ESPID Education. LORROT M. Jun 7, 2011; 7715

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Osteo-articular infections caused by Staphylococcus aureus producing Panton-Valentine leukocidin in children.

P Lethellier1, B Ilharreborde2, C Doit3, P Bidet3, C Vitoux2, F Fitoussi2 , P Mariani-Kurkdjian3, Y Lefevre2, A Faye1, K Mazda2, S Bonacorsi3, GF Penneçot 2, E Bingen3, M Lorrot1.
1 : General Pediatric Unit, Hôpital Robert Debré, Assistance Publique Hôpitaux de Paris et UFR Denis Diderot, Paris 7, France,
2 : Pediatric Orthopaedics Unit, Hôpital Robert Debré, Assistance Publique Hôpitaux de Paris et UFR Denis Diderot, Paris 7, France,
3: Microbiology Unit, Hôpital Robert Debré, Assistance Publique Hôpitaux de Paris et UFR Denis Diderot, Paris 7, France.

Panton-Valentine leukocidin (PVL) secreted by Staphylococcus aureus (SA) is known to cause severe osteo-articular infections (OAI) in children.
To analyze the complications of SA IOA after adapted treatment (antibiotic and surgical drainage) and their occurrence in relation with PVL production.
We retrospectively analyzed cases of children hospitalized with SA OAI in Robert Debré Hospital (Paris, France) from April 2000 to May 2010.
73 children were identified (29arthritis, 32osteomyelitis, 12osteo-arthritis). The children mean age was 8,3years (range: 0.5-17.5). SA obtained from blood (n=37) or synovial fluid (n=28) or bone (n=8) were methicillin- susceptible in 88% of cases. 16/58 (28%) isolates were PLV+. 13/16 SA PVL+ were methicillin- susceptible.
44 children (49 %) presented complications. Complications were more frequent in group PVL+ versus PVL- (87 % vs 38%, p<0,001) with abscess (44 % vs 17 %), subperiosteal abscess (44 % vs 17 %), myositis (31 % vs 2 %), pneumonia (37 % vs 7 %), and thrombophlebitis (19 % vs 0 %). In group PVL+, 13/16 children (81%) presented complications occurred in the first 5 days of treatment versus 13/42 children (31%) in group PVL-. No complications occurred after 16 days of treatment in group LPV- whereas 2 children of the LPV+ group presented late suppurative complications, at 41 and 49 days of treatment.
The presence of PVL is associated with complications in 87% of cases, comforting its role in the severity of the disease.
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