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O269 Methicillin-resistant Staphylococcus aureus producing Panton-Valentine leukocidin: a cause of acute osteomyelitis in children
Community-acquired bacterial infection I
S55
1 hour of birth for enrichment culture. Data on risk factors and antibiotic therapy collected prospectively. Results: 1. Enriched culture gave an overall (vaginal and/or rectal) colonisation rate of 21% compared to 10% with standard culture. 2. 32% of women studied had at least one risk factor, most commonly prolonged rupture of membranes (49%). 3. 50% of women with any risk factor did not receive IAP (Table 1). 4. Only 21% of GBS carriers received IAP, whilst 67% of women who received IAP were GBS-negative (Table 2). 5. The baby colonisation rate was 8% (90/1125). Positive vaginal culture identified 78% of the positive babies; positive rectal culture 89% and both rectal and vaginal positive culture combined 93%. Table 1 Antibiotics risk factor
YES NO
IAP YES
NO
136 25
135 913
Table 2 Antibiotics GBS culture
POSITIVE NEGATIVE
S. pneumoniae by nasopharyngeal culture. All the 18 pneumococcal isolates were susceptible to penicillin and other commonly used antibiotics. Nine (50%) of the 18 isolates were of serotype 7F, five (28%) were of serotype 9N, three (17%) were of serotype 23F, and one (6%) was of serotype 16. MLST results corresponded with serotype results: all 7F serotypes were of ST2331, the 9N serotypes were of ST525, the 23F serotypes were of ST36, and the serotype 16 was of ST30. Three of the 18 pneumococcal carriers had no preceding symptoms while 15 presented with fever, rhinitis or sore throat. None had any underlying conditions known to be a risk factor for invasive pneumococcal disease. Conclusions: Pneumococcal serotype 7F, ST2331, was clearly associated with the outbreak of pneumonia and nasopharyngeal carriage in this military encampment. Outbreaks of invasive pneumococcal disease can occur in a crowded environment such as military training facility even among previously healthy young men.
IAP YES
NO
51 104
198 832
Conclusions: 1. The prevalence of GBS in labouring women was higher than in many previous European studies. 2. Our data confirms that the need for enrichment culture of vaginal and rectal swabs for maximum diagnostic yield. 3. There was a large percentage of women with risk factors who did not receive IAP, whilst only one third of women carrying GBS received IAP. 4. Rectal culture performs better than vaginal, although ideally they should be combined. O268 An outbreak of pneumonia caused by S. pneumoniae at a military training facility in Finland in 2006 A. Vainio, O. Lyytik¨ainen, R. Skytt¨a, T. Kaijalainen, A. Virolainen (Helsinki, Oulu, FI) Objectives: A cluster of pneumonia cases occurred among military recruits following a one-week hard encampment in Eastern Finland in the summer of 2006; several recruits were hospitalised and some had positive blood cultures for S. pneumoniae. To assess the extent of the outbreak and the carriage rate and microbiological characteristics of S. pneumoniae, all recruits who had participated in the encampment were screened for nasopharyngeal carriage of aerobic flora. Methods: Nasopharyngeal cultures were taken from all 43 recruits who had participated in the military encampment and blood cultures were taken from all hospitalised recruits. All S. pneumoniae isolates were studied for antibiotic susceptibility, serotyped by latex agglutination and/or counterimmunoelectrophoresis, CIEP, and genotyped by multi locus sequence typing, MLST. Medical records of the hospitalised recruits were reviewed and all recruits were interviewed regarding the preceding symptoms, medical history, medication, and smoking habits. Results: Of the 43 military recruits, five (12%) were hospitalised with pneumonia and two (5%) of them were positive for S. pneumoniae by blood culture. These two isolates were both of serotype 7F and ST2331. Eighteen (42%) of the 43 men were detected positive for
O269 Methicillin-resistant Staphylococcus aureus producing Panton-Valentine leukocidin: a cause of acute osteomyelitis in children V. Chini, G. Sdougkos, D.A. Papanastasiou, G. Christodoulou, D. Garantziotou, A. Vris, G. Dimitracopoulos, I. Spiliopoulou (Patras, GR) Objectives: Staphylococcus aureus remains the prevalent bacterium causing acute osteomyelitis in children. The involvement of methicillinresistant S. aureus (MRSA) as a cause of acute childhood osteomyelitis was investigated. Methods: Included in the study were all children treated for acute osteomyelitis due to S. aureus in Western Greece from January 2005 until August 2006. Bone scan, MRI and X-rays were performed in order to ascertain the diagnosis and to assess the severity of the disease. S. aureus was isolated from blood and/or bone tissue when surgical drainage was necessary. The Staphylococcal Cassette Chromosome (SCCmec) type and Panton-Valentine leukocidin (PVL) genes (lukS-PV and lukFPV) were detected by PCRs. MRSA clones were defined by PFGE of SmaI DNA digests. Signs, symptoms and laboratory findings were prospectively registered and statistically evaluated (Mann-Whitney-U test) in all patients until cessation of activity of the disease. Results: Nineteen patients, 12 males and 7 females, median age 11 years, range 2−13 years, were diagnosed as having acute staphylococcal osteomyelitis. Three children had a suspected site of bacterial entrance (injury, burn, insect bite). S. aureus was isolated from the blood of nine patients, from the tissue of nine more patients and from both clinical specimens in one patient. In five children community-acquired MRSA (CA-MRSA) carrying SCCmec type IV and PVL was identified. Among the 14 MSSA isolated from the remaining patients, two were PVLpositive. The maximal ESR and CRP values as well as the time necessary for normalisation of ESR and CRP differed statistically significantly in patients with PVL positive stains (MRSA and MSSA) compared to PVLnegative MSSA (p < 0.05). Surgical drainage was more often necessary among patients with PVL-positive stains. Conclusions: PVL-positive CA-MRSA are recovered not only from patients with superficial but also with invasive musculoskeletal infections. The production of PVL seems to be the main factor that contributes to the course of acute osteomyelitis. O270 Methicillin-resistant Staphylococcus aureus clones producing toxic shock syndrome toxin 1: first case of intrafamily transmission C. Francois, X. Lemaire, L. Legout, E. Senneville, E. Beltrand, M. Caillaux, G. Lina, J. Etienne, Y. Yazdanpanah (Tourcoing, Lyon, FR) Background: in the past decade, new strains of MRSA have emerged in the community, causing aggressive infections in young, otherwise healthy people. Most of community MRSA (C-MRSA) isolates expressed Panton-Valentine leukocidin (PVL), a highly potent toxin previously implicated in theses types of infections. Recently, a new clone of
S55
1 hour of birth for enrichment culture. Data on risk factors and antibiotic therapy collected prospectively. Results: 1. Enriched culture gave an overall (vaginal and/or rectal) colonisation rate of 21% compared to 10% with standard culture. 2. 32% of women studied had at least one risk factor, most commonly prolonged rupture of membranes (49%). 3. 50% of women with any risk factor did not receive IAP (Table 1). 4. Only 21% of GBS carriers received IAP, whilst 67% of women who received IAP were GBS-negative (Table 2). 5. The baby colonisation rate was 8% (90/1125). Positive vaginal culture identified 78% of the positive babies; positive rectal culture 89% and both rectal and vaginal positive culture combined 93%. Table 1 Antibiotics risk factor
YES NO
IAP YES
NO
136 25
135 913
Table 2 Antibiotics GBS culture
POSITIVE NEGATIVE
S. pneumoniae by nasopharyngeal culture. All the 18 pneumococcal isolates were susceptible to penicillin and other commonly used antibiotics. Nine (50%) of the 18 isolates were of serotype 7F, five (28%) were of serotype 9N, three (17%) were of serotype 23F, and one (6%) was of serotype 16. MLST results corresponded with serotype results: all 7F serotypes were of ST2331, the 9N serotypes were of ST525, the 23F serotypes were of ST36, and the serotype 16 was of ST30. Three of the 18 pneumococcal carriers had no preceding symptoms while 15 presented with fever, rhinitis or sore throat. None had any underlying conditions known to be a risk factor for invasive pneumococcal disease. Conclusions: Pneumococcal serotype 7F, ST2331, was clearly associated with the outbreak of pneumonia and nasopharyngeal carriage in this military encampment. Outbreaks of invasive pneumococcal disease can occur in a crowded environment such as military training facility even among previously healthy young men.
IAP YES
NO
51 104
198 832
Conclusions: 1. The prevalence of GBS in labouring women was higher than in many previous European studies. 2. Our data confirms that the need for enrichment culture of vaginal and rectal swabs for maximum diagnostic yield. 3. There was a large percentage of women with risk factors who did not receive IAP, whilst only one third of women carrying GBS received IAP. 4. Rectal culture performs better than vaginal, although ideally they should be combined. O268 An outbreak of pneumonia caused by S. pneumoniae at a military training facility in Finland in 2006 A. Vainio, O. Lyytik¨ainen, R. Skytt¨a, T. Kaijalainen, A. Virolainen (Helsinki, Oulu, FI) Objectives: A cluster of pneumonia cases occurred among military recruits following a one-week hard encampment in Eastern Finland in the summer of 2006; several recruits were hospitalised and some had positive blood cultures for S. pneumoniae. To assess the extent of the outbreak and the carriage rate and microbiological characteristics of S. pneumoniae, all recruits who had participated in the encampment were screened for nasopharyngeal carriage of aerobic flora. Methods: Nasopharyngeal cultures were taken from all 43 recruits who had participated in the military encampment and blood cultures were taken from all hospitalised recruits. All S. pneumoniae isolates were studied for antibiotic susceptibility, serotyped by latex agglutination and/or counterimmunoelectrophoresis, CIEP, and genotyped by multi locus sequence typing, MLST. Medical records of the hospitalised recruits were reviewed and all recruits were interviewed regarding the preceding symptoms, medical history, medication, and smoking habits. Results: Of the 43 military recruits, five (12%) were hospitalised with pneumonia and two (5%) of them were positive for S. pneumoniae by blood culture. These two isolates were both of serotype 7F and ST2331. Eighteen (42%) of the 43 men were detected positive for
O269 Methicillin-resistant Staphylococcus aureus producing Panton-Valentine leukocidin: a cause of acute osteomyelitis in children V. Chini, G. Sdougkos, D.A. Papanastasiou, G. Christodoulou, D. Garantziotou, A. Vris, G. Dimitracopoulos, I. Spiliopoulou (Patras, GR) Objectives: Staphylococcus aureus remains the prevalent bacterium causing acute osteomyelitis in children. The involvement of methicillinresistant S. aureus (MRSA) as a cause of acute childhood osteomyelitis was investigated. Methods: Included in the study were all children treated for acute osteomyelitis due to S. aureus in Western Greece from January 2005 until August 2006. Bone scan, MRI and X-rays were performed in order to ascertain the diagnosis and to assess the severity of the disease. S. aureus was isolated from blood and/or bone tissue when surgical drainage was necessary. The Staphylococcal Cassette Chromosome (SCCmec) type and Panton-Valentine leukocidin (PVL) genes (lukS-PV and lukFPV) were detected by PCRs. MRSA clones were defined by PFGE of SmaI DNA digests. Signs, symptoms and laboratory findings were prospectively registered and statistically evaluated (Mann-Whitney-U test) in all patients until cessation of activity of the disease. Results: Nineteen patients, 12 males and 7 females, median age 11 years, range 2−13 years, were diagnosed as having acute staphylococcal osteomyelitis. Three children had a suspected site of bacterial entrance (injury, burn, insect bite). S. aureus was isolated from the blood of nine patients, from the tissue of nine more patients and from both clinical specimens in one patient. In five children community-acquired MRSA (CA-MRSA) carrying SCCmec type IV and PVL was identified. Among the 14 MSSA isolated from the remaining patients, two were PVLpositive. The maximal ESR and CRP values as well as the time necessary for normalisation of ESR and CRP differed statistically significantly in patients with PVL positive stains (MRSA and MSSA) compared to PVLnegative MSSA (p < 0.05). Surgical drainage was more often necessary among patients with PVL-positive stains. Conclusions: PVL-positive CA-MRSA are recovered not only from patients with superficial but also with invasive musculoskeletal infections. The production of PVL seems to be the main factor that contributes to the course of acute osteomyelitis. O270 Methicillin-resistant Staphylococcus aureus clones producing toxic shock syndrome toxin 1: first case of intrafamily transmission C. Francois, X. Lemaire, L. Legout, E. Senneville, E. Beltrand, M. Caillaux, G. Lina, J. Etienne, Y. Yazdanpanah (Tourcoing, Lyon, FR) Background: in the past decade, new strains of MRSA have emerged in the community, causing aggressive infections in young, otherwise healthy people. Most of community MRSA (C-MRSA) isolates expressed Panton-Valentine leukocidin (PVL), a highly potent toxin previously implicated in theses types of infections. Recently, a new clone of