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Community-associated Staphylococcus aureus pneumonia among Greek children: epidemiology, molecular characteristics,
A G Doudoulakakis1, D Bouras2, E Drougka3
1Department of Microbiology, "P. & A. Aglaia Kyriakou" Children's Hospital, Athens, Greece. tassosd@hotmail.com.
Insights
Community-associated Staphylococcus aureus pneumonia is rare in children but often severe. Methicillin-resistant S. aureus (MRSA), particularly the ST80-IV clone, predominated, leading to frequent complications and intensive care unit admissions.
Area of Science:
- Pediatrics
- Infectious Diseases
- Microbiology
Background:
- Community-associated Staphylococcus aureus (CA-SA) pneumonia is an infrequent yet serious infection in children.
- Understanding the characteristics of CA-SA pneumonia is crucial for effective management and public health strategies.
Purpose of the Study:
- To evaluate the clinical, epidemiological, microbiological, and molecular features of CA-SA pneumonia in hospitalized children.
- To identify prevalent strains and resistance patterns of S. aureus causing pneumonia in pediatric patients.
Main Methods:
- Retrospective review of medical records for pediatric CA-SA pneumonia cases admitted between 2007 and 2014.
- Molecular analysis including PCR for mecA, Panton-Valentine leukocidin (PVL), and fibronectin binding protein A (fnbA) genes.
- Genotyping using agr groups, pulsed-field gel electrophoresis (PFGE), SCCmec, and multilocus sequencing typing (MLST).
Main Results:
- A total of 41 cases were identified, with a median age of 4.3 months; 75.6% were caused by methicillin-resistant S. aureus (MRSA).
- Complications were frequent, including empyema (61%) and pneumatoceles (17%), with 58.5% requiring ICU admission.
- The ST80-IV/agr3/PVL-positive clone was predominant among MRSA isolates (90%), while methicillin-susceptible S. aureus (MSSA) strains showed polyclonality.
Conclusions:
- MRSA, particularly the ST80-IV clone, is the dominant pathogen in pediatric CA-SA pneumonia.
- Despite high rates of clindamycin resistance and high vancomycin MICs, treatment was effective in most cases.
- The study highlights the need for vigilant surveillance and tailored treatment approaches for pediatric staphylococcal pneumonia.
Abstract:
Staphylococcus aureus is an infrequent cause of community-associated (CA-SA) pneumonia in children. The aim of this study was to evaluate the clinical, epidemiological, microbiological, and molecular characteristics of CA-SA pneumonia among children hospitalized in two large tertiary care referral centers during an 8-year period. Cases of CA-SA pneumonia admitted between 2007 and 2014 were retrospectively examined through medical record review. Molecular investigation was performed for available strains; mecA, Panton-Valentine leukocidin (PVL) (lukS-lukF-PV), and fibronectin binding protein A (fnbA) genes were detected by polymerase chain reaction (PCR). Clones were assigned by agr groups, pulsed-field gel electrophoresis (PFGE), SCCmec, and multilocus sequencing typing (MLST). In total, 41 cases were recorded (boys, 61 %), with a median age of 4.3 months (range, 1-175). Methicillin-resistant S. aureus (MRSA) accounted for 31 cases (75.6 %). Complications included empyema (25/41, 61 %), pneumatoceles (7/41, 17 %), and lung abscess (1/41, 2.5 %). Intensive care unit (ICU) admission was required in 58.5 %. Two deaths occurred (4.9 %). Definitive therapy was based on vancomycin with or without other antibiotics (55.9 %), followed by clindamycin and linezolid (26.5 % each). All isolates were susceptible to vancomycin (MIC90 2 mg/L, range 1-2), teicoplanin, and linezolid, whereas 26.8 % were resistant to clindamycin. Among the 25 studied strains, 20 were mecA-positive (MRSA), carrying also the fnbA gene. Of these, 90 % belonged to the ST80-IV/agr3/PVL-positive clone. Methicillin-susceptible S. aureus (MSSA) strains showed polyclonality, 3/5 were PVL-positive, and 3/5 were fnbA-positive. MRSA and particularly the ST80-IV clone predominated among staphylococcal pneumonia cases in children. Treatment provided was effective in all but two patients, despite the relatively high minimum inhibitory concentration (MIC) of vancomycin and a high resistance to clindamycin.
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