Abstract

The Panton-Valentine leukocidin (PVL) genes of methicillin-resistant Staphylococcus aureus (MRSA) have previously been associated with severe infections. Here, the impact of the PVL genes on severity of disease and clinical outcome of patients with hospital-acquired pneumonia (HAP) or ventilator-associated pneumonia (VAP) due to MRSA was investigated in a single center observational study in a hospital in China. HAP due to MRSA was diagnosed in 100 patients and 13 of the patients were PVL positive, while VAP was diagnosed in 5 patients and 2 were PVL positive. The PVL positive patient group showed a significantly higher Acute Physiology and Chronic Health Evaluation (APACHE) II score (14.3 ±7.8 vs. 10.1 ±4.7, P = 0.005) and significantly more patients with CRP levels >80 mg/L (8/15 vs. 12/90, P = 0.006) or WBC counts >15x109/L (7/15 vs. 12/90, P = 0.006), indicating that the severity of disease is affected by the presence of the PVL genes. The outcome of the study was defined by 30-day mortality. Four (27%) of the PVL positive patients and four (4%) of the PVL negative patients died within 30 days (P = 0.01, Fisher exact test). Kaplan-Meier survival curves were generated for the PVL positive and PVL negative patient groups, which differed significantly (P = 0.003). Among the patients that died, the mean interval between diagnosis and death was shorter for the PVL positive patients (9.3 ±5.6 vs. 40.8 ±6.6 days, P = 0.013). Further analysis within the HAP and VAP patient groups showed that the presence of PVL in MRSA impacted the severity of disease and clinical outcome of HAP, but for VAP the number of patients included in the study was too low. In conclusion, in this single center study in a Chinese hospital the presence of the PVL genes in MRSA impacted the severity of disease and clinical outcome in patients with HAP due to MRSA.

Highlights

  • Methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of nosocomial infections and is frequently identified in hospital-acquired pneumonia (HAP) and ventilatorassociated pneumonia (VAP) [1]

  • We investigated the impact of the presence of the Panton-Valentine leukocidin (PVL) genes in MRSA on the severity of disease and clinical outcome in patients with HAP and VAP due to MRSA

  • A total of 105 MRSA strains from patients with HAP or VAP were analyzed for the presence of the PVL genes and 15 (14%) were found to be PVL positive

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Summary

Introduction

Methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of nosocomial infections and is frequently identified in hospital-acquired pneumonia (HAP) and ventilatorassociated pneumonia (VAP) [1]. In a retrospective observational study of patients with HAP and VAP in four academic medical centers in the USA, the severity of disease and clinical outcome were not associated with the presence of the PVL genes in MRSA [6]. In two multinational clinical trials studying the safety and efficacy of telavancin for the treatment of HAP caused by MRSA, no significant association between the presences of the PVL genes and the clinical outcome of the disease was observed [7]. Both of these studies included patients from multiple centers with a diverse ethnic background.

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