Panton-Valentine leukocidin genes are associated with enhanced inflammatory response and local disease in acute hematogenous Staphylococcus aureus osteomyelitis in children
Panton-Valentine leukocidin genes are associated with enhanced inflammatory response and local disease in acute hematogenous Staphylococcus aureus osteomyelitis in children
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DOI：
10.1542/peds.2005-0566
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发表时间：
2006-02-01
期刊：
影响因子：
8
通讯作者：
Kaplan, SL
中科院分区：
文献类型：
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作者：
Bocchini, CE;Hulten, KG;Kaplan, SL
背景。与 pvl 阴性 (pvl(-)) 菌株相比，携带潘顿瓦伦丁杀白细胞素 (pvl 阳性 [pvl(+)]) 编码基因的金黄色葡萄球菌菌株与儿童发热天数更长和骨髓炎并发症发生率更高相关。 目的。对 pvl(+) 和 pvl(-) 金黄色葡萄球菌菌株引起的骨髓炎儿童的选定临床、实验室和放射学检查结果进行比较。对 2001 年 8 月至 2004 年 7 月期间在德克萨斯儿童医院前瞻性发现的社区获得性金黄色葡萄球菌骨髓炎儿童的人口统计、选定的临床特征、实验室值和放射学结果进行了审查。采用聚合酶链式反应检测金黄色葡萄球菌分离株中的pvl（luk-S-PV和luk-F-PV）和纤连蛋白结合蛋白（fnbB）基因。采用chi(2)、2样本t检验、多元logistic回归进行统计分析。结果。甲氧西林敏感和耐甲氧西林金黄色葡萄球菌（分别为 MSSA 和 MRSA）分别导致 33 名和 56 名儿童发生骨髓炎。 26 个分离株为 pvl(-)（26 个 MSSA），59 个为 pvl(+)（3 个 MSSA，56 个 MRSA），4 个分离株不可用于分析（4 个 MSSA）。在单变量分析中，pvl（+）金黄色葡萄球菌分离株患者的红细胞沉降率（ESR）和C反应蛋白（CRP）水平均显着较高，无论是就诊时还是住院期间的最大值，并且入院时更有可能出现金黄色葡萄球菌血培养阳性。 MRI 上显示，与 pvl(-) 金黄色葡萄球菌分离株患者相比，pvl(+) 金黄色葡萄球菌分离株患者更容易并发肌炎或化脓性肌炎。在多变量分析中，pvl 与就诊时的 ESR 和 CRP 水平以及血培养金黄色葡萄球菌呈阳性显着相关。 pvl(+) 状态和年轻年龄与 MRI 显示的肌炎相关。结论。与pvl(+)金黄色葡萄球菌引起的骨髓炎相比，pvl(+)金黄色葡萄球菌菌株引起的骨髓炎与更严重的局部疾病和更强的全身炎症反应相关。
BACKGROUND. Staphylococcus aureus strains carrying the genes encoding Panton-Valentine leukocidin (pvl-positive [pvl(+)]) are associated with more febrile days and higher complication rates of osteomyelitis in children than are pvl-negative (pvl(-)) strains.OBJECTIVES. Selected clinical, laboratory, and radiographic findings in children with osteomyelitis caused by pvl(+) and pvl(-) S aureus strains were compared.METHODS. The demographics, selected clinical features, laboratory values, and radiographic findings of children with community-acquired S aureus osteomyelitis prospectively identified at Texas Children's Hospital between August 2001 and July 2004 were reviewed. Polymerase chain reaction was performed to detect the genes for pvl (luk-S-PV and luk-F-PV) and fibronectin-binding protein ( fnbB) in S aureus isolates. chi(2), 2-sample t test, and multiple logistic regression were used for statistical analysis.RESULTS. Methicillin-susceptible and methicillin-resistant S aureus (MSSA and MRSA, respectively) caused osteomyelitis in 33 and 56 children, respectively. Twenty-six isolates were pvl(-) (26 MSSA), 59 were pvl(+) (3 MSSA, 56 MRSA), and 4 were not available for analysis (4 MSSA). On univariate analysis, patients with pvl(+) S aureus isolates had significantly higher erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level both at presentation and as a maximum value during hospitalization and were more likely to have a blood culture positive for S aureus during their admission. Patients with pvl(+) S aureus isolates were significantly more likely to have concomitant myositis or pyomyositis compared with patients with pvl(-) S aureus isolates on MRI. In a multivariate analysis pvl remained significantly associated with ESR and CRP levels at presentation and blood culture positive for S aureus. pvl(+) status and younger age were associated with myositis on MRI.CONCLUSIONS. Osteomyelitis caused by pvl(+) S aureus strains were associated with more severe local disease and a greater systemic inflammatory response compared with osteomyelitis caused by pvl(+) S aureus.