45. Đặc điểm lâm sàng và kết quả điều trị nhiễm khuẩn huyết do Staphylococcus aureus tiết độc tố PVL ở trẻ em
Nội dung chính của bài viết
Tóm tắt
Độc tố Panton–Valentine leukocidin (PVL), là độc lực chính do Staphylococcus aureus tiết ra, đã được chứng minh có liên quan đến một số biểu hiện nhiễm trùng nặng. Tuy nhiên, vai trò của PVL trong nhiễm khuẩn huyết do Staphylococcus aureus vẫn chưa thực sự rõ ràng. Chúng tôi tiến hành nghiên cứu mô tả loạt ca bệnh trên 187 trẻ nhiễm khuẩn huyết do Staphylococcus aureus tại Bệnh viện Nhi Trung ương từ 2022 đến 2025, với mục tiêu đánh giá mối liên quan giữa sự hiện diện của độc tố PVL với bệnh cảnh lâm sàng, cận lâm sàng và kết quả điều trị ở những bệnh nhân nhiễm khuẩn huyết do Staphylococcus aureus. Kết quả nghiên cứu cho thấy tỷ lệ chủng tụ cầu kháng methicillin (MRSA) chiếm 87,7%, trong đó tỉ lệ chủng S. aureus đa kháng kháng sinh chiếm 36,4%. Tụ cầu nhạy cảm hoàn toàn với vancomycin. Chủng mang gen độc tố PVL chiếm 71,1%. Chủng S. aureus mang gen PVL có liên quan đến nhiễm trùng xương khớp (viêm xương tuỷ, viêm khớp). Không có sự khác biệt về kết quả điều trị giữa hai nhóm S. aureus PVL dương tính và PVL âm tính gây nhiễm khuẩn huyết ở trẻ em.
Chi tiết bài viết
Từ khóa
PVL, Staphylococcus aureus, nhiễm khuẩn huyết, trẻ em
Tài liệu tham khảo
1. Inagaki K, Lucar J, Blackshear C, et al. Methicillin-susceptible and Methicillin-resistant Staphylococcus aureus Bacteremia: Nationwide Estimates of 30-Day Readmission, In-hospital Mortality, Length of Stay, and Cost in the United States. Clin Infect Dis Off Publ Infect Dis Soc Am. 2019; 69(12): 2112-2118. doi:10.1093/cid/ciz123.
2. Kaneko J, Kamio Y. Bacterial two-component and hetero-heptameric pore-forming cytolytic toxins: structures, pore-forming mechanism, and organization of the genes. Biosci Biotechnol Biochem. 2004; 68(5): 981-1003. doi:10.1271/bbb.68.981.
3. Panton PN, Valentine FCO. Staphylococcal Toxin. The Lancet. 1932; 219(5662): 506-508. doi:10.1016/S0140-6736(01)24468-7.
4. Vandenesch F, Naimi T, Enright MC, et al. Community-acquired methicillin-resistant Staphylococcus aureus carrying Panton-Valentine leukocidin genes: worldwide emergence. Emerg Infect Dis. 2003; 9(8): 978-984. doi:10.3201/eid0908.030089.
5. Shallcross LJ, Fragaszy E, Johnson AM, et al. The role of the Panton-Valentine leucocidin toxin in staphylococcal disease: a systematic review and meta-analysis. Lancet Infect Dis. 2013; 13(1): 43-54. doi:10.1016/S1473-3099(12)70238-4.
6. Goldstein B, Giroir B, Randolph A, International Consensus Conference on Pediatric Sepsis. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med J Soc Crit Care Med World Fed Pediatr Intensive Crit Care Soc. 2005; 6(1): 2-8. doi:10.1097/01.PCC.0000149131.72248.E6.
7. Magiorakos AP, Srinivasan A, Carey RB, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect. 2012; 18(3): 268-281. doi:10.1111/j.1469-0691.2011.03570.x.
8. Campbell AJ, Mowlaboccus S, Coombs GW, et al. Whole genome sequencing and molecular epidemiology of paediatric Staphylococcus aureus bacteraemia. J Glob Antimicrob Resist. 2022; 29: 197-206. doi:10.1016/j.jgar.2022.03.012.
9. Qu MD, Kausar H, Smith S, et al. Epidemiological and clinical features of Panton-Valentine Leukocidin positive Staphylococcus aureus bacteremia: A case-control study. PLoS ONE. 2022; 17(3): e0265476. doi:10.1371/journal.pone.0265476.
10. Gijón M, Bellusci M, Petraitiene B, et al. Factors associated with severity in invasive community-acquired Staphylococcus aureus infections in children: a prospective European multicentre study. Clin Microbiol Infect Off Publ Eur Soc Clin Microbiol Infect Dis. 2016; 22(7): 643.e1-6. doi:10.1016/j.cmi.2016.04.004.
11. Bocchini CE, Hulten KG, Mason EO Jr, et al. Panton-Valentine leukocidin genes are associated with enhanced inflammatory response and local disease in acute hematogenous Staphylococcus aureus osteomyelitis in children. Pediatrics. 2006; 117(2): 433-440. doi:10.1542/peds.2005-0566.
12. Dohin B, Gillet Y, Kohler R, et al. Pediatric bone and joint infections caused by Panton-Valentine leukocidin-positive Staphylococcus aureus. Pediatr Infect Dis J. 2007; 26(11): 1042-1048. doi:10.1097/INF.0b013e318133a85e.
13. Gillet Y, Issartel B, Vanhems P, et al. Association between Staphylococcus aureus strains carrying gene for Panton-Valentine leukocidin and highly lethal necrotising pneumonia in young immunocompetent patients. Lancet Lond Engl. 2002; 359(9308): 753-759. doi:10.1016/S0140-6736(02)07877-7.
14. Murray RJ, Robinson JO, White JN, et al. Community-acquired pneumonia due to pandemic A(H1N1)2009 influenzavirus and methicillin resistant Staphylococcus aureus co-infection. PloS One. 2010; 5(1): e8705. doi:10.1371/journal.pone.0008705.
15. Correa-Jiménez O, Pinzón-Redondo H, Reyes N. High frequency of Panton-Valentine leukocidin in Staphylococcus aureus causing pediatric infections in the city of Cartagena-Colombia. J Infect Public Health. 2016 Jul-Aug; 9(4): 415-20. doi: 10.1016/j.jiph.2015.10.017.
16. Gillet Y, Dumitrescu O, Tristan A, et al. Pragmatic management of Panton-Valentine leukocidin-associated staphylococcal diseases. Int J Antimicrob Agents. 2011; 38(6): 457-464. doi:10.1016/j.ijantimicag.2011.05.003.
17. Saeed K, Gould I, Esposito S, et al. Panton-Valentine leukocidin-positive Staphylococcus aureus: a position statement from the International Society of Chemotherapy. Int J Antimicrob Agents. 2018; 51(1): 16-25. doi:10.1016/j.ijantimicag.2017.11.002.
18. Lewis D, Campbell R, Cookson B, et al. Guidance on the diagnosis and management of PVL-associated Staphylococcus aureus infections (PVL-SA) in England. Health Prot Agency Lond UK. Published online 2008.
19. Yamaki J, Lee M, Shriner KA, Wong-Beringer A. Can clinical and molecular epidemiologic parameters guide empiric treatment with vancomycin for methicillin-resistant Staphylococcus aureus infections? Diagn Microbiol Infect Dis. 2011; 70(1): 124-130. doi:10.1016/j.diagmicrobio.2010.12.003.
20. Wehrhahn MC, Robinson JO, Pearson JC, et al. Clinical and laboratory features of invasive community-onset methicillin-resistant Staphylococcus aureus infection: a prospective case-control study. Eur J Clin Microbiol Infect Dis Off Publ Eur Soc Clin Microbiol. 2010; 29(8): 1025-1033. doi:10.1007/s10096-010-0973-4.
21. Darboe S, Dobreniecki S, Jarju S, et al. Prevalence of Panton-Valentine Leukocidin (PVL) and Antimicrobial Resistance in Community-Acquired Clinical Staphylococcus aureus in an Urban Gambian Hospital: A 11-Year Period Retrospective Pilot Study. Front Cell Infect Microbiol. 2019; 9: 170. doi:10.3389/fcimb.2019.00170.
22. McGuire E, Neill C, Collin SM, et al. Is Panton-Valentine leucocidin (PVL) toxin associated with poor clinical outcomes in patients with community-acquired Staphylococcus aureus bacteraemia? J Med Microbiol. 2023; 72(4). doi:10.1099/jmm.0.001683.
2. Kaneko J, Kamio Y. Bacterial two-component and hetero-heptameric pore-forming cytolytic toxins: structures, pore-forming mechanism, and organization of the genes. Biosci Biotechnol Biochem. 2004; 68(5): 981-1003. doi:10.1271/bbb.68.981.
3. Panton PN, Valentine FCO. Staphylococcal Toxin. The Lancet. 1932; 219(5662): 506-508. doi:10.1016/S0140-6736(01)24468-7.
4. Vandenesch F, Naimi T, Enright MC, et al. Community-acquired methicillin-resistant Staphylococcus aureus carrying Panton-Valentine leukocidin genes: worldwide emergence. Emerg Infect Dis. 2003; 9(8): 978-984. doi:10.3201/eid0908.030089.
5. Shallcross LJ, Fragaszy E, Johnson AM, et al. The role of the Panton-Valentine leucocidin toxin in staphylococcal disease: a systematic review and meta-analysis. Lancet Infect Dis. 2013; 13(1): 43-54. doi:10.1016/S1473-3099(12)70238-4.
6. Goldstein B, Giroir B, Randolph A, International Consensus Conference on Pediatric Sepsis. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med J Soc Crit Care Med World Fed Pediatr Intensive Crit Care Soc. 2005; 6(1): 2-8. doi:10.1097/01.PCC.0000149131.72248.E6.
7. Magiorakos AP, Srinivasan A, Carey RB, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect. 2012; 18(3): 268-281. doi:10.1111/j.1469-0691.2011.03570.x.
8. Campbell AJ, Mowlaboccus S, Coombs GW, et al. Whole genome sequencing and molecular epidemiology of paediatric Staphylococcus aureus bacteraemia. J Glob Antimicrob Resist. 2022; 29: 197-206. doi:10.1016/j.jgar.2022.03.012.
9. Qu MD, Kausar H, Smith S, et al. Epidemiological and clinical features of Panton-Valentine Leukocidin positive Staphylococcus aureus bacteremia: A case-control study. PLoS ONE. 2022; 17(3): e0265476. doi:10.1371/journal.pone.0265476.
10. Gijón M, Bellusci M, Petraitiene B, et al. Factors associated with severity in invasive community-acquired Staphylococcus aureus infections in children: a prospective European multicentre study. Clin Microbiol Infect Off Publ Eur Soc Clin Microbiol Infect Dis. 2016; 22(7): 643.e1-6. doi:10.1016/j.cmi.2016.04.004.
11. Bocchini CE, Hulten KG, Mason EO Jr, et al. Panton-Valentine leukocidin genes are associated with enhanced inflammatory response and local disease in acute hematogenous Staphylococcus aureus osteomyelitis in children. Pediatrics. 2006; 117(2): 433-440. doi:10.1542/peds.2005-0566.
12. Dohin B, Gillet Y, Kohler R, et al. Pediatric bone and joint infections caused by Panton-Valentine leukocidin-positive Staphylococcus aureus. Pediatr Infect Dis J. 2007; 26(11): 1042-1048. doi:10.1097/INF.0b013e318133a85e.
13. Gillet Y, Issartel B, Vanhems P, et al. Association between Staphylococcus aureus strains carrying gene for Panton-Valentine leukocidin and highly lethal necrotising pneumonia in young immunocompetent patients. Lancet Lond Engl. 2002; 359(9308): 753-759. doi:10.1016/S0140-6736(02)07877-7.
14. Murray RJ, Robinson JO, White JN, et al. Community-acquired pneumonia due to pandemic A(H1N1)2009 influenzavirus and methicillin resistant Staphylococcus aureus co-infection. PloS One. 2010; 5(1): e8705. doi:10.1371/journal.pone.0008705.
15. Correa-Jiménez O, Pinzón-Redondo H, Reyes N. High frequency of Panton-Valentine leukocidin in Staphylococcus aureus causing pediatric infections in the city of Cartagena-Colombia. J Infect Public Health. 2016 Jul-Aug; 9(4): 415-20. doi: 10.1016/j.jiph.2015.10.017.
16. Gillet Y, Dumitrescu O, Tristan A, et al. Pragmatic management of Panton-Valentine leukocidin-associated staphylococcal diseases. Int J Antimicrob Agents. 2011; 38(6): 457-464. doi:10.1016/j.ijantimicag.2011.05.003.
17. Saeed K, Gould I, Esposito S, et al. Panton-Valentine leukocidin-positive Staphylococcus aureus: a position statement from the International Society of Chemotherapy. Int J Antimicrob Agents. 2018; 51(1): 16-25. doi:10.1016/j.ijantimicag.2017.11.002.
18. Lewis D, Campbell R, Cookson B, et al. Guidance on the diagnosis and management of PVL-associated Staphylococcus aureus infections (PVL-SA) in England. Health Prot Agency Lond UK. Published online 2008.
19. Yamaki J, Lee M, Shriner KA, Wong-Beringer A. Can clinical and molecular epidemiologic parameters guide empiric treatment with vancomycin for methicillin-resistant Staphylococcus aureus infections? Diagn Microbiol Infect Dis. 2011; 70(1): 124-130. doi:10.1016/j.diagmicrobio.2010.12.003.
20. Wehrhahn MC, Robinson JO, Pearson JC, et al. Clinical and laboratory features of invasive community-onset methicillin-resistant Staphylococcus aureus infection: a prospective case-control study. Eur J Clin Microbiol Infect Dis Off Publ Eur Soc Clin Microbiol. 2010; 29(8): 1025-1033. doi:10.1007/s10096-010-0973-4.
21. Darboe S, Dobreniecki S, Jarju S, et al. Prevalence of Panton-Valentine Leukocidin (PVL) and Antimicrobial Resistance in Community-Acquired Clinical Staphylococcus aureus in an Urban Gambian Hospital: A 11-Year Period Retrospective Pilot Study. Front Cell Infect Microbiol. 2019; 9: 170. doi:10.3389/fcimb.2019.00170.
22. McGuire E, Neill C, Collin SM, et al. Is Panton-Valentine leucocidin (PVL) toxin associated with poor clinical outcomes in patients with community-acquired Staphylococcus aureus bacteraemia? J Med Microbiol. 2023; 72(4). doi:10.1099/jmm.0.001683.