Severe Community-Onset Pneumonia in Healthy Adults Caused by Methicillin-Resistant Staphylococcus aureus Carrying the Panton-Valentine Leukocidin Genes

Francis, J. Sullivan; Doherty, Meg; Lopatin, Uri; Johnston, Cecilia P.; Sinha, Gautam; Ross, Tracy; Cai, Mian; Hansel, Nadia N.; Perl, Trish M.; Ticehurst, John R.; Carroll, Karen C.; Thomas, David L.; Nuermberger, Eric L.; Bartlett, John G.

doi:10.1086/427148

Cited by 657 publications

(514 citation statements)

References 32 publications

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“…Type I ACME has been postulated to contribute to growth and survival of USA300 within the host, and promote colonization of the human skin [26]. ACME is integrated downstream of type IV SCCmec (Figure 2), utilizing the same cassette chromosome recombinases A and B (ccrAB) contained with SCCmec for mobilization and transfer [15][16][17][18][19][20][21][22][23][24]34]. Type I ACME is a distinctive genetic feature of the USA300 pandemic clone [26,34,35], although ACME-like elements have been detected in sporadic MRSA [32][33][34].…”

Section: Unique Genomic Contentsmentioning

confidence: 99%

“…Pneumonia is a rare disease caused by CA-MRSA [17,24]. Using purified toxin or a laboratory strain of S. aureus that overproduced PVL via a multicopy plasmid, PVL was shown to impact mouse survival in a model of pneumonia using BALB/c mice [47].…”

Section: Pvl In Experimental Pneumonia: An Exception?mentioning

confidence: 99%

“…Not seen before the year 2000, USA300 is now pandemic in communities across 38 U.S. states, Canada, and 9 European countries [11]. The pandemic clone USA300 has been implicated in unusually severe human diseases, including endocarditis, pneumonia, sepsis, and necrotizing fasciitis [16,17,29]. Remarkably, the introduction of USA300 into a new geographic area has often been associated with the displacement of locally endemic CA-MRSA strains belonging to ST1, ST30, ST59 and ST80 clonal lineages [22,23,32,33].…”

Section: Community-associated Clones Of Mrsamentioning

confidence: 99%

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The role of virulence determinants in community-associated MRSA pathogenesis

Diep

Otto

2008

Trends in Microbiology

287

279

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The recent emergence of community-associated methicillin resistant Staphylococcus aureus (CA-MRSA) marked a quantum step change in the biology and epidemiology of a major human pathogen. Various virulence determinants unique to CA-MRSA have been recently uncovered, shedding light on how these strains spread easily and sustainably among humans and frequently cause severe disease. The role of the Panton Valentine leukocidin (PVL) in CA-MRSA pathogenesis is a matter of much debate. While epidemiological data have suggested a role of PVL in the CA-MRSA disease process, recent data from relevant animal models suggest that PVL does not impact virulence of prevalent CA-MRSA strains. Identifying specialized pathogenic traits of CA-MRSA remains a challenge that will yield new diagnostic tools and therapeutic targets for drug and vaccine development.

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Section: Unique Genomic Contentsmentioning

confidence: 99%

Section: Pvl In Experimental Pneumonia: An Exception?mentioning

confidence: 99%

Section: Community-associated Clones Of Mrsamentioning

confidence: 99%

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The role of virulence determinants in community-associated MRSA pathogenesis

Diep

Otto

2008

Trends in Microbiology

287

279

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“…This also extends the finding of previous case studies reporting that MRSA CAP with PVL toxin is associated with worse outcomes. [24][25][26][27][28][29][30] Moreover, we clearly document that PVL-positive strains are emerging as a cause of pulmonary infection in broader clinical scenarios. As such, physicians must remain vigilant for this toxin-producing strain.…”

Section: Discussionmentioning

confidence: 88%

“…23 Recent studies of acute pneumonia with animal models and in humans have suggested that the PVL toxin-alone or in combination with other virulence factors-is associated with the development of necrotizing pneumonia. [24][25][26][27][28][29][30] In our study, 23 patients with MRSA CAP had strains that contained PVL toxin, and these patients had longer stays in hospital and higher total hospital charges than those with MRSA CAP not containing the PVL toxin. This is an important finding, as length of stay is an important proxy for morbidity and case severity.…”

Section: Discussionmentioning

confidence: 93%

Clinical and economic outcomes in patients with community‐acquired Staphylococcus aureus pneumonia

Taneja

Haque

Oster

et al. 2010

Journal of Hospital Medicine

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BACKGROUND:While the clinical and economic consequences of S. aureus pneumonia in healthcare settings have been well documented, much less is known about community‐acquired S. aureus pneumonia (CAP).METHODS:We retrospectively identified all patients admitted to a large US urban teaching hospital between January 2005 and May 2008 with pneumonia and positive blood or respiratory cultures for S. aureus within 48 hours of admission. Patients with suspected healthcare‐associated pneumonia (HCAP) were excluded from the study sample, using established criteria (eg, recent hospitalization, admission from nursing home, hemodialysis). Patients were designated as having methicillin‐resistant (MRSA) or methicillin‐susceptible (MSSA) CAP based on initial S. aureus isolates. Initial therapy was designated “appropriate” vs. “inappropriate” based on expected susceptibility of the organism to the regimen received.RESULTS:We identified a total of 128 CAP patients with S. aureus isolates; mean (standard deviation [SD]) age was 60 (17) years. A total of 55 patients (43%) had initial cultures positive for MRSA. Patients with MRSA CAP were more likely to receive inappropriate initial therapy (24 [44%] vs. 13 [18%] for MSSA; P = 0.002). Approximately 25% of all patients underwent surgery for pneumonia, 69% received mechanical ventilation, 79% were admitted to intensive care unit (ICU), and 24% died in hospital. Mean (SD) length of stay was 17.0 (15.7) days, and total hospital charges averaged $127,922 ($154,605) per patient; there were no significant differences between patients with MRSA vs. MSSA CAP.CONCLUSION:Outcomes are poor, hospital stays are long, and costs of care are high in patients with S. aureus CAP, and do not differ between those with MRSA vs. MSSA. Journal of Hospital Medicine 2010. © 2010 Society of Hospital Medicine.

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