Staphylococcus aureus bloodstream infections in children: A population-based assessment

BACKGROUND:

Although Staphylococcus aureus is a major cause of bloodstream infections, population-based data on these infections in children are limited.

OBJECTIVE:

To describe the epidemiology of S aureus bacteremia in children.

METHODS:

Population-based surveillance for all incident S aureus bacteremias was conducted among children (18 years of age or younger) living in the Calgary Health Region (Alberta) from 2000 to 2006.

RESULTS:

During the seven-year study, 120 S aureus bloodstream infections occurred among 119 patients; 27% were nosocomial, 18% health care associated and 56% community acquired. The annual incidence was 6.5/100,000 population and 0.094/1000 live births. A total of 52% had a significant underlying condition, and this was higher for nosocomial cases. Bone and joint (40%), bacteremia without a focus (33%), and skin and soft tissue infections (15%) were the most common clinical syndromes. Infections due to methicillin-resistant S aureus were uncommon (occurring in one infection) and three patients (2.5%) died.

CONCLUSIONS:

S aureus bacteremia is an important cause of morbidity in the paediatric age group. Underlying medical conditions and implanted devices are important risk factors. Methicillin-resistant S aureus and mortality rates are low.     

Transmission of Panton-Valentine leukocidin-positive Staphylococcus aureus between patients with cystic fibrosis

Panton-Valentine leukocidin-producing Staphylococcus aureus is an emerging pathogen world-wide, causing necrotizing lung infections in otherwise healthy individuals. We describe 2 episodes of patient-to-patient transmission of Panton-Valentine leukocidin-producing S. aureus, resulting in acute, life-threatening pulmonary complications in patients with cystic fibrosis. Appropriate infection control measures may be warranted to prevent similar episodes.     

Clinical and molecular characteristics of staphylococcal skin abscesses in children

Forty-nine children with skin abscesses (36 methicillin-resistant Staphylococcus aureus and 13 methicillin-susceptible S. aureus) exhibited similar disease severity. Both pathogen groups were pulse field type USA300, multilocus sequence type 8, and possessed Panton-Valentine leukocidin genes. Related microbial genetic architecture may account for similarities in disease severity despite differences in antibiotic susceptibility.     

Community-associated methicillin-resistant Staphylococcus aureus in Indigenous communities in Canada

Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections have emerged as a significant issue in some Indigenous communities (including First Nations, Inuit and Métis) in Canada. Primarily associated with skin and soft-tissue infections, this organism can also result in significant morbidity and mortality. Canadian and American guidelines for managing CA-MRSA infections have been published. The specific epidemiology, microbiology and susceptibility patterns, and the social/environmental circumstances of CA-MRSA infections in Indigenous communities need to be considered for strategies to reduce transmission. While reducing household crowding and improving in-home potable water supply are optimal strategies to reduce the impact of this illness, implementing Canadian guidelines along with increased prevention strategies are recommended as interim measures.     

Outpatient Management of Community-associated Methicillin-resistant Staphylococcus aureus Skin and Soft Tissue Infection

During the past decade, there has been a dramatic increase in the number of patients presenting with skin and soft tissue infections in the outpatient setting. The predominant causative bacterium for these infections has recently been identified as community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA). It is estimated that nearly 80% of infections caused by CA-MRSA manifest as skin and soft tissue infections which are of mild to modest severity. However, invasive disease and fatal illness has been reported among otherwise healthy adults and children. The rapid evolution of CA-MRSA presents a unique challenge for pediatric health care providers. As such, it is critical to raise awareness regarding the epidemiology, microbiology, and evidence-based treatment options for treating skin and soft tissue infections in the age of CA-MRSA. The aims of this article include discussion regarding the epidemiology, microbiology, and evidence-based management of CA-MRSA as well as publication of a more relevant one-page evidence-based treatment flow diagram and antimicrobial prescribing table for health care providers practicing in the ambulatory care setting.     

儿童金黄色葡萄球菌脓毒症抗生素治疗现状分析

目的 回顾性分析金黄色葡萄球菌脓毒症患儿经验性抗生素治疗现状,探讨治疗模式对其预后的影响。方法 将2014年1月至2017年8月收治的78例金黄色葡萄球菌脓毒症患儿,依据血培养报告金黄色葡萄球菌生长前经验性首选抗生素治疗类型分为碳青霉烯类治疗组（n=16）、β-内酰胺类治疗组（n=37）、万古霉素治疗组（n=15）、万古霉素+β-内酰胺类治疗组（n=10）。收集各组患儿的一般情况、基础疾病、急性生理功能与慢性健康状况评分系统Ⅱ（APACHE Ⅱ）、免疫抑制剂使用史、甲氧西林耐药性及预后资料,进行回顾性分析。采用logistic回归探讨经验性抗生素治疗方案对金黄色葡萄球菌脓毒症患儿临床疗效及预后的影响。结果 各组患儿一般情况、基础疾病、免疫抑制剂使用史、APACHE Ⅱ评分、院内感染、MRSA检出率比较差异无统计学意义（P > 0.05）。四组间脓毒性休克、院内死亡率比较差异有统计学意义（P < 0.05）,其中碳青霉烯类治疗组脓毒性休克、院内死亡率均最高（分别为69%、50%）。多因素logistic回归分析结果提示,经验性抗生素治疗类型是金黄色葡萄球菌脓毒症患儿发生脓毒性休克和院内死亡的独立危险因素（P < 0.05）;APACHE Ⅱ评分≥ 15是金黄色葡萄球菌脓毒症患儿发生脓毒性休克的独立危险因素（P < 0.05）;与使用万古霉素治疗组相比,碳青霉烯类治疗组发生脓毒性休克和院内死亡的风险高（P < 0.05）。结论 不恰当的经验性使用抗生素治疗可能导致儿童金黄色葡萄球菌脓毒症预后不佳。临床疑诊金黄色葡萄球菌脓毒症患儿,不建议经验性使用碳青霉烯类抗菌药物治疗。     

Epidemiology and clinical management of tuberculosis in children in Canada

Although often regarded as a foreign disease, latent tuberculosis or tuberculosis disease will be encountered in many clinical situations by the Canadian child health practitioner. There are key differences between tuberculosis in children and adults. In the present article, the changing epidemiology of tuberculosis in children in Canada and around the world, the pathogenesis of infection, diagnostic tests, and clinical management of childhood latent tuberculosis and tuberculosis disease are reviewed.     

A Randomized Double-Blind Placebo-Controlled Trial of Lactobacillus reuteri for Chronic Functional Abdominal Pain in Children

Background:

Functional abdominal pain (FAP) is one of the most common diseases, and large percentages of children suffer from it.

Objectives:

The purpose of the study was to evaluate the effect of Lactobacillus reuteri in treatment of children with functional abdominal pain.

Patients and Methods:

This study was a randomized double-blind placebo-controlled trial. Children aged 4 to 16 years with chronic functional abdominal pain (based on Rome III criteria) were enrolled in the study. They were randomly divided into two groups, one receiving probiotic and the other placebo.

Results:

Forty children received probiotic and forty others placebo. There were no significant differences in age, weight, sex, location of pain, associated symptoms, frequency and intensity of pain between the groups. The severity and frequency of abdominal pain in the first month compared to baseline was significantly less and at the end of the second month, there was no significant difference between both groups compared to the end of the first month.

Conclusions:

This study showed that the severity of pain was significantly reduced in both groups. There was no significant difference in pain scores between them. The effect of probiotic and placebo can probably be attributed to psychological effect of the drugs.     

Using probiotics in the paediatric population

As more is learned about the importance of the intestinal microbiome to human health there is increasing interest in the potential benefits of probiotics. Probiotics are live micro-organisms which, when consumed in adequate amounts, confer a health effect on the host by altering its microflora. Probiotics have been administered both prophylactically and therapeutically for various conditions. This statement defines the development and role of intestinal microflora, and examines the evidence supporting the use of different probiotics to treat common paediatric conditions, such as diarrhea, atopy, functional intestinal disorders and necrotizing enterocolitis.     

Community-genotype strains of methicillin-resistant Staphylococcus aureus with high-level mupirocin resistance in a neonatal intensive care unit

Aim

The aim of this study was to investigate the genotypes of mupirocin-resistant methicillin-resistant Staphylococcus aureus (MR-MRSA) isolates in our neonatal intensive care unit (NICU) and their potential source.

Study design

One hundred one MRSA isolates obtained from 59 inborn and 42 outborn infants were identified and their antimicrobial susceptibility determined. Using pulse-field gel electrophoresis (PFGE) analysis, MR-MRSA isolates obtained from the neonatal patients in the NICU were compared with those from adult hospitalized in the same hospital and with community-associated MRSA (CA-MRSA) isolates recovered from different hospitals in Korea.

Results

Overall, 47% of CA-MRSA and 79% of healthcare-associated MRSA isolates exhibited high-level mupirocin resistance (HLMR). Forty-five percent of the outborn infants were considered to have CA-MRSA at the time of admission to our NICU. Most HLMR-MRSA isolates from neonates were grouped into a single cluster by PFGE analysis, and which included CA-MRSA isolates with HLMR recovered from outborn infants who were already colonized when they were transferred to our NICU. They belonged to the same PFGE group as the community-genotype strains isolated from different hospitals in Korea. HLMR-MRSA isolates from adults patients were classified as different clones. None of the attending staff in the NICU were nasal carriers.

Conclusion

Community-genotype strains of MRSA with HLMR may be imported to our NICU through obstetrics clinics and contribute to MRSA colonization or infection in facilities with a high rate of admission of outborn infants.     

Antimicrobial stewardship in daily practice: Managing an important resource

Antimicrobial stewardship is a recent concept that embodies the practical, judicious use of antimicrobials to decrease adverse outcomes from antimicrobials while optimizing the treatment of bacterial infections to reduce the emergence of resistant pathogens. The objectives of the present statement are to illustrate the principles of antimicrobial stewardship and to offer practical examples of how to make antimicrobial stewardship part of everyday hospital and outpatient practice. Vital components of antimicrobial stewardship include appropriate testing to diagnose whether infections are viral or bacterial, and using clinical follow-up rather than antibiotics in cases in which the child is not very ill and uncertainty exists. Other specific, important actions include questioning whether positive urine cultures are contaminated when there is no evidence of pyuria or inflammatory changes, and obtaining a chest radiograph to support a diagnosis of bacterial pneumonia. Optimizing the choice and dosage of antimicrobials also reduces the probability of clinical failures and subsequent courses of antimicrobials. A list of common clinical scenarios to promote stew-ardship is included.     

金黄色葡萄球菌感染住院患儿鼻部携带菌株的研究

目的 观察金黄色葡萄球菌(简称金葡菌)感染的住院患儿鼻部携带菌株与金葡菌感染之间的相关关系。方法 以56 例金葡菌感染的住院患儿为研究对象,采集鼻拭子标本进行培养,检测患儿的金葡菌鼻部携带率,并采用PCR 方法分别检测临床菌株和鼻部携带菌株的mecA 耐药基因和PVL 毒力基因。结果 56例金葡菌感染患儿中,22 例(39%)鼻部携带金葡菌,携带患儿以婴儿为主(18 例)。50%(11/22)携带患儿既往1 年内有住院史。在感染株中,耐甲氧西林金葡菌(MRSA)占29%(16/56);在携带株中,MRSA 占32%(7/22)。PCR 检测携带患儿的临床感染菌株和鼻部携带菌株mecA 阳性结果完全一致,可一一对应;90%(4/5)的PVL 阳性鼻部携带菌株可以与临床感染菌株一一对应,且均为MRSA 菌株。结论 鼻部定植是金葡菌感染的潜在危险因素。医院内传播可能是导致金葡菌鼻部携带,最终导致其感染的重要潜在危险。金葡菌鼻部携带菌株与感染菌株可能具有同源关系,需要进一步通过多位点序列分型明确其同源关系。     

Venous thrombosis and thromboembolism in children with osteomyelitis

OBJECTIVE: To determine the prevalence and clinical features of deep vein thrombosis (DVT) complicating osteomyelitis during childhood. STUDY DESIGN: We retrospectively reviewed medical records of all patients with osteomyelitis admitted to Children's Medical Center Dallas between July 1, 2003 and December 31, 2004. Analysis was performed on patients with proximal upper or lower extremity, pelvic or vertebral osteomyelitis (a subgroup considered to be at highest risk for infection-related thrombosis). RESULTS: Thirty-five patients had confirmed osteomyelitis of the proximal humerus, proximal tibia/fibula, femur, pelvis, or vertebrae. Ten of these 35 children (29%) developed DVT during the acute infection based on imaging studies performed. Eight thrombi occurred adjacent to the infection and two occurred in relation to central venous catheters. Six of the 10 children with DVT also had evidence of infection disseminated to lung, brain, or heart, compared with only 1 of 25 patients without DVT (P = .001). Hospitalization was longer in those with DVT than without (33.5 v. 14.2 days, P = .001). CONCLUSION: Thromboembolic complications can occur in the setting of osteomyelitis, and affected patients may be at higher risk of disseminated infection.