Frequency of Panton-Valentine Leukocidin-Producing Methicillin-Sensitive Staphylococcus Strains in Patients with Complicated Skin and Soft Tissue Infection in Bronx, New York

Abstract

lukF-PV was present in 36% of skin and soft tissue infection (SSTI)-derived methicillin-susceptible Staphylococcus aureus (MSSA) strains and comprised six distinct clones, which contained fewer enterotoxin genes than strains without lukF-PV. Clinical presentations and outcomes of lukF-PV ؉ methicillin-resistant S. aureus (MRSA) and MSSA SSTIs were comparable. In multivariable analysis, the presence of lukF-PV remained a significant predictor for incision and drainage among MSSA strains.In the United States, Panton-Valentine leukocidin (PVL), a pore-forming cytotoxin, is investigated mostly in the emerging community-acquired methicillin-resistant Staphylococcus aureus (MRSA) clone USA300 (10). PVL contribution to virulence is disputed, as summarized by Schlievert (6). PVL is also produced by strains other than USA300, and levels vary considerably among individual strains (2, 8). Some methicillinsusceptible S. aureus (MSSA) strains produce large amounts of PVL, which has been associated with more-severe skin lesions in a murine model (8). In this study, we compared the prevalences of PVL in MSSA and MRSA strains from patients with skin and soft tissue infections (SSTIs) and compared the clinical presentations. S. aureus isolates from wound (n ϭ 108) and blood (n ϭ 99) were collected by the microbiology laboratory of Montefiore Medical Center as described previously (9). Detection of enterotoxin genes (staphylococcal enterotoxin A [SEA], SEB, SEC, and toxic shock syndrome toxin [TSST] genes), multilocus sequence typing (MLST), and spa typing were done in the context of a previously published study (9). For this study, detection of PVL in MSSA isolates was performed by real-time PCR targeting the lukF-PV gene (7). Also, a retrospective chart review was performed on all 104 patients from whom wound isolates had been collected and 11 patients from whom PVL-producing S. aureus strains were cultured from blood. Information on demographic characteristics, clinical presentation, antibiotic therapy, complications, and outcomes was obtained. Fever was defined as greater than 38.0°C and leukocytosis as Ն12.0 K/l. Health care-associated (HA) risk factors included end-stage renal disease (ESRD) on dialysis, hospitalization 6 months prior to admission, history of S. aureus infection, and nursing home residence. The Wilcoxon rank-sum test was used to compare continuous variables, and the 2 or Fisher exact test was used to compare proportions. To assess the outcome variable of incision and drainage, selected predictor variables whose P values were less than 0.20 in univariate analysis were introduced into a multivariate logistic regression model for further analysis.Chart review determined that 101 wound isolates were derived from patients with SSTIs (46 on extremities, 55 from other body parts). Clinical data from 4 patients were not retrievable, and 3 wound isolates were excluded as they were grown from infected bone biopsy specimens and an infected vascular graft. MSSA and MRSA strains were isolated in 57% and 43% of SSTI case...

Epidemiological investigation of community-acquired Staphylococcus aureus infection

“…The virulence-related genes encoding PVL, TSST-1, SEC, SEH, and ET were amplified using PCR based on methods provided in the literature (Chen et al, 2009;Kaltsas et al, 2011;Khokhlova et al, 2012;Zhao et al, 2012). The target genes were 433 bp for PVL, 350 bp for TSST-1, 257 bp for SEC, 375 bp for SEH, and 119 bp for ET.…”

“…Therefore, investigating the molecular structure and genetic makeup of CA-MSSA is of great significance for understanding CA-MRSA formation. In addition, virulence factors play an important role in CA-SA infections (Kaltsas et al, 2011;Khokhlova et al, 2012), such as Panton-Valentine leukocytic toxin (PVL), toxic shock syndrome toxin-1 (TSST-1), staphylococcal enterotoxin C (SEC), staphylococcal enterotoxin H (SEH), staphylococcal exfoliative toxins (ET), and so on.…”

Identification of virulence genes carried by bacteriophages obtained from clinically isolated methicillin-resistant Staphylococcus aureus

“…In addition to that, more CA-MRSA genotypes contain the lukSF-PV gene compared to the HA-MRSA [26]. It was also shown that lukF-Pv carrying phages contain fewer enterotoxin genes than strains without lukF-PV [25,26]. In this study, none of the 43 phages contain the lukF-PV gen.…”

“…The presence of lukF-Pv shows diversity depending on different factors. For example, a higher proportion of S. aureus strains (both MSSA and MRSA strains) that were derived from skin and soft tissue infection contain the lukF-PV gene compared to the S. aureus strains isolated from blood [25]. In addition to that, more CA-MRSA genotypes contain the lukSF-PV gene compared to the HA-MRSA [26].…”

Efficacy of the essential oil of Origanum glandulosum Desf against skin infections With PVL-producing Staphylococcus aureus strains in mice

“…Skin and soft tissue infections (SSTI) are among the human diseases that have shown an alarming increase in the prevalence in recent years (Kaltsas et al, 2011). These infections are due to a variety of species of microorganisms among which Staphylococcus aureus is classified primarily (May et al, 2009).…”