{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T05:26:36Z","timestamp":1792041996661,"version":"4.4.0"},"reference-count":32,"publisher":"American Academy of Pediatrics (AAP)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2005,3,1]]},"abstract":"<jats:p>Objective. More than 70% of the community-acquired (CA) staphylococcal infections treated at Texas Children's Hospital are caused by methicillin-resistant Staphylococcus aureus (MRSA). Since September 2002, an increase in the number of severely ill patients with S aureus infections has occurred. This study provides a clinical description of severely ill adolescent patients and an analysis of their isolates using molecular methods.<\/jats:p>\n               <jats:p>Methods. We identified adolescent patients meeting criteria for severe sepsis requiring admission to the PICU. Patient records were reviewed, and isolates were obtained for susceptibility testing and DNA extraction. Isolates were tested for the presence of virulence genes (cna, tst, lukS-PV, and lukF-PV) and enterotoxin genes (sea, seb, sec, sed, seh, and sej) by polymerase chain reaction. Genomic fingerprints were determined by repetitive-element polymorphism polymerase chain reaction and pulse-field gel electrophoresis. SCCmec cassette type was determined.<\/jats:p>\n               <jats:p>Results. Fourteen adolescents with severe CA S aureus infections were identified between August 2002 and January 2004. All were admitted to the PICU with sepsis and coagulopathy. Twelve patients had CA-MRSA infections; 2 had CA methicillin-susceptible Staphylococcus aureus (MSSA) infections. The mean age was 12.9 years (range: 10-15 years). Thirteen patients had pulmonary involvement and\/or bone and joint infection; 10 patients had \u22652 bones or joints infected (range: 2-10); 4 patients developed vascular complications (deep venous thrombosis); and 3 patients died. All isolates were identical or closely related to the previously reported predominant clone in Houston, Texas (multilocus sequence type 8, USA300), and carried lukS-PV and lukF-PV genes as well as the SCCmec type IVa cassette (12 MRSA isolates) but did not contain cna or tst. Only 1 strain carried enterotoxin genes (sed and sej).<\/jats:p>\n               <jats:p>Conclusions. Severe staphylococcal infections in previously healthy adolescents without predisposing risk factors have presented more frequently at Texas Children's Hospital since September 2002. CA MRSA and clonally related CA MSSA characterized as USA300 and sequence type 8 have been isolated from these patients.<\/jats:p>","DOI":"10.1542\/peds.2004-2300","type":"journal-article","created":{"date-parts":[[2005,3,1]],"date-time":"2005-03-01T19:22:35Z","timestamp":1109704955000},"page":"642-648","source":"Crossref","is-referenced-by-count":306,"title":["Severe Staphylococcal Sepsis in Adolescents in the Era of Community-Acquired Methicillin-Resistant <i>Staphylococcus aureus<\/i>"],"prefix":"10.1542","volume":"115","author":[{"given":"Blanca E.","family":"Gonzalez","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Baylor College of Medicine, Houston, Texas"},{"name":"Texas Children's Hospital, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerardo","family":"Martinez-Aguilar","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Baylor College of Medicine, Houston, Texas"},{"name":"Medical Research Unit in Clinical Epidemiology, Mexican Social Security Institute, Durango, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristina G.","family":"Hulten","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Baylor College of Medicine, Houston, Texas"},{"name":"Texas Children's Hospital, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wendy A.","family":"Hammerman","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Baylor College of Medicine, Houston, Texas"},{"name":"Texas Children's Hospital, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge","family":"Coss-Bu","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Baylor College of Medicine, Houston, Texas"},{"name":"Texas Children's Hospital, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Avalos-Mishaan","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Baylor College of Medicine, Houston, Texas"},{"name":"Texas Children's Hospital, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr","given":"Edward O.","family":"Mason","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Baylor College of Medicine, Houston, Texas"},{"name":"Texas Children's Hospital, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheldon L.","family":"Kaplan","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Baylor College of Medicine, Houston, Texas"},{"name":"Texas Children's Hospital, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2005,3,1]]},"reference":[{"key":"2021121011185677900_R1","unstructured":"Sattler CV, Correa AG. Coagulase-positive staphylococcal infections (Staphylococcus aureus). In: Feigin RD, Cherry JD, Demmler GJ, Kaplan SL, eds. Textbook of Pediatric Infectious Diseases. 5th ed. Philadelphia, PA: Saunders; 2004:1099\u20131129"},{"key":"2021121011185677900_R2","doi-asserted-by":"crossref","unstructured":"Caksen H, Uzum K, Yuksel S. Prognostic factors in children with Staphylococcus aureus sepsis. J Emerg Med.\u20082003;25:199\u2013201","DOI":"10.1016\/S0736-4679(03)00171-9"},{"key":"2021121011185677900_R3","doi-asserted-by":"crossref","unstructured":"Martinez-Aguilar G, Hammerman WA, Mason EO Jr, Kaplan SL. Clindamycin treatment of invasive infections caused by community-acquired, methicillin-resistant and methicillin-susceptible Staphylococcus aureus in children. Pediatr Infect Dis J.\u20082003;22:593\u2013598","DOI":"10.1097\/01.inf.0000073163.37519.ee"},{"key":"2021121011185677900_R4","doi-asserted-by":"crossref","unstructured":"Mongkolrattanothai K, Boyle S, Kahana MD, Daum RS. Severe Staphylococcus aureus infections caused by clonally related community-acquired methicillin-susceptible and methicillin-resistant isolates. Clin Infect Dis.\u20082003;15;37:1050\u20131058","DOI":"10.1086\/378277"},{"key":"2021121011185677900_R5","doi-asserted-by":"crossref","unstructured":"Centers for Disease Control and Prevention. Four pediatric deaths from community-acquired methicillin-resistant Staphylococcus aureus\u2014Minnesota and North Dakota, 1997\u20131999. JAMA.\u20081999;282:1123\u20131125","DOI":"10.1001\/jama.282.12.1123"},{"key":"2021121011185677900_R6","doi-asserted-by":"crossref","unstructured":"Fey PD, Said-Salim B, Rupp ME, et al. Comparative molecular analysis of community- or hospital-acquired methicillin-resistant Staphylococcus aureus. Antimicrob Agents Chemother.\u20082003;47:196\u2013203","DOI":"10.1128\/AAC.47.1.196-203.2003"},{"key":"2021121011185677900_R7","doi-asserted-by":"crossref","unstructured":"Dufour P, Gillet Y, Bes M, et al. Community-acquired methicillin-resistant Staphylococcus aureus infections in France: emergence of a single clone that produces Panton-Valentine leukocidin. Clin Infect Dis.\u20082002;35:819\u2013824","DOI":"10.1086\/342576"},{"key":"2021121011185677900_R8","doi-asserted-by":"crossref","unstructured":"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.\u20082002;359:753\u2013759","DOI":"10.1016\/S0140-6736(02)07877-7"},{"key":"2021121011185677900_R9","doi-asserted-by":"crossref","unstructured":"Lowy FD. Staphylococcus aureus infections. N Engl J Med.\u20081998;339:520\u2013532","DOI":"10.1056\/NEJM199808203390806"},{"key":"2021121011185677900_R10","doi-asserted-by":"crossref","unstructured":"Shulman ST, Ayoub EM. Severe staphylococcal sepsis in adolescents. Pediatrics.\u20081976;58:59\u201366","DOI":"10.1542\/peds.58.1.59"},{"key":"2021121011185677900_R11","unstructured":"National Committee for Clinical Laboratory Standards. Performance Standards for Antimicrobial Susceptibility Testing. Fourteenth Informational Supplement (Aerobic Dilution). M100-S14 (M7). Wayne, PA: National Committee for Clinical Laboratory Standards; 2003"},{"key":"2021121011185677900_R12","doi-asserted-by":"crossref","unstructured":"Levy MM, Fink MP, Marshall JC, et al. 2001 SCCM\/ESICM\/ACCP\/ATS\/SIS International Sepsis Definitions Conference. Crit Care Med.\u20082003;31:1250\u20131256","DOI":"10.1097\/01.CCM.0000050454.01978.3B"},{"key":"2021121011185677900_R13","doi-asserted-by":"crossref","unstructured":"Despond O, Proulx F, Carcillo JA, Lacroix J. Pediatric sepsis and multiple organ dysfunction syndrome. Curr Opin Pediatr.\u20082001;13:247\u2013253","DOI":"10.1097\/00008480-200106000-00006"},{"key":"2021121011185677900_R14","unstructured":"Young LS. Sepsis syndrome. In: Mandell GL, Bennett JC, Dolin R, eds. Mandell, Douglas and Bennett's Principles and Practice of Infectious Diseases. 5th ed. Philadelphia, PA: Churchill Livingstone; 2000:806\u2013819"},{"key":"2021121011185677900_R15","doi-asserted-by":"crossref","unstructured":"Pollack MM, Ruttimann UE, Getson PR. Pediatric risk of mortality (PRISM) score. Crit Care Med.\u20081988;16:1110\u20131116","DOI":"10.1097\/00003246-198811000-00006"},{"key":"2021121011185677900_R16","unstructured":"National Committee for Clinical Laboratory Standards. Performance Standards for Antimicrobial Susceptibility Testing. Fourteenth Informational Supplement (Aerobic Dilution). M100-S14 (M7). Table 2C: MIC interpretive standards (\u03bcg\/mL) for Staphylococcus aureus. Wayne, PA: National Committee for Clinical Laboratory Standards; 2003"},{"key":"2021121011185677900_R17","doi-asserted-by":"crossref","unstructured":"Murchan S, Kaufmann ME, Deplano A, et al. Harmonization of pulsed-field gel electrophoresis protocols for epidemiological typing of strains of methicillin-resistant Staphylococcus aureus: a single approach developed by consensus in 10 European laboratories and its application for tracing the spread of related strains. J Clin Microbiol.\u20082003;41:1574\u20131585","DOI":"10.1128\/JCM.41.4.1574-1585.2003"},{"key":"2021121011185677900_R18","doi-asserted-by":"crossref","unstructured":"Tenover FC, Arbeit RD, Goering RV, et al. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol.\u20081995;33:2233\u20132239","DOI":"10.1128\/jcm.33.9.2233-2239.1995"},{"key":"2021121011185677900_R19","doi-asserted-by":"crossref","unstructured":"Okuma K, Iwakawa K, Turnidge JD, et al. Dissemination of new methicillin-resistant Staphylococcus aureus clones in the community. J Clin Microbiol.\u20082002;40:4289\u20134294","DOI":"10.1128\/JCM.40.11.4289-4294.2002"},{"key":"2021121011185677900_R20","doi-asserted-by":"crossref","unstructured":"Jarraud S, Mougel C, Thioulouse J, et al. Relationships between Staphylococcus aureus genetic background, virulence factors, agr groups (alleles), and human disease. Infect Immun.\u20082002;70:631\u2013641","DOI":"10.1128\/IAI.70.2.631-641.2002"},{"key":"2021121011185677900_R21","doi-asserted-by":"crossref","unstructured":"Avalos Mishaan AM, Mason EO Jr, Martinez-Aguilar G, et al. Emergence of a predominant clone of community acquired Staphylococcus aureus among children in Houston, Texas. Pediatr Infect Dis J.\u20082005; In press","DOI":"10.1097\/01.inf.0000151107.29132.70"},{"key":"2021121011185677900_R22","doi-asserted-by":"crossref","unstructured":"Fadahunsi HO. Severe staphylococcal sepsis in Nigerian children: a report of 27 cases. 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