Paediatric and adult patients from New Caledonia Island admitted to the ICU for community-acquired Panton-Valentine leucocidin-producing Staphylococcus aureus infections

Abstract

Severe infections involving Panton-Valentine leukocidin-producing Staphylococcus aureus (PVL + Sa) are increasing. This monocentre, retrospective descriptive cohort assessed clinical characteristics and outcome of paediatric and adult patients admitted for community-acquired PVL + Sa infections to the unique intensive care unit (ICU) on New Caledonia Island. Overall, 72 patients (including 23 children) admitted for acute respiratory failure (42%), sepsis/septic shock (21%), and/or postoperative care (32%) were analysed. Most patients had pulmonary (64%), skin/soft tissue (SSTI) (54%) and/or osteoarticular (38%) infections. Multifocal infections (≥ 2 sites) and bacteraemia were reported in 65% and 76% of the patients, respectively. Methicillin-resistant S. aureus isolates were reported in 61% of adult cases versus 30% in children (p < 0.05). Mechanical ventilation, vasoactive support and source control were administered in 53%, 43% and 58% of the patients, respectively. All paediatric patients received adequate empirical antibiotic therapy versus 30/49 adults (p < 0.001). Adequate documented therapy was obtained ≤ 72 h in 70/72 (97%) patients. Death was only reported in adults (n = 10 (14%)), mainly during pulmonary infection (22%), SSTIs (21%) and bacteraemia (24%)). In summary, in ICU patients from New Caledonia Island the clinical presentation of severe community-acquired PVL + Sa infections seems different from Western European observations with high rates of multifocal infections and methicillin-resistant strains.

Acute Prosthetic Joint Infections with Poor Outcome Caused by Staphylococcus Aureus Strains Producing the Panton–Valentine Leukocidin

“…PVL production, on the other hand, has not been associated with an risk invasive infection or bacteremia during PJI, in contrast to other reports in the literature [36,38].…”

Identifying patients with difficult-to-treat acute bacterial skin infections

“…is mainly reported in patients who previously had wounds exposed to seawater or brackish water in warm coastal regions (American and Asian countries), especially in cases of flooding or storm surges [3,32]. Staphylococcus aureus infections also have the risk of inducing severe necrotizing infections in the case of Panton-Valentine leucocidin (PVL)-producing strains [3,4 ▪ ,31,35 ▪ ]. A retrospective cohort reported multifocal infections involving PVL-producing strains in both adult and paediatric cases with severe ABSIs [35 ▪ ].…”

“…Staphylococcus aureus infections also have the risk of inducing severe necrotizing infections in the case of Panton-Valentine leucocidin (PVL)-producing strains [3,4 ▪ ,31,35 ▪ ]. A retrospective cohort reported multifocal infections involving PVL-producing strains in both adult and paediatric cases with severe ABSIs [35 ▪ ].…”

“…Multidrug-resistant Staphylococcus aureus is by-far the most common microorganism in purulent and nonpurulent ABSIs, including diabetic foot infection, severe cellulitis and NSTIs [1,40,41 ▪ ] (Table 2). MRSA isolates are reported in community-acquired infections in up to 34% of cases [39] and are frequently PVL-positive [35 ▪ ,36]. In healthcare-associated ABSIs, such as surgical wound infections, chronic wounds and diabetic foot infections, MRSA is the predominant multidrug-resistant organism [3,4 ▪ ,31,35 ▪ ,41 ▪ ].…”

“…MRSA isolates are reported in community-acquired infections in up to 34% of cases [39] and are frequently PVL-positive [35 ▪ ,36]. In healthcare-associated ABSIs, such as surgical wound infections, chronic wounds and diabetic foot infections, MRSA is the predominant multidrug-resistant organism [3,4 ▪ ,31,35 ▪ ,41 ▪ ]. Vancomycin-resistant enterococci are multidrug-resistant aerobic Gram-positive cocci in ABSIs that are frequently reported in diabetic foot infections [42 ▪ ].…”