Panton-Valentine Leukocidin Producing Staphylococcus aureus Causing Acute Hematogenous Osteomyelitis in the Pediatric Population: Implications on Clinical Course and Outcome

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BACKGROUND: Panton-Valentine leukocidin (PVL) is a necrotizing cytotoxin that is produced by certain strains of Staphylococcus aureus, causing acute hematogenous osteomyelitis (AHOM). The PVL-positive strains are particularly virulent in the pediatric population, causing profound inflammatory responses. This study aimed to investigate whether the presence of PVL-producing S. aureus altered the clinical course of pediatric patients presenting with AHOM. METHODS: This prospective descriptive study included all patients aged 16 years or younger who presented to our institution with AHOM caused by S. aureus from September 2021 to September 2024. Patient demographics, clinical presentation and laboratory results, extent of the bone involvement, extraosseous involvement, and management were all recorded. Routinely collected samples were stored and tested in batches for PVL and specific clonal clusters. RESULTS: Seventy-four patients were included in the study period. Seventy-two out of 74 (97.3%) isolates tested positive for PVL. Twenty-three (31.10%) patients experienced a severe clinical course. Many patients required 3 or more surgical debridements. No association between PVL-positive S. aureus infection or specific spa-clonal clusters and experiencing a severe clinical course was observed. CONCLUSIONS: Despite almost a third of the study participants having a severe clinical course of disease, 97.3% of the patients tested positive for a PVL-producing S. aureus strain, suggesting that having a severe clinical course ismultifactorial. Given the high number of PVL-positive cases, we postulate that these bacteria cause AHOM with subperiosteal abscess formation requiring surgical drainage in our population.

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