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Siddiqui S, Lone M S, Qureshi U A, Khanday R. Clinico-epidemiology and resistance patterns of community-acquired and hospital-acquired staphylococcus aureus sepsis in children. mljgoums 2025; 19 (3) :4-8
URL: http://mlj.goums.ac.ir/article-1-1759-en.html
URL: http://mlj.goums.ac.ir/article-1-1759-en.html
1- Department of Pediatrics, Government Medical College (GMC), Srinagar, Jammu and Kashmir, India
2- Department of Pediatric Microbiology, Government Medical College (GMC), Srinagar, Jammu and Kashmir, India
3- Department of Pediatrics, Government Medical College (GMC), Srinagar, Jammu and Kashmir, India ,dromarqureshi@rediffmail.com
2- Department of Pediatric Microbiology, Government Medical College (GMC), Srinagar, Jammu and Kashmir, India
3- Department of Pediatrics, Government Medical College (GMC), Srinagar, Jammu and Kashmir, India ,
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Discussion
This study investigated the demographic, clinical, and microbial characteristics of S. aureus sepsis in infants and children admitted to the Postgraduate Department of Pediatrics, GB Panth Children Hospital, Srinagar, Kashmir. Of the 56 pediatric patients admitted with S. aureus sepsis, a male predominance was observed, consistent with findings from other Indian studies (12,13). Furthermore, the majority of the enrolled children (71.43%) resided in rural areas. This demographic trend may be attributed to a higher prevalence of undernutrition in rural households, which is known to elevate susceptibility to childhood infections (14).
Trauma, skin infections, and fractures have been identified as primary predisposing factors for sepsis. Specifically, a history of trauma frequently correlates with S. aureus sepsis, likely due to the inoculation of bacteria into skin and soft tissues, leading to bacteremia and subsequent complications. It is important to consider that this relationship may be temporal. Consistent with these findings, Baranwal et al. (15) reported pustules (26%), blunt trauma (15%), and injections (8%) as prevalent predisposing conditions in their study.
In our study, we observed that the predominant form of S. aureus sepsis among patients was CA-SA sepsis, accounting for 66.10% of cases. The ratio of CA-SS to HA-SS can serve as an indicator of two key factors: the standard of aseptic care maintained within healthcare facilities and the prevalence of S. aureus within the broader community.
In the studied cohort, fever was the predominant symptom, observed in 92.85% of individuals, with musculoskeletal symptoms being the next most frequent. This observation aligns with findings from prior research, specifically those reported by Bathla A, et al. (12) and Mathew et al. (16).
In our study, pneumonia was observed in 73.70% of HA-SS cases and 56.80% of CA-SS cases. Hospitalized individuals are susceptible to rapid oropharyngeal colonization by nosocomial flora, which can subsequently culminate in lower respiratory tract infections caused by these organisms (17).
In staphylococcal illnesses, the organ systems most frequently affected include necrotizing soft tissue, pleuropulmonary, pericardial effusion, osteoarticular, and meningitis, as reported by Baranwal et al. (15). Our study specifically revealed a significant correlation between pleuropulmonary disease and HA-SS, while necrotizing soft tissue disease was significantly associated with CA-SS.
Untreated S. aureus sepsis can lead to complications such as septic shock, respiratory failure, multi-organ dysfunction, and pyopneumothorax (18). Our clinical observations align with these findings, as we have also encountered patients exhibiting similar complications.
Abnormalities in leucocyte count, platelet count, renal function, hepatic function, coagulation, or erythrocyte levels were not found to be significant predictors of either CA or HA infections.
A notable proportion of patients, specifically 31 (55%), required ICU admission for critical interventions, including vasopressor administration, heated high-flow nasal cannula oxygen therapy, and mechanical ventilatory support. A statistically significant correlation was observed between the utilization of high-flow therapy and the cohort of patients with HA-SS. This association is likely attributable to the elevated prevalence of severe pulmonary disease within this particular subgroup. In our clinical setting, high-flow therapy is routinely employed as a primary therapeutic modality for pediatric patients presenting with acute respiratory distress accompanied by hypoxia within the PICU.
In the present investigation, S. aureus sepsis was identified in cultures from 50 patients. Of these, MRSA accounted for 48 isolates, while MSSA comprised the remaining 2. Further categorization of the MRSA isolates revealed that 32 originated from CA infections, with the remaining 16 being HA. Both MSSA isolates were also determined to be CA. These findings contrast with a prior study conducted at the same institution in 2019 by Qadri, I et al. (19), which reported a lower prevalence of methicillin resistance, with only 35% of specimens identified as such. In an Iranian investigation, a substantial prevalence of methicillin resistance (48%) was observed among S. aureus isolates, with all strains confirmed to carry the mecA gene (20). This finding aligns with global trends, as evidenced by a multicenter study conducted by Camacho-Cruz, J. et al., which reported a 38% incidence of methicillin-resistant isolates (21). These converging data suggest a shift in the community resistance patterns, likely attributable to the widespread misuse of antibiotics.
This study has several limitations. We were unable to obtain MIC values for all antibiotics, and we did not perform molecular characterization, including the detection of Panton-Valentine leukocidin (PVL) and mecA genes. Furthermore, the proportionate carriage of S. aureus was not determined. Finally, due to the cross-sectional design of the study, we could not establish causality for identified risk factors.
Conclusion
Our research indicates that CA-SA sepsis continues to be more prevalent than HA-SA cases. A significant observation, both within our specific setting and globally, is the marked shift in the antimicrobial sensitivity patterns of S. aureus, characterized by a concerning increase in methicillin-resistant strains. This evolving trend necessitates immediate focus to inform the development of effective treatment strategies and robust infection control measures.
Acknowledgement
Not applicable.
Funding sources
No funding.
Ethical statement
The present study was approved by the Institutional Ethics Committee (IEC No. F (Minutes-BOPGS) Acad/KU/22).
Conflicts of interest
No conflicts of interest.
Author contributions
Mohd Suhail and Umer Qureshi: Conceiving and designing the experiments, Analyzing the data, and Preparing the figures; Rayees Khanday: Writing the main manuscript; Sahar Siddiqui: Collecting samples and Performing the experiments. All authors reviewed and completed the manuscript, played a role in the article, and approved the submitted version.
Data availability statement
The data are available.
Full-Text: (113 Views)
Introduction
Staphylococcus aureus (S. aureus) commonly resides as an asymptomatic commensal on human skin and mucosal surfaces. The anterior nares are considered the primary colonization site, although the bacterium can also be isolated from the skin or pharynx. Colonized individuals can facilitate the transmission of these bacteria to others, either through direct contact via their hands or indirectly through airborne droplets originating from the nasal passages. In hospitals, staphylococcal infections are frequently attributed to healthcare workers' hands. Key risk factors for developing such infections involve compromised skin integrity, including but not limited to wounds, dermatological conditions like eczema or epidermolysis bullosa, and burns, ventriculoperitoneal shunts, and indwelling intravascular or intrathecal catheters (1). These infections can manifest across various bodily systems, including the skin, bones, joints, and lungs. Invasive infections often develop following a pre-existing skin and soft tissue infection or a viral respiratory tract infection, particularly influenza. However, they can also manifest spontaneously in healthy children without any identifiable prior infections or risk factors (2). This pathogen is responsible for both community-acquired (CA) and hospital-acquired (HA) infections (3). Notably, staphylococcal infections, especially those attributed to methicillin-resistant S. aureus (MRSA), are associated with elevated patient morbidity and mortality rates (4,5). MRSA was initially documented in the United Kingdom in 1961 (6). Historically, MRSA infections, termed HA-MRSA, were predominantly linked to patients in nosocomial environments. However, the last decade has witnessed a substantial epidemiological shift due to the rise of CA-MRSA (7). Notably, S. aureus is a leading etiology of sepsis requiring admission to pediatric intensive care units (PICUs), with an estimated incidence ranging from 4 to 26 cases per 100,000 children annually (8,9).
This prospective study aimed to characterize the demographic, clinical, and microbiological features of invasive S. aureus infections in pediatric patients. Secondary objectives included assessing the need for PICU admission and identifying any shifts in antimicrobial resistance patterns.
Methods
This descriptive study was conducted at a tertiary care hospital in Srinagar, J&K, spanning from January 2021 to December 2022. Ethical clearance (Institutional Ethical Committee (IEC) No. F (Minutes-BOPGS) Acad/KU/22) was secured from the institutional ethics committee prior to the study's commencement. Informed consent was obtained in the local language from each patient's guardian before their enrollment.
This study enrolled individuals between one 1 and 18 years of age who fulfilled specific diagnostic criteria. Sepsis caused by S. aureus was identified based on the presence of systemic inflammatory response syndrome (SIRS) concurrently with a culture-confirmed staphylococcal infection. The diagnosis of SIRS adhered to the 2005 International Consensus Criteria on Pediatric Sepsis. The criteria consisted of an abnormal core temperature (>38.5°C or <36.5°C), cardiovascular issues (Mean heart rate >2 standard deviation (SD) above the normal range for age, or bradycardia in infants under 1 year with a mean heart rate below the 10th percentile for their age), respiratory issues (Mean respiratory rate >2 SD above the normal range for age or the requirement for mechanical ventilation), and issues in leukocyte count (Either an elevated or decreased white blood cell count for age or >10% immature neutrophils). Disseminated staphylococcal disease is characterized by pyogenic infection at a minimum of two non-contiguous anatomical sites. This definition requires a clinical suspicion of staphylococcal disease, further supported by either a culture-confirmed S. aureus isolation from a sterile site or microscopic identification of gram-positive cocci in clusters within sterile body fluid. Infections were categorized as CA-MRSA if they met the following criteria: Symptom onset occurred prior to admission, cultures were obtained within 48 hours of admission, there was no documented history of S. aureus infection (i.e., no prior positive cultures), and no record of admission, surgery, or invasive medical device use within the preceding 12 months. Conversely, infections that did not fulfill these conditions were classified as HA-MRSA (10).
Microbiological cultures of diverse samples were performed using established methodologies. Specifically, blood culture, body fluid, and pus samples were cultured in BacT/Alert blood culture bottles. Bottles indicating a positive result via the BacT/Alert system underwent subculture onto standard bacteriological media. Subsequent microbial growth was then subjected to antimicrobial susceptibility testing utilizing both the automated VITEK 2 Compact system and the manual Kirby-Bauer disc diffusion method. Urine cultures were performed using a semi-quantitative method on Hi-Chrome urinary tract infection (UTI) agar. Antibiotic sensitivity testing was subsequently conducted manually via the Kirby-Bauer disc diffusion method (11). Cefoxitin discs (30 mcg; Himedia Labs India) were utilized to differentiate between MRSA and methicillin-susceptible S. aureus (MSSA). Additional antibiotics assessed by disc diffusion included linezolid (10 mcg), gentamicin (10 mcg), amikacin (30 mcg), cotrimoxazole (25 mcg), and clindamycin (2 mcg) (Himedia Labs India). Minimum inhibitory concentrations (MICs) for teicoplanin and vancomycin were determined using the VITEK 2 Compact system.
Statistical analysis
The collected data were systematically organized and initially recorded in a Microsoft Excel spreadsheet. Subsequently, these data were transferred to the SPSS Version 25 (SPSS Inc., Chicago, Illinois, USA) data editor for further analysis. Continuous variables are presented as the mean ± SD, while categorical variables are reported as proportions. For comparisons involving two or more groups with qualitative data, the chi-square test was employed. Statistical significance was established at a P ≤ 0.05.
Results
Among 56 pediatric patients diagnosed with S. aureus sepsis or disseminated staphylococcal infection, culture positivity was observed in 50 cases (89.30%). The cohort comprised 37 (66.10%) CA infections and 19 (33.90%) HA infections, resulting in a CA severe sepsis (CA-SS) to HA severe sepsis (HA-SS) ratio of 2:1 (66.1%: 33.9%). Further analysis of the 50 culture-positive S. aureus sepsis cases revealed that 48 (96%) were MRSA, while only 2 were MSSA. Linezolid, vancomycin, and teicoplanin demonstrated 100% sensitivity against the isolated strains, followed by gentamicin (70%), amikacin (60%), cotrimoxazole (50%), and clindamycin (30%).
Among the 48 MRSA cases, 32 were identified as CA sepsis, while 16 were HA sepsis. Both MSSA cases presented with CA sepsis. The patient cohort was predominantly male (n = 35, 62.50%) and originated from rural areas (n = 40, 71.43%). Trauma was the most frequently observed predisposing factor (21.42%), with pustules (10.71%), fractures (5.35%), and burns (3.60%) also contributing to the infections.
Upon admission, the prevalent symptoms observed were fever, localized musculoskeletal issues, cough, and altered sensorium. Of these, only localized musculoskeletal symptoms (91.90%) demonstrated a significant association with CA-SA (Table 1). The most frequently noted signs at admission included tachypnea, hypotension, tachycardia, crepitation, and feeble pulses; however, none of these signs showed a statistically significant correlation with either CA-SA or HA-SA (Table 1). Upon admission, common organ system involvements observed in patients with S. aureus sepsis included pleuropulmonary disease, necrotizing soft tissue disease, osteoarticular disease, meningitis, and pericardial effusion. A significant association was identified between pleuropulmonary disease and HA-SS, whereas necrotizing soft tissue disease showed a significant association with CA-SS (Table 2). The predominant clinical presentations of the disease were pneumonia, followed by abscess formation (Table 3). Notably, the presence of an abscess was significantly associated with CA-SS.
Patients with HA-SS experienced higher incidences of several complications compared to those with CA-SS, such as septic shock (47.4% vs. 37.8%), respiratory failure (21.05% vs. 5.4%), multi-organ dysfunction (15.8% vs. 5.4%), and pneumothorax (5.3% vs. 2.7%). However, these differences did not reach statistical significance. Additionally, acute respiratory distress syndrome (ARDS) was observed in two CA-SS patients.
No significant association was observed between the presence of abnormal leukocyte count, platelet count, renal function, hepatic function, coagulopathy, or anemia and the occurrence of either CA or HA infections (Table 4). Furthermore, left ventricular (LV) dysfunction was found in comparable proportions across patient groups, specifically in 5.40% of patients with CA-SS and 5.30% of those with HA-SS.
All patients received anti-staphylococcal antibiotics. Additional interventions were nasal prong oxygen for 33 (59%) patients, vasopressor support for 23 (41%) patients, incision drainage for 20 (36%) patients, packed cell transfusion for 19 (34%) patients, heated high-flow nasal cannula for 16 (28%) patients, ventilator support for 6 (11%) patients, intercostal tube drainage for 9 (16%) patients, and pericardiocentesis for 1 (0.02%) patient.
A notable correlation was found between the use of high flow in the HA-SS population (P = 0.025).
The mean ± SD hospital stay was for patients with CA-SS 13.32 ± 4.26 days and 14.78±5.53 days for patients with HA-SS. This difference was not statistically significant. Mortality rates were observed to be higher in the HA-SS group (10.50%) compared to the CA-SS group (5.40%), although this difference also did not reach statistical significance.
Staphylococcus aureus (S. aureus) commonly resides as an asymptomatic commensal on human skin and mucosal surfaces. The anterior nares are considered the primary colonization site, although the bacterium can also be isolated from the skin or pharynx. Colonized individuals can facilitate the transmission of these bacteria to others, either through direct contact via their hands or indirectly through airborne droplets originating from the nasal passages. In hospitals, staphylococcal infections are frequently attributed to healthcare workers' hands. Key risk factors for developing such infections involve compromised skin integrity, including but not limited to wounds, dermatological conditions like eczema or epidermolysis bullosa, and burns, ventriculoperitoneal shunts, and indwelling intravascular or intrathecal catheters (1). These infections can manifest across various bodily systems, including the skin, bones, joints, and lungs. Invasive infections often develop following a pre-existing skin and soft tissue infection or a viral respiratory tract infection, particularly influenza. However, they can also manifest spontaneously in healthy children without any identifiable prior infections or risk factors (2). This pathogen is responsible for both community-acquired (CA) and hospital-acquired (HA) infections (3). Notably, staphylococcal infections, especially those attributed to methicillin-resistant S. aureus (MRSA), are associated with elevated patient morbidity and mortality rates (4,5). MRSA was initially documented in the United Kingdom in 1961 (6). Historically, MRSA infections, termed HA-MRSA, were predominantly linked to patients in nosocomial environments. However, the last decade has witnessed a substantial epidemiological shift due to the rise of CA-MRSA (7). Notably, S. aureus is a leading etiology of sepsis requiring admission to pediatric intensive care units (PICUs), with an estimated incidence ranging from 4 to 26 cases per 100,000 children annually (8,9).
This prospective study aimed to characterize the demographic, clinical, and microbiological features of invasive S. aureus infections in pediatric patients. Secondary objectives included assessing the need for PICU admission and identifying any shifts in antimicrobial resistance patterns.
Methods
This descriptive study was conducted at a tertiary care hospital in Srinagar, J&K, spanning from January 2021 to December 2022. Ethical clearance (Institutional Ethical Committee (IEC) No. F (Minutes-BOPGS) Acad/KU/22) was secured from the institutional ethics committee prior to the study's commencement. Informed consent was obtained in the local language from each patient's guardian before their enrollment.
This study enrolled individuals between one 1 and 18 years of age who fulfilled specific diagnostic criteria. Sepsis caused by S. aureus was identified based on the presence of systemic inflammatory response syndrome (SIRS) concurrently with a culture-confirmed staphylococcal infection. The diagnosis of SIRS adhered to the 2005 International Consensus Criteria on Pediatric Sepsis. The criteria consisted of an abnormal core temperature (>38.5°C or <36.5°C), cardiovascular issues (Mean heart rate >2 standard deviation (SD) above the normal range for age, or bradycardia in infants under 1 year with a mean heart rate below the 10th percentile for their age), respiratory issues (Mean respiratory rate >2 SD above the normal range for age or the requirement for mechanical ventilation), and issues in leukocyte count (Either an elevated or decreased white blood cell count for age or >10% immature neutrophils). Disseminated staphylococcal disease is characterized by pyogenic infection at a minimum of two non-contiguous anatomical sites. This definition requires a clinical suspicion of staphylococcal disease, further supported by either a culture-confirmed S. aureus isolation from a sterile site or microscopic identification of gram-positive cocci in clusters within sterile body fluid. Infections were categorized as CA-MRSA if they met the following criteria: Symptom onset occurred prior to admission, cultures were obtained within 48 hours of admission, there was no documented history of S. aureus infection (i.e., no prior positive cultures), and no record of admission, surgery, or invasive medical device use within the preceding 12 months. Conversely, infections that did not fulfill these conditions were classified as HA-MRSA (10).
Microbiological cultures of diverse samples were performed using established methodologies. Specifically, blood culture, body fluid, and pus samples were cultured in BacT/Alert blood culture bottles. Bottles indicating a positive result via the BacT/Alert system underwent subculture onto standard bacteriological media. Subsequent microbial growth was then subjected to antimicrobial susceptibility testing utilizing both the automated VITEK 2 Compact system and the manual Kirby-Bauer disc diffusion method. Urine cultures were performed using a semi-quantitative method on Hi-Chrome urinary tract infection (UTI) agar. Antibiotic sensitivity testing was subsequently conducted manually via the Kirby-Bauer disc diffusion method (11). Cefoxitin discs (30 mcg; Himedia Labs India) were utilized to differentiate between MRSA and methicillin-susceptible S. aureus (MSSA). Additional antibiotics assessed by disc diffusion included linezolid (10 mcg), gentamicin (10 mcg), amikacin (30 mcg), cotrimoxazole (25 mcg), and clindamycin (2 mcg) (Himedia Labs India). Minimum inhibitory concentrations (MICs) for teicoplanin and vancomycin were determined using the VITEK 2 Compact system.
Statistical analysis
The collected data were systematically organized and initially recorded in a Microsoft Excel spreadsheet. Subsequently, these data were transferred to the SPSS Version 25 (SPSS Inc., Chicago, Illinois, USA) data editor for further analysis. Continuous variables are presented as the mean ± SD, while categorical variables are reported as proportions. For comparisons involving two or more groups with qualitative data, the chi-square test was employed. Statistical significance was established at a P ≤ 0.05.
Results
Among 56 pediatric patients diagnosed with S. aureus sepsis or disseminated staphylococcal infection, culture positivity was observed in 50 cases (89.30%). The cohort comprised 37 (66.10%) CA infections and 19 (33.90%) HA infections, resulting in a CA severe sepsis (CA-SS) to HA severe sepsis (HA-SS) ratio of 2:1 (66.1%: 33.9%). Further analysis of the 50 culture-positive S. aureus sepsis cases revealed that 48 (96%) were MRSA, while only 2 were MSSA. Linezolid, vancomycin, and teicoplanin demonstrated 100% sensitivity against the isolated strains, followed by gentamicin (70%), amikacin (60%), cotrimoxazole (50%), and clindamycin (30%).
Among the 48 MRSA cases, 32 were identified as CA sepsis, while 16 were HA sepsis. Both MSSA cases presented with CA sepsis. The patient cohort was predominantly male (n = 35, 62.50%) and originated from rural areas (n = 40, 71.43%). Trauma was the most frequently observed predisposing factor (21.42%), with pustules (10.71%), fractures (5.35%), and burns (3.60%) also contributing to the infections.
Upon admission, the prevalent symptoms observed were fever, localized musculoskeletal issues, cough, and altered sensorium. Of these, only localized musculoskeletal symptoms (91.90%) demonstrated a significant association with CA-SA (Table 1). The most frequently noted signs at admission included tachypnea, hypotension, tachycardia, crepitation, and feeble pulses; however, none of these signs showed a statistically significant correlation with either CA-SA or HA-SA (Table 1). Upon admission, common organ system involvements observed in patients with S. aureus sepsis included pleuropulmonary disease, necrotizing soft tissue disease, osteoarticular disease, meningitis, and pericardial effusion. A significant association was identified between pleuropulmonary disease and HA-SS, whereas necrotizing soft tissue disease showed a significant association with CA-SS (Table 2). The predominant clinical presentations of the disease were pneumonia, followed by abscess formation (Table 3). Notably, the presence of an abscess was significantly associated with CA-SS.
Patients with HA-SS experienced higher incidences of several complications compared to those with CA-SS, such as septic shock (47.4% vs. 37.8%), respiratory failure (21.05% vs. 5.4%), multi-organ dysfunction (15.8% vs. 5.4%), and pneumothorax (5.3% vs. 2.7%). However, these differences did not reach statistical significance. Additionally, acute respiratory distress syndrome (ARDS) was observed in two CA-SS patients.
No significant association was observed between the presence of abnormal leukocyte count, platelet count, renal function, hepatic function, coagulopathy, or anemia and the occurrence of either CA or HA infections (Table 4). Furthermore, left ventricular (LV) dysfunction was found in comparable proportions across patient groups, specifically in 5.40% of patients with CA-SS and 5.30% of those with HA-SS.
All patients received anti-staphylococcal antibiotics. Additional interventions were nasal prong oxygen for 33 (59%) patients, vasopressor support for 23 (41%) patients, incision drainage for 20 (36%) patients, packed cell transfusion for 19 (34%) patients, heated high-flow nasal cannula for 16 (28%) patients, ventilator support for 6 (11%) patients, intercostal tube drainage for 9 (16%) patients, and pericardiocentesis for 1 (0.02%) patient.
A notable correlation was found between the use of high flow in the HA-SS population (P = 0.025).
The mean ± SD hospital stay was for patients with CA-SS 13.32 ± 4.26 days and 14.78±5.53 days for patients with HA-SS. This difference was not statistically significant. Mortality rates were observed to be higher in the HA-SS group (10.50%) compared to the CA-SS group (5.40%), although this difference also did not reach statistical significance.
|
Table 1. Distribution of studied population as per symptoms and signs at admission
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Discussion
This study investigated the demographic, clinical, and microbial characteristics of S. aureus sepsis in infants and children admitted to the Postgraduate Department of Pediatrics, GB Panth Children Hospital, Srinagar, Kashmir. Of the 56 pediatric patients admitted with S. aureus sepsis, a male predominance was observed, consistent with findings from other Indian studies (12,13). Furthermore, the majority of the enrolled children (71.43%) resided in rural areas. This demographic trend may be attributed to a higher prevalence of undernutrition in rural households, which is known to elevate susceptibility to childhood infections (14).
Trauma, skin infections, and fractures have been identified as primary predisposing factors for sepsis. Specifically, a history of trauma frequently correlates with S. aureus sepsis, likely due to the inoculation of bacteria into skin and soft tissues, leading to bacteremia and subsequent complications. It is important to consider that this relationship may be temporal. Consistent with these findings, Baranwal et al. (15) reported pustules (26%), blunt trauma (15%), and injections (8%) as prevalent predisposing conditions in their study.
In our study, we observed that the predominant form of S. aureus sepsis among patients was CA-SA sepsis, accounting for 66.10% of cases. The ratio of CA-SS to HA-SS can serve as an indicator of two key factors: the standard of aseptic care maintained within healthcare facilities and the prevalence of S. aureus within the broader community.
In the studied cohort, fever was the predominant symptom, observed in 92.85% of individuals, with musculoskeletal symptoms being the next most frequent. This observation aligns with findings from prior research, specifically those reported by Bathla A, et al. (12) and Mathew et al. (16).
In our study, pneumonia was observed in 73.70% of HA-SS cases and 56.80% of CA-SS cases. Hospitalized individuals are susceptible to rapid oropharyngeal colonization by nosocomial flora, which can subsequently culminate in lower respiratory tract infections caused by these organisms (17).
In staphylococcal illnesses, the organ systems most frequently affected include necrotizing soft tissue, pleuropulmonary, pericardial effusion, osteoarticular, and meningitis, as reported by Baranwal et al. (15). Our study specifically revealed a significant correlation between pleuropulmonary disease and HA-SS, while necrotizing soft tissue disease was significantly associated with CA-SS.
Untreated S. aureus sepsis can lead to complications such as septic shock, respiratory failure, multi-organ dysfunction, and pyopneumothorax (18). Our clinical observations align with these findings, as we have also encountered patients exhibiting similar complications.
Abnormalities in leucocyte count, platelet count, renal function, hepatic function, coagulation, or erythrocyte levels were not found to be significant predictors of either CA or HA infections.
A notable proportion of patients, specifically 31 (55%), required ICU admission for critical interventions, including vasopressor administration, heated high-flow nasal cannula oxygen therapy, and mechanical ventilatory support. A statistically significant correlation was observed between the utilization of high-flow therapy and the cohort of patients with HA-SS. This association is likely attributable to the elevated prevalence of severe pulmonary disease within this particular subgroup. In our clinical setting, high-flow therapy is routinely employed as a primary therapeutic modality for pediatric patients presenting with acute respiratory distress accompanied by hypoxia within the PICU.
In the present investigation, S. aureus sepsis was identified in cultures from 50 patients. Of these, MRSA accounted for 48 isolates, while MSSA comprised the remaining 2. Further categorization of the MRSA isolates revealed that 32 originated from CA infections, with the remaining 16 being HA. Both MSSA isolates were also determined to be CA. These findings contrast with a prior study conducted at the same institution in 2019 by Qadri, I et al. (19), which reported a lower prevalence of methicillin resistance, with only 35% of specimens identified as such. In an Iranian investigation, a substantial prevalence of methicillin resistance (48%) was observed among S. aureus isolates, with all strains confirmed to carry the mecA gene (20). This finding aligns with global trends, as evidenced by a multicenter study conducted by Camacho-Cruz, J. et al., which reported a 38% incidence of methicillin-resistant isolates (21). These converging data suggest a shift in the community resistance patterns, likely attributable to the widespread misuse of antibiotics.
This study has several limitations. We were unable to obtain MIC values for all antibiotics, and we did not perform molecular characterization, including the detection of Panton-Valentine leukocidin (PVL) and mecA genes. Furthermore, the proportionate carriage of S. aureus was not determined. Finally, due to the cross-sectional design of the study, we could not establish causality for identified risk factors.
Conclusion
Our research indicates that CA-SA sepsis continues to be more prevalent than HA-SA cases. A significant observation, both within our specific setting and globally, is the marked shift in the antimicrobial sensitivity patterns of S. aureus, characterized by a concerning increase in methicillin-resistant strains. This evolving trend necessitates immediate focus to inform the development of effective treatment strategies and robust infection control measures.
Acknowledgement
Not applicable.
Funding sources
No funding.
Ethical statement
The present study was approved by the Institutional Ethics Committee (IEC No. F (Minutes-BOPGS) Acad/KU/22).
Conflicts of interest
No conflicts of interest.
Author contributions
Mohd Suhail and Umer Qureshi: Conceiving and designing the experiments, Analyzing the data, and Preparing the figures; Rayees Khanday: Writing the main manuscript; Sahar Siddiqui: Collecting samples and Performing the experiments. All authors reviewed and completed the manuscript, played a role in the article, and approved the submitted version.
Data availability statement
The data are available.
Research Article: Original Paper |
Subject:
Microbiology
Received: 2023/12/11 | Accepted: 2024/10/12 | Published: 2025/08/19 | ePublished: 2025/08/19
Received: 2023/12/11 | Accepted: 2024/10/12 | Published: 2025/08/19 | ePublished: 2025/08/19
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