Pragmatic management of Panton–Valentine leukocidin-associated staphylococcal diseases

Abstract

Panton-Valentine leukocidin (PVL)-producing Staphylococcus aureus is associatedwith a broad spectrum of diseases, ranging from common uncomplicated soft tissue infections to severe diseases such as complicated soft tissue infections, extensive bone and joint infections, and necrotizing pneumonia. Specialised management of infection based on the presence of PVL may not be required for mild infections, whereas it could be lifesaving in other settings. Moreover, most severe PVL diseases are recently identified entities and a 'gold standard' treatment from comparatives studies of different therapeutic options is lacking. Thus, recommendations are based on expert opinions, which are elaborated based on theory, in vitro data and analogies with other toxin-mediated diseases. In this review, we consider the potential need for specialised PVL-based management and, if required, which tools should be used to achieve optimal management.

Atypical Pneumonia Linked to Community-Acquired <b><i>Staphylococcus aureus</i></b> Cross-Transmission in the Nursery

“…PVL has necrotic and proinflammatory properties, and treatments must be effective on both the bacterium and its toxins. Antibiotics such as clindamycin and rifampin have an antitoxin activity [7]. Clindamycin is of limited use in neonates, as the intravenous formulation may contain alcohol.…”

“…Clindamycin is of limited use in neonates, as the intravenous formulation may contain alcohol. When PVL is associated with MRSA, bactericidal antibiotics such as vancomycin or linezolid are also required [7]. The strains involved in this report all belonged to the European CA-MRSA clone, a minor clone described in invasive CA-MRSA infections in France [8], which is endemic in Algeria where the index mother lived [9].…”

Staphylococcus aureus Infections: Epidemiology, Pathophysiology, Clinical Manifestations, and Management

“…There are no such data available for S. aureus necrotizing fasciitis, and IDSA guidelines do not specifically recommend the addition of clindamycin in this setting (370). Nonetheless, other groups recommend adding clindamycin for its antitoxin effect (380). The successful use of linezolid to switch off toxin production in a surgical wound with S. aureus-associated toxic shock syndrome (TSS) has also been reported (381).…”

Treatment of severe MRSA infections: current practice and further development

“…Nonspecific passive immunotherapy has been reported to be useful in the control of the effect of S. aureus exotoxin such as Panton-Valentine leukocidin which may be responsible for very severe forms of infections. Experts currently recommend the combination of high dose nonspecific human immunoglobulins with an antibiotic able to downregulate its production such as clindamycin, rifampin, or linezolid [16]. Biotechnologies resulted in the production of highly specific human monoclonal antibodies.…”