Panton-Valentine-Leukozidin-assoziierte Infektionen bei ambulanten Patienten in Niedersachsen

Abstract

Staphylococcus aureus (S. aureus) isolates carrying genes that encode for Panton-Valentine-Leukocidin (PVL) are mainly associated with deep skin and soft tissue infections (SSTI). However, they can also cause severe invasive infections with a high fatality rate. Production of PVL occurs independent of resistance characteristics of S. aureus. The worldwide spread of PVL- positive Methicillin-resistant strains of S. aureus in the general population becomes more and more important as so called community-acquired MRSA (cMRSA).The present study was conducted to determine the frequency of PVL-positive isolates among outpatients in Lower Saxony. From May 2007 until May 2009 swabs of 494 patients with SSTI were tested for S. aureus. All isolates (n=273) were screened for PVL genes (lukS / luk F) by polymerase chain reaction (PCR). 20,9% of the S. aureus isolates tested positive for PVL genes were susceptible to Methicillin (PVL-MSSA), whereas 2,2% of the isolates were Methicillin-resistant (PVL-MRSA).In patients with PVL-associated infections physicians were recommended to take swabs from the patient s nasopharynx to detect nasal colonization as well as to examine close contact persons. 14 of 23 investigated patients (60,9%) were nasal carriers of the same strain like the one isolated from the site of infection. Additionally, in 7 out of 21 cases with PVL-MSSA-infection familiar transmission occurred. Most likely due to the small number of cases, familiar transmissions for PVL-MRSA were not documented, although a similar risk of infection can be assumed.The present study indicates a high prevalence of PVL-positive MSSA in Lower Saxony compared to PVL-producing MRSA. In addition, laboratory-confirmed intrafamiliar spread suggests a distinctive epidemic potential of PVL-MSSA.