**6. Location of DVT**

72 Venous Thrombosis – Principles and Practice

Location Recorded occurrence Percent Thoracic spine 1 2%

Total 10 Femur Unspecified 13 25%

Total 26 Tibia Unspecified 7 13%

Total 13

Total 3 Total 53 100% Multifocal 6 12%

*Staphylococcus aureus* was found to be the causative organism in 38 of 43 culture positive cases (88.4%) and, of those isolates, 18 (47.4%) were identified as Methicillin-resistant *Staphylococcus aureus*. In one series, the rise in recognition of DVT in their practice appeared to coincide with the establishment of USA 300 ST8 as the predominant clone of CA-MRSA in

The identification of Panton-Valentine leukocidin (PVL) genes in the isolates of *Staphylococcus* aureus in children with DVT has been reported in several studies.3,6,8,10,11 These reports suggest that PVL may be associated with enhanced inflammatory response in cases of musculoskeletal infection including pneumonia, multifocal osteomyelitis, bacteremia, and concurrent pyomyositis, subperiosteal abscesses or intra-osseous abscesses requiring surgical debridment.3,6,8,10,11 The advent of rapid PCR technology as a tool to identify the presence of PVL may prove valuable in identifying potentially "silent" cases of DVT that would otherwise go unrecognized. To this point, however, the technology to perform rapid testing to identify the bacterial genetics of the *S*. *aureus* isolates is not readily available at most institutions. Our meta-analysis identified 20 children out of the 58 reported

cases with DVT who were found to be PVL positive (34.5%).3,6,8,10,11

Ilium 5 9% Ischium 1 2% Pubis 1 2% Sacrum 3 6%

Proximal 7 13% Distal 6 11%

Proximal 5 9% Distal 1 2%

Proximal 1 2% Distal 2 4%

Pelvis

Fibula

**4. Causative organism** 

**5. Panton-Valentine leukocidin** 

their community.6

Table 2. Frequency Distribution of Osteomyelitis Site

Among the 58 children with DVT, the location of occurrence of the DVT was recorded in 45 cases and was noted to be multi-focal in 22 (48.9%) children (see table 3). 79 specific locations of the DVT were recorded with the most common being femoral (25 or 32%); popliteal (14 or 18%); iliac (12 or 15%); and inferior vena cava (6 or 8%). Overall, the reported incidence of DVT involving a location inclusive of the inferior vena cava, pelvis, or lower extremities was 62 of the 79 occurrences (78.5%).


Table 3. Frequency Distribution of DVT Location
