.309 ^b b Mann–Whitney U-test.
Range	0–1	0–1	0.098 ^b b Mann–Whitney U-test.	(2–43)	(0–434)	0.038 ^b b Mann–Whitney U-test.	(0–50)	(0–434)	0.309 ^b b Mann–Whitney U-test.

Service
Internal medicine	28 (75.7)	42 (65.6)	0.264	10 (55.6)	27 (64.3)	0.369	43 (66.1)	75 (64.1)	0.388
Pediatric ICU	2 (5.4)	5 (7.8)		2 (11.1)	9 (21.4)		5 (7.7)	15 (12.8)
Orthopedics	3 (8.1)	14 (21.9)		1 (5.6)	0 (0)		4 (6.2)	15 (12.8)
Surgery	1 (2.7)	0 (0)		3 (16.7)	5 (11.9)		7 (10.8)	8 (6.8)
Emergency	1 (2.7)	2 (3.1)		1 (5.6)	0 (0)		3 (4.6)	2 (1.7)
Other	2 (5.4)	1 (1.6)		1 (5.6)	1 (2.4)		3 (4.6)	2 (1.7)

Infection type
Skin and soft tissue	18 (48.6)	32 (50.0)	0.011	9 (50)	16 (38.1)	0.329	27 (41.5)	48 (41.0)	0.155
Pneumonia	1 (2.7)	13 (20.3)		2 (11.1)	7 (16.7)		3 (4.6)	20 (17.1)
Blood stream	4 (10.8)	5 (7.8)		4 (22.2)	3 (7.1)		8 (12.3)	8 (6.8)
Catheter-related blood stream	4 (10.8)	0 (0)		3 (16.7)	11 (26.2)		7 (10.8)	11 (9.4)
Osteomyelitis	1 (2.7)	6 (9.4)		0 (0)	0 (0)		1 (1.5)	6 (5.1)
Arthritis	1 (2.7)	3 (4.7)		0 (0)	1 (2.4)		1 (1.5)	4 (3.4)
Intra-abdominal	1(2.7)	0 (0)		0 (0)	0 (0)		1 (1.5)	0 (0)
Surgical site	--	--		--	--		10 (15.4)	11 (9.4)
Other	7 (18.9)	5 (7.8)		0 (0)	4 (9.5)		7 (10.8)	9 (7.7)

Comorbidities
Co-morbidities	30 (81.1)	35 (54.7)	0.008	15 (83.3)	38 (90.5)	0.419	53 (81.5)	82 (70.1)	0.091
Atopy	7 (18.9)	8 (12.5)	0.382	1 (5.6)	8 (19.0)	0.255 ^a a Fisher's exact test.	9 (13.8)	16 (13.71)	0.974
Immunosuppression	6 (16.2)	5 (7.8)	0.204 ^a a Fisher's exact test.	3 (16.7)	3 (7.1)	0.352 ^a a Fisher's exact test.	9 (13.8)	9 (7.7)	0.183
Chronic renal disease	3 (8.1)	2 (3.1)	0.353 ^a a Fisher's exact test.	1 (5.6)	3 (7.1)	1.000 ^a a Fisher's exact test.	4 (6.2)	5 (4.3)	0.493 ^a a Fisher's exact test.
Neoplasia	3 (8.1)	1 (1.6)	0.138 ^a a Fisher's exact test.	0 (0)	2 (4.8)	1.000 ^a a Fisher's exact test.	3 (4.6)	4 (3.4)	0.702 ^a a Fisher's exact test.
Other co-morbidity ^c c Other co-morbidities: cardiovascular disease, chronic lung disease, nervous system diseases, skin diseases, malnutrition, cholestatic syndrome, subglottic stenosis, snake bite, Rh-ABO incompatibility, short bowel syndrome, nesidioblastosis, laryngeal and lung papillomatosis, hemophilia B, chronic osteomyelitis, congenital malformations, nephropathy, and others.	12 (32.4)	13 (20.3)	0.174	6 (33.3)	24 (57.1)	0.091	26 (40.0)	45 (38.5)	0.838
Cardiovascular disease	3 (8.1)	1 (1.6)	0.138 ^a a Fisher's exact test.	1 (5.6)	5 (11.9)	0.658 ^a a Fisher's exact test.	11 (16.9)	11 (9.4)	0.136
Lung disease	1 (2.7)	1 (1.6)	1.000 ^a a Fisher's exact test.	0 (0)	8 (19.0)	0.091 ^a a Fisher's exact test.	1 (1.5)	9 (7.7)	0.099 ^a a Fisher's exact test.

Treatment
Surgical treatment	22 (59.5)	43 (67.2)	0.435	8 (44.4)	20 (47.6)	0.821	34 (52.3)	71 (60.7)	0.273

Outcome
Healing	21 (56.8)	22 (34.4)	0.028	14 (77.8)	35 (83.3)	0.719 ^a a Fisher's exact test.	41 (63.1)	62 (53.0)	0.188
Improvement	16 (43.2)	40 (62.5)	0.061	4 (22.2)	5 (11.9)	0.431 ^a a Fisher's exact test.	24 (36.9)	49 (41.9)	0.513
Death	0 (0)	2 (3.1)^a a Fisher's exact test.	0.531^a a Fisher's exact test.	0 (0)	2 (4.8)	1.000 ^a a Fisher's exact test.	0 (0)	6 (5.1)	0.090^a a Fisher's exact test.

Sociedade Brasileira de Pediatria Av. Carlos Gomes, 328 cj. 304, CEP: 90480-000 , Tel.: (+55 51) 3108-3328 - Porto Alegre - RS - Brazil
E-mail: assessoria@jped.com.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Conflicts of interest

The authors declare no conflicts of interest.