On line appendix Table : Chronologic summerized presentation of the main clinical, biological and outcome datas of the 14 cases of PVL-positive BJI.

Patient/
Gender/
Age/ / Type of infection /
Localisation/
Initial lesions / Delay for
first
exami-nation / Remarkable initial features / Initials WBC (x 109/L)
CRP
(mg/L) / Antibiotics
duration (m=month) / Positive culture / Febrile days /
Hospital days / Musculo- skeletal
imaging / Outcome: remarkable events / Surgical procedures* / Delay for surgery (days)/
Number of procedure (surg) / Gene mecA / Follow-up
(months)
Case 1
M
13y2m / Osteomyelitis/
Left tibia/
Superficial wound / 72 h / Fever>39°C
Septic shock / WBC=5.8
CRP=233 / 109 days IV and
Per oral: 12 m / Blood cultures,
Articular and abscess samples (2) / 21 days /
2 months / X Rays
Echography
TDM / Osteomyelitis, sub periosteal abscess, necrotizing fasciitis with abscess
Renal failure, hepatitis, emphysema and abscess of the lung, intestinal obstruction / Drainages of sub periosteal abscess(8d), knee joint (12d), fasciotomy (15d)
Enterotomy (10d)
Total: 4 surg(+ 2 samples =6) / - / 54
Case 2
M
8y / Arthritis
Right knee
Superficial wound / 24 h / Fever > 39°5C
Disorders of the digestive system
Septic shock / WBC=2.8
CRP=215 / 1 m IV
Per oral: 6 m / Blood culture
Articular puncture (1) / 26days /
90days / X Rays
MRI
Scintigraphy / Periosteal abscess, osteomyelitis of the whole femur
Lung abscess, kidney abscess, hepatitis
Femoral fracture
Leg length discrepancy / Surgical drainages of 2 abscess (10d / 29d)
Total: 2 surg (+1 sample =3) / - / 12
Case 3
F
14m / Arthritis
Left hip
None / 4 days / Fever>40°C
Total functional disability of the left leg / WBC=5
CRP=415 / 3 m IV
Per oral: 3 m / Blood culture Articular puncture (1) / 60 days /
nd / X Rays
TDM / Femoral shaft osteomyelitis
Sub periosteal abscess
Gram-negative infection of the surgical wound
Bone sequestrum / Arthrotomy (3d), drainage of sub periosteal abscess (28d)
Bone sequestrectomy (90d)
Total: 3 surg (+1sample = 4) / - / nd
Case 4
M
14y / Arthritis
Right shoulder
Boil / 24 h / Fever > 39°C
Septic shock / WBC=8.8
CRP=124 / 2 m IV
Per oral : 6 m / Blood culture Articular puncture (1) / 22 days /
43 days + 30 days of home-care / X Rays
MRI / Proximal humeral ostéomyelitis, peri articular soft tissues abscess, elbow arthritis
Lung abscess / Drainages of soft tissues abscess(11d), shoulder joint(17d), elbow joint(18d)
Total: 3 surg (+1sample=4) / - / 6
Case 5
M
14y10m / Osteomyelitis and arthritis
Pelvis (ilio-pubial) and right hip
None / 24 h / Fever > 39°C / WBC=13.4
CRP=325 / 2m IV
Per oral: 4 m / Blood culture
Abscess sample (1) / 2 months /
2 months / X Rays
4 TDM
2 MRI / Osteomyelitis and arthritis of the hip
Relapsed ilio-pubial abscess
Thrombosis of the right iliac venous
Pelvic abscess / Ilio-pubial abscess drainage (1d) Repeated drainages of ilio-pubial abscess (4) (5d/9d/26d/32d)
Total: 5 surg (+1sample = 6) / - / 9
Case 6
M
14y1m / Osteomyelitis
Right tibia
Superficial wound / 24 h / Fever> 39°C
Knee pain and swelling / WBC=14.6
CRP=209 / 49 days IV
Per oral: 3 weeks / Blood cultures / 14 days/
28 days / X Rays
2 MRI
3 TDM
1 Scintigraphy / Proximal tibia osteomyelitis, sub periosteal abscess
Necrotizing fasciitis
Thrombosis of the popliteal venous / None / - / 11
Case 7
M
3y6m / Arthritis
Right hip
Sty left eye / 48 h / Fever> 39°C
Septic shock
Toxic shock syndrome (TSS) / WBC=11.5
CRP=350 / 128 days IV
Per oral: 6 m
Immunoglobulin (6 injections) / Blood cultures
Articular puncture (1) / 41days/
60days / X Rays
TDM
2 MRI
Scintigraphy 18 months later / Articular abscess, osteomyelitis of the femoral shaft
Renal failure, hepatitis, emphysema and abscess of the lung
Thrombosis of the right femoral deep venous
Necrosis of the femoral neck and stiffening of the hip
4 years follow-up: geode of the metaphysis and bone condensation of the femoral shaft. / Articular drainage of the hip (2) (1d/9d) Femoral neck trepanation (18d) Femoral shaft trepanation (21d)
Total: 4 surg (+1 sample=5) / - / 48

Case 8

F
12y11m / Osteomyelitis
Left femoral shaft None / 12 h / Fever> 39°C
Septic shock / nd / nd / 15 days IV
Per oral: 59 m / Blood cultures
Bone sample (1) / 75 days/
75 days / X-ray
MRI
Scintigraphy / Osteomyelitis of the distal part of the femur, myositis
Chronic osteomyelitis
Scintigraphy: normal 2 years later
3.5 years later: reconstruction of the femoral shaft / Surgical drainage (13d)
Total: 1 surg (+1 sample = 2) / - / 44
Case 9
M
5y10m / Osteomyelitis
Right tibia
Finger pulp infection and
Superficial wound / 24 h / Fever>39°c / WBC=16
CRP=101 / 35 days IV
Per oral: 6 m / Blood cultures / 10 days/
45 days / X Rays
Scintigraphy
MRI / Osteomyelitis of the tibia, sub periosteal abscess, bone infarction of the tibia
Necrotizing fasciitis
Fracture of the tibia (4 months): consolidation with conservative treatment / Fasciotomy(4d), drainage of sub periosteal abscess(5d)
Total: 2 surg / + / 15
Case 10
M
9m / Osteomyelitis and
arthritis
Distal left tibia and ankle
None / 12 h / Fever > 39°5c / WBC=10.3
(28.1 at 3rd day)
CRP=58.7 / 11days IV
Per oral: 3 weeks / Blood cultures / 10 days/
14days / X Rays
Scintigraphy / Favourable outcome
None complication / None / - / 22
Case 11
M
8y3m / Arthritis
Right knee
Superficial wound / 24 h / Fever 39°c / WBC=9.3
(5.3 at 3 rd day)
CRP=163 / 10 days IV
Per oral: nd / Blood culture Articular puncture (1) / 4days/
10days / X Rays
MRI / Osteomyelitis of the femur, sub periosteal abscess, arthritis of the knee / None / - / 18
Case 12
M
12y8m / Osteomyelitis
Left tibia Superficial wound / 15 days / Fever>39°c
Septic shock / WBC=14.7
CRP=153 / ** 2 months 17 days IV
Per oral: ***
6 months later:
5 weeks IV
Per oral: 6 m / Blood cultures Abscess samples (3) / 24days/
32 days
+ 8 m for second therapy / X Rays
TDM
2 MRI
Scintigraphy / Osteomyelitis of the tibia, sub periosteal abscess, intramuscular abscess
Lung abscess, renal failure, hepatitis
Intra osseous sequester
1follow-up: abnormal x-ray and positive scingraphy but no relapse infection on the TDM and the IRM / Surgical drainages (3) (1d/4d/17d) Surgical drainage and sequestrectomy of the distal tibia ( 6 months)
Total: 4 surg / - / 16

Case 13

M
17y10m / Osteomyelitis
Left femoral shaft Boil / 6 days / Fever 39°
Diagnosis was made 3 weeks after initial onset (femoral shaft fracture) / WBC=9.7
CRP=185 / 2 m IV
Per oral: 2 m / Osseous samples (2) / nd /
2 months / X Rays
Scintigraphy
TDM
MRI / Osteomyélitis of the femoral shaft
Rib localisation
Fracture of the femoral shaft 3 weeks later initial onset and first examination / Femoral shaft riming after one month of antibiotic treatment (30d) then osteosynthesis (48d)
Total: 2 surg / - / 12
Case14
M
7y4m / Osteomyelitis
Left tibial
Boil / 24 h / Fever 39°5c
Abdominal pain / WBC=17.6
CRP=102 / 12 days IV
Per oral: 28 days / Blood cultures Osseous sample(1) / 5days /
14 days / X Rays
MRI / Osteomyelitis of the left tibia
None complication
Excellent outcome 12 months later / None / + / 12

nd: not documented, *: all surgical procedures underwent during hospitalization, if not the time of onset is noted, ** Initial treatment at 2nd day in an other country without benefit (unknow antibiotic during 8 days), *** The patient stopped the treatment 1 month later.

1B Dohin et al.