Infective pyomyositis and myositis in children in the era of community-acquired, methicillin-resistant Staphylococcus aureus infection
Infective pyomyositis and myositis in children in the era of community-acquired, methicillin-resistant Staphylococcus aureus infection
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DOI：
10.1086/507637
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发表时间：
2006-10-15
影响因子：
11.8
通讯作者：
Kaplan, Sheldon L.
中科院分区：
文献类型：
--
作者：
Pannaraj, Pia S.;Hulten, Kristina G.;Kaplan, Sheldon L.
背景资料。自2000年以来，德克萨斯儿童医院(休斯顿)的化脓性肌炎和肌炎病例一直在增加。这种增加似乎与社区获得性耐甲氧西林金黄色葡萄球菌(MRSA)的出现有关。回顾了2000年1月至2005年12月期间在德克萨斯儿童医院住院的化脓性肌炎和肌炎患者的病历。获得可用的金黄色葡萄球菌分离株进行药敏试验，以确定PVL(Luks-PV和LukF-PV)的存在，并进行脉冲场凝胶电泳分析。对45例细菌性化脓性肌炎或肌炎的既往健康儿童进行了分析。病原菌以金黄色葡萄球菌(57.8%)和化脓性链球菌(2.2%)为主，培养结果阴性者占40.0%。病例数量在2000年至2005年期间有所增加，主要是由于社区获得性耐甲氧西林金黄色葡萄球菌流行率的增加。患者年龄0.06~15岁，平均5.5岁。大腿(40.0%)和骨盆(28.9%)是最常见的受累部位。脓肿直径平均3.5 cm。18名儿童至少需要1次肌肉引流手术。在可用的24株金黄色葡萄球菌中(15株社区获得的MRSA分离株和9株社区获得的甲氧西林敏感的金黄色葡萄球菌[MSSA]分离株)，16株脉冲场凝胶电泳法发现USA300，17株携带PVL。社区获得的MRSA、USA300和/或PVL阳性菌株的患者比社区获得的MSSA、非USA300和/或PVL阴性菌株的患者需要更多的引流手术(分别为81%对40%[P=0.05]、82%对29%[P=0.02]和81%对38%[P=0.07])。社区获得性耐甲氧西林金黄色葡萄球菌是引起儿童化脓性肌炎和肌炎的一个日益增加的原因。社区获得的MRSA、USA300和PVL阳性金黄色葡萄球菌分离株分别比社区获得的MSSA、非USA300和PVL阴性分离株引起更严重的疾病。
Background. Cases of pyomyositis and myositis have been increasing in frequency at Texas Children's Hospital ( Houston) since 2000. The increase appears to correlate with the emergence of community-acquired methicillin-resistant Staphylococcus aureus (MRSA).Methods. The medical records of patients with pyomyositis and myositis hospitalized at Texas Children's Hospital during the period from January 2000 through December 2005 were reviewed. Available S. aureus isolates were obtained for susceptibility testing, to determine the presence of pvl (lukS-PV and lukF-PV), and for pulsed-field gel electrophoresis analysis.Results. Forty-five previously healthy children with bacterial pyomyositis or myositis were analyzed. The causes were S. aureus (in 57.8% of children) and Streptococcus pyogenes (in 2.2%); 40.0% of children had negative culture results. The number of cases increased between 2000 and 2005, primarily as a result of an increase in the prevalence of community-acquired MRSA. The mean patient age was 5.5 years (range, 0.06-15 years). The thigh ( 40.0% of children) and pelvis (28.9%) were the most commonly affected sites. The mean abscess diameter was 3.5 cm. Eighteen children required at least 1 muscle drainage procedure. Of the 24 available S. aureus isolates (15 community-acquired MRSA isolates and 9 community-acquired, methicillin-susceptible S. aureus [MSSA] isolates), 16 were found to be USA300 by pulsed-field gel electrophoresis, and 17 carried pvl. Patients with community-acquired MRSA, USA300, and/or pvl-positive strains required more drainage procedures than did those with community-acquired MSSA, non-USA300, and/or pvl-negative strains (81% vs. 40% [P = .05], 82% vs. 29% [P = .02], and 81% vs. 38% [P = .07], respectively).Conclusions. Community-acquired MRSA is an increasing cause of pyomyositis and myositis in children. Community-acquired MRSA, USA300, pvl-positive S. aureus isolates caused more severe disease than did community-acquired MSSA, non-USA300, and pvl-negative isolates, respectively.