Staphylococcus aureus abscesses: methicillin-resistance or Panton-Valentine leukocidin presence?

López, Marta Barrios; González, Carmen; Orellana, María Ángeles; Cháves, Fernando; Rojo, Pablo

doi:10.1136/archdischild-2012-302695

Cited by 17 publications

(7 citation statements)

References 10 publications

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“…Some authors, mostly from the United States, have associated MRSA with more severe infections [7,8]. As previously reported, MRSA is presumably only a marker of severity by itself, and it is probably not as important in USA300 lowprevalence areas nor a significant independent predictor of severity [9,26].…”

Section: Discussionmentioning

confidence: 87%

Factors associated with severity in invasive community-acquired Staphylococcus aureus infections in children: a prospective European multicentre study

Gijón

Bellusci

Petraitienė

et al. 2016

Clinical Microbiology and Infection

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Staphylococcus aureus is the main pathogen responsible for bone and joint infections worldwide and is also capable of causing pneumonia and other invasive severe diseases. Panton-Valentine leukocidin (PVL) and methicillin-resistant S. aureus (MRSA) have been studied as factors related with severity in these infections. The aims of this study were to describe invasive community-acquired S. aureus (CA-SA) infections and to analyse factors related to severity of disease. Paediatric patients (aged 0-16 years) who had a CA-SA invasive infection were prospectively recruited from 13 centres in 7 European countries. Demographic, clinical and microbiological data were collected. Severe infection was defined as invasive infection leading to death or admission to intensive care due to haemodynamic instability or respiratory failure. A total of 152 children (88 boys) were included. The median age was 7.2 years (interquartile range, 1.3-11.9). Twenty-six (17%) of the 152 patients had a severe infection, including 3 deaths (2%). Prevalence of PVL-positive CA-SA infections was 18.6%, and 7.8% of the isolates were MRSA. The multivariate analysis identified pneumonia (adjusted odds ratio (aOR) 13.39 (95% confidence interval (CI) 4.11-43.56); p 0.008), leukopenia at admission (<3000/mm(3)) (aOR 18.3 (95% CI 1.3-259.9); p 0.03) and PVL-positive infections (aOR 4.69 (95% CI 1.39-15.81); p 0.01) as the only factors independently associated with severe outcome. There were no differences in MRSA prevalence between severe and nonsevere cases (aOR 4.30 (95% CI 0.68- 28.95); p 0.13). Our results show that in European children, PVL is associated with more severe infections, regardless of methicillin resistance.

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Section: Discussionmentioning

confidence: 87%

Factors associated with severity in invasive community-acquired Staphylococcus aureus infections in children: a prospective European multicentre study

Gijón

Bellusci

Petraitienė

et al. 2016

Clinical Microbiology and Infection

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“…Several underlying reasons are offered for the finding, including reduced efficacy of many anti-MRSA antibiotics (Deresinski, 2007), delay in appropriate treatment because of failure to recognize MRSA infection (Kim et al, 2004), and the possibility that MRSA is more pathogenic compared to MSSA. Though the association of MRSA with increased pathogenicity has been suggested by several clinical studies, pertinent pathogenic factors have not been identified (Barrios Lopez et al, 2013, Watkins et al, 2012). In this study we demonstrated that PBP2A, the factor that makes MRSA resistant to β-lactam treatment, contributes to the pathogenicity of MRSA infection by changing PGN structure and augmenting immunopathology, although this effect is not observed until mecA is induced by β-lactam antibiotics.…”

Section: Discussionmentioning

confidence: 99%

Poorly Cross-Linked Peptidoglycan in MRSA Due to mecA Induction Activates the Inflammasome and Exacerbates Immunopathology

Müller

Wolf

Iliev

et al. 2015

Cell Host & Microbe

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Summary Methicillin-resistant S. aureus (MRSA) is a leading health problem. Compared to methicillin-sensitive S. aureus, MRSA infections are associated with greater morbidity and mortality but the mechanisms underlying MRSA pathogenicity are unclear. Here we show that the protein conferring β-lactam antibiotic resistance, penicillin-binding protein 2A (encoded by the mecA gene), directly contributes to pathogenicity during MRSA infection. MecA induction leads to a reduction in peptidoglycan cross-linking that allows for enhanced degradation and detection by phagocytes, resulting in robust IL-1β production. Peptidoglycan isolated from β-lactam-challenged MRSA strongly induces the NLRP3 inflammasome in macrophages but these effects are lost upon peptidoglycan solubilization. Mutant MRSA bacteria with naturally-occurring short peptidoglycan cross-links induce high IL-1β levels in vitro, and cause increased pathology in vivo. β-lactam treatment of MRSA skin infection exacerbates immunopathology, which is IL-1-dependent. Thus, antibiotic-induced expression of mecA during MRSA skin infection contributes to immunopathology by altering peptidoglycan structure.

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“…Staphylococcus aureus is the leading cause of skin and soft tissue infections (SSTIs) in children, 1 and may cause bacteremia and other invasive diseases such as osteoarticular infections and pneumonia. 2 For the past 20 years, an increase in both community-associated and hospitalacquired infections by S. aureus has been observed, 3,4 causing significant morbidity and mortality.…”

Section: Introductionmentioning

confidence: 99%

Staphylococcus aureus Nasal Colonization in Spanish Children. The COSACO Nationwide Surveillance Study

Rosal

Méndez-Echevarría

Vera

et al. 2020

IDR

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Objective To assess the prevalence and risk factors for S. aureus and methicillin-resistant S. aureus (MRSA) nasal colonization in Spanish children. Methods Cross-sectional study of patients <14 years from primary care centers all over Spain. Clinical data and nasal aspirates were collected from March to July 2018. Results A total of 1876 patients were enrolled. Prevalence of S. aureus and MRSA colonization were 33% (95% CI 30.9–35.1) and 1.44% (95% CI 0.9–2), respectively. Thirty-three percent of the children (633/1876) presented chronic conditions, mainly atopic dermatitis, asthma and/or allergy (524/633). Factors associated with S. aureus colonization were age ≥5 years (OR 1.10, 95% CI 1.07–1.12), male sex (OR 1.43, 95% CI 1.17–1.76), urban setting (OR 1.46, 95% CI 1.08–1.97) and the presence of asthma, atopic dermatitis or allergies (OR 1.25; 95% CI: 1.093–1.43). Rural residence was the only factor associated with MRSA colonization (OR 3.62, 95% CI 1.57–8.36). MRSA was more frequently resistant than methicillin-susceptible S. aureus to ciprofloxacin [41.2% vs 2.6%; p<0.0001], clindamycin [26% vs 16.9%; p=0.39], and mupirocin [14.3% vs 6.7%; p=0.18]. None of the MRSA strains was resistant to tetracycline, fosfomycin, vancomycin or daptomycin. Conclusions The main risk factors for S. aureus colonization in Spanish children are being above five years of age, male gender, atopic dermatitis, asthma or allergy, and residence in urban areas. MRSA colonization is low, but higher than in other European countries and is associated with rural settings.

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Staphylococcus aureus abscesses: methicillin-resistance or Panton-Valentine leukocidin presence?

Abstract: Our study found a high prevalence of PVL presence in community-onset S aureus SSTIs in children in Spain. This toxin is associated with more abscess formation, regardless of methicillin resistance.

Cited by 17 publications

References 10 publications

Factors associated with severity in invasive community-acquired Staphylococcus aureus infections in children: a prospective European multicentre study

Factors associated with severity in invasive community-acquired Staphylococcus aureus infections in children: a prospective European multicentre study

Poorly Cross-Linked Peptidoglycan in MRSA Due to mecA Induction Activates the Inflammasome and Exacerbates Immunopathology

Staphylococcus aureus Nasal Colonization in Spanish Children. The COSACO Nationwide Surveillance Study

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