Epidemiological, clinical, outcome and antibiotic susceptibility differences between PVL positive and PVL negative Staphylococcus aureus infections in Western Australia: a case control study

doi:10.1186/s12879-014-0742-6

. 2015 Jan 9:15:10.

doi: 10.1186/s12879-014-0742-6.

Epidemiological, clinical, outcome and antibiotic susceptibility differences between PVL positive and PVL negative Staphylococcus aureus infections in Western Australia: a case control study

Peter Boan¹, Hui-Leen Tan^{2

3}, Julie Pearson^{4

5}, Geoffrey Coombs^{6

7}, Christopher H Heath⁸, James Owen Robinson^{9

10}

Affiliations

¹ Department of Microbiology and Infectious Diseases and PathWest Laboratory Medicine WA, Royal Perth Hospital, Wellington St, Perth, WA, 6000, Australia. Peter.Boan@health.wa.gov.au.
² Department of Microbiology and Infectious Diseases and PathWest Laboratory Medicine WA, Royal Perth Hospital, Wellington St, Perth, WA, 6000, Australia. HuiLeen.Tan@health.wa.gov.au.
³ Australian Collaborating Centre for Enterococcus and Staphylococcus Species (ACCESS) Typing and Research, PathWest Laboratory Medicine WA and Curtin University of Technology, GPO Box X2213, Perth, WA, 6847, Australia. HuiLeen.Tan@health.wa.gov.au.
⁴ Department of Microbiology and Infectious Diseases and PathWest Laboratory Medicine WA, Royal Perth Hospital, Wellington St, Perth, WA, 6000, Australia. Julie.Pearson@health.wa.gov.au.
⁵ Australian Collaborating Centre for Enterococcus and Staphylococcus Species (ACCESS) Typing and Research, PathWest Laboratory Medicine WA and Curtin University of Technology, GPO Box X2213, Perth, WA, 6847, Australia. Julie.Pearson@health.wa.gov.au.
⁶ Department of Microbiology and Infectious Diseases and PathWest Laboratory Medicine WA, Royal Perth Hospital, Wellington St, Perth, WA, 6000, Australia. Geoffrey.Coombs@health.wa.gov.au.
⁷ Australian Collaborating Centre for Enterococcus and Staphylococcus Species (ACCESS) Typing and Research, PathWest Laboratory Medicine WA and Curtin University of Technology, GPO Box X2213, Perth, WA, 6847, Australia. Geoffrey.Coombs@health.wa.gov.au.
⁸ Department of Microbiology and Infectious Diseases and PathWest Laboratory Medicine WA, Royal Perth Hospital, Wellington St, Perth, WA, 6000, Australia. Chris.Heath@health.wa.gov.au.
⁹ Department of Microbiology and Infectious Diseases and PathWest Laboratory Medicine WA, Royal Perth Hospital, Wellington St, Perth, WA, 6000, Australia. Owen.Robinson@health.wa.gov.au.
¹⁰ Australian Collaborating Centre for Enterococcus and Staphylococcus Species (ACCESS) Typing and Research, PathWest Laboratory Medicine WA and Curtin University of Technology, GPO Box X2213, Perth, WA, 6847, Australia. Owen.Robinson@health.wa.gov.au.

PMID: 25572896
PMCID: PMC4297412
DOI: 10.1186/s12879-014-0742-6

Epidemiological, clinical, outcome and antibiotic susceptibility differences between PVL positive and PVL negative Staphylococcus aureus infections in Western Australia: a case control study

Peter Boan et al. BMC Infect Dis. 2015.

. 2015 Jan 9:15:10.

doi: 10.1186/s12879-014-0742-6.

Authors

Peter Boan¹, Hui-Leen Tan^{2

3}, Julie Pearson^{4

5}, Geoffrey Coombs^{6

7}, Christopher H Heath⁸, James Owen Robinson^{9

10}

Affiliations

¹ Department of Microbiology and Infectious Diseases and PathWest Laboratory Medicine WA, Royal Perth Hospital, Wellington St, Perth, WA, 6000, Australia. Peter.Boan@health.wa.gov.au.
² Department of Microbiology and Infectious Diseases and PathWest Laboratory Medicine WA, Royal Perth Hospital, Wellington St, Perth, WA, 6000, Australia. HuiLeen.Tan@health.wa.gov.au.
³ Australian Collaborating Centre for Enterococcus and Staphylococcus Species (ACCESS) Typing and Research, PathWest Laboratory Medicine WA and Curtin University of Technology, GPO Box X2213, Perth, WA, 6847, Australia. HuiLeen.Tan@health.wa.gov.au.
⁴ Department of Microbiology and Infectious Diseases and PathWest Laboratory Medicine WA, Royal Perth Hospital, Wellington St, Perth, WA, 6000, Australia. Julie.Pearson@health.wa.gov.au.
⁵ Australian Collaborating Centre for Enterococcus and Staphylococcus Species (ACCESS) Typing and Research, PathWest Laboratory Medicine WA and Curtin University of Technology, GPO Box X2213, Perth, WA, 6847, Australia. Julie.Pearson@health.wa.gov.au.
⁶ Department of Microbiology and Infectious Diseases and PathWest Laboratory Medicine WA, Royal Perth Hospital, Wellington St, Perth, WA, 6000, Australia. Geoffrey.Coombs@health.wa.gov.au.
⁷ Australian Collaborating Centre for Enterococcus and Staphylococcus Species (ACCESS) Typing and Research, PathWest Laboratory Medicine WA and Curtin University of Technology, GPO Box X2213, Perth, WA, 6847, Australia. Geoffrey.Coombs@health.wa.gov.au.
⁸ Department of Microbiology and Infectious Diseases and PathWest Laboratory Medicine WA, Royal Perth Hospital, Wellington St, Perth, WA, 6000, Australia. Chris.Heath@health.wa.gov.au.
⁹ Department of Microbiology and Infectious Diseases and PathWest Laboratory Medicine WA, Royal Perth Hospital, Wellington St, Perth, WA, 6000, Australia. Owen.Robinson@health.wa.gov.au.
¹⁰ Australian Collaborating Centre for Enterococcus and Staphylococcus Species (ACCESS) Typing and Research, PathWest Laboratory Medicine WA and Curtin University of Technology, GPO Box X2213, Perth, WA, 6847, Australia. Owen.Robinson@health.wa.gov.au.

PMID: 25572896
PMCID: PMC4297412
DOI: 10.1186/s12879-014-0742-6

Abstract

Background: Panton Valentine Leukocidin (PVL) has been associated with invasive Staphylococcus aureus soft tissue and pneumonic infections.

Methods: From September 2007 to January 2009 at Royal Perth Hospital we tested for the PVL gene in S. aureus isolates from an invasive site, a suspected PVL-related soft tissue infection and all MRSA isolates. We could access medical records for 141 PVL positive (PVL + ve) infections and compared these to a control group comprised of 148 PVL negative (PVL-ve) infections.

Results: In the PVL + ve group 62 isolates were MRSA (48 were ST93-MRSA-IV) and 79 isolates were methicillin-sensitive S. aureus, and in the PVL-ve group 56 were MRSA (50 were WA-MRSA strains) and 92 were methicillin-sensitive S. aureus. We found the presence of PVL to be significantly associated with younger age, aboriginality, intravenous drug use, community acquisition, shorter length of hospital stay and lower mortality at 1 year. Overall PVL + ve infections more often required surgical intervention (73.0% versus 44.6%, p < 0.001) and were less often polymicrobial (8.5% versus 41.2%, p < 0.001). PVL + ve isolates were more often susceptible to clindamycin (87.9% versus 73.0%, p = 0.002).

Conclusions: This study demonstrates that PVL + ve infections are associated with a distinct clinical picture, predominantly pyogenic skin and soft tissue infections often requiring surgery, disproportionately affecting patients who are younger, indigenous or with fewer health-care risk factors.

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References

1. Udo EE, Pearman JW, Grubb WB. Genetic analysis of community isolates of methicillin-resistant Staphylococcus aureus in Western Australia. J Hosp Infect. 1993;25:97–108. doi: 10.1016/0195-6701(93)90100-E. - DOI - PubMed
1. Moran GJ, Krishnadasan A, Gorwitz RJ, Fosheim GE, McDougal LK, Carey RB, Talan DA. Methicillin-resistant S. aureus infections among patients in the emergency department. N Engl J Med. 2006;355:666–674. doi: 10.1056/NEJMoa055356. - DOI - PubMed
1. Vandenesch F, Naimi T, Enright MC, Lina G, Nimmo GR, Heffernan H, Liassine N, Bes M, Greenland T, Reverdey ME, Etienne J. Community-acquired methicillin-resistant Staphylococcus aureus carrying Panton-Valentine leukocidin genes: worldwide emergence. Emerg Infect Dis. 2003;9:978–984. doi: 10.3201/eid0908.030089. - DOI - PMC - PubMed
1. Wehrhahn MC, Robinson JO, Pearson JC, O’Brien FG, Tan HL, Coombs GW, Pascoe EM, Lee R, Salvaris P, Salvaris R, New D, Murray RJ. Clinical and laboratory features of invasive community-onset methicillin-resistant Staphylococcus aureus infection: a prospective case–control study. Eur J Clin Microbiol Infect Dis. 2010;29:1025–1033. doi: 10.1007/s10096-010-0973-4. - DOI - PubMed
1. Miller LG, Perdreau-Remington F, Rieg G, Mehdi S, Perlroth J, Bayer AS, Tang AW, Phung TO, Spellberg B. Necrotizing fasciitis caused by community-associated methicillin-resistant Staphylococcus aureus in Los Angeles. N Engl J Med. 2005;352:1445–1453. doi: 10.1056/NEJMoa042683. - DOI - PubMed

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[1] Udo EE, Pearman JW, Grubb WB. Genetic analysis of community isolates of methicillin-resistant Staphylococcus aureus in Western Australia. J Hosp Infect. 1993;25:97–108. doi: 10.1016/0195-6701(93)90100-E. - DOI - PubMed

[2] Udo EE, Pearman JW, Grubb WB. Genetic analysis of community isolates of methicillin-resistant Staphylococcus aureus in Western Australia. J Hosp Infect. 1993;25:97–108. doi: 10.1016/0195-6701(93)90100-E. - DOI - PubMed

[3] Moran GJ, Krishnadasan A, Gorwitz RJ, Fosheim GE, McDougal LK, Carey RB, Talan DA. Methicillin-resistant S. aureus infections among patients in the emergency department. N Engl J Med. 2006;355:666–674. doi: 10.1056/NEJMoa055356. - DOI - PubMed

[4] Moran GJ, Krishnadasan A, Gorwitz RJ, Fosheim GE, McDougal LK, Carey RB, Talan DA. Methicillin-resistant S. aureus infections among patients in the emergency department. N Engl J Med. 2006;355:666–674. doi: 10.1056/NEJMoa055356. - DOI - PubMed

[5] Vandenesch F, Naimi T, Enright MC, Lina G, Nimmo GR, Heffernan H, Liassine N, Bes M, Greenland T, Reverdey ME, Etienne J. Community-acquired methicillin-resistant Staphylococcus aureus carrying Panton-Valentine leukocidin genes: worldwide emergence. Emerg Infect Dis. 2003;9:978–984. doi: 10.3201/eid0908.030089. - DOI - PMC - PubMed

[6] Vandenesch F, Naimi T, Enright MC, Lina G, Nimmo GR, Heffernan H, Liassine N, Bes M, Greenland T, Reverdey ME, Etienne J. Community-acquired methicillin-resistant Staphylococcus aureus carrying Panton-Valentine leukocidin genes: worldwide emergence. Emerg Infect Dis. 2003;9:978–984. doi: 10.3201/eid0908.030089. - DOI - PMC - PubMed

[7] Wehrhahn MC, Robinson JO, Pearson JC, O’Brien FG, Tan HL, Coombs GW, Pascoe EM, Lee R, Salvaris P, Salvaris R, New D, Murray RJ. Clinical and laboratory features of invasive community-onset methicillin-resistant Staphylococcus aureus infection: a prospective case–control study. Eur J Clin Microbiol Infect Dis. 2010;29:1025–1033. doi: 10.1007/s10096-010-0973-4. - DOI - PubMed

[8] Wehrhahn MC, Robinson JO, Pearson JC, O’Brien FG, Tan HL, Coombs GW, Pascoe EM, Lee R, Salvaris P, Salvaris R, New D, Murray RJ. Clinical and laboratory features of invasive community-onset methicillin-resistant Staphylococcus aureus infection: a prospective case–control study. Eur J Clin Microbiol Infect Dis. 2010;29:1025–1033. doi: 10.1007/s10096-010-0973-4. - DOI - PubMed

[9] Miller LG, Perdreau-Remington F, Rieg G, Mehdi S, Perlroth J, Bayer AS, Tang AW, Phung TO, Spellberg B. Necrotizing fasciitis caused by community-associated methicillin-resistant Staphylococcus aureus in Los Angeles. N Engl J Med. 2005;352:1445–1453. doi: 10.1056/NEJMoa042683. - DOI - PubMed

[10] Miller LG, Perdreau-Remington F, Rieg G, Mehdi S, Perlroth J, Bayer AS, Tang AW, Phung TO, Spellberg B. Necrotizing fasciitis caused by community-associated methicillin-resistant Staphylococcus aureus in Los Angeles. N Engl J Med. 2005;352:1445–1453. doi: 10.1056/NEJMoa042683. - DOI - PubMed

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Epidemiological, clinical, outcome and antibiotic susceptibility differences between PVL positive and PVL negative Staphylococcus aureus infections in Western Australia: a case control study

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Epidemiological, clinical, outcome and antibiotic susceptibility differences between PVL positive and PVL negative Staphylococcus aureus infections in Western Australia: a case control study

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