Panton-Valentine leukocidin associated staphylococcal disease: a cross-sectional study at a London hospital, England

• Published in: Clinical microbiology and infection Vol. 16; no. 11; pp. 1644 - 1648
• Main Authors: Shallcross, L.J., Williams, K., Hopkins, S., Aldridge, R.W., Johnson, A.M., Hayward, A.C.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Elsevier Ltd 01.11.2010; Blackwell Publishing Ltd; Wiley-Blackwell; Elsevier Limited
• Subjects: Adolescent; Adult; Aged; Aging; Bacterial diseases; Bacterial Toxins - genetics; Bacterial Typing Techniques; Biological and medical sciences; Child; Child, Preschool; Clinical isolates; Community-acquired infection; Community-Acquired Infections - epidemiology; Community-Acquired Infections - microbiology; Cross-Sectional Studies; Drug resistance; England; epidemiology; Exotoxins - genetics; Female; Genes, Bacterial; Hospitals; Human bacterial diseases; Humans; Infection; infection control; Infectious diseases; leukocidin; Leukocidins - genetics; Male; medical records; Medical sciences; Methicillin-Resistant Staphylococcus aureus - genetics; Middle Aged; Polymerase Chain Reaction; Risk Factors; Skin; Soft Tissue Infections - epidemiology; Soft Tissue Infections - microbiology; Soft tissues; Staphylococcal Infections - epidemiology; Staphylococcal Infections - microbiology; Staphylococcal infections, streptococcal infections, pneumococcal infections; Staphylococcal Skin Infections - epidemiology; Staphylococcal Skin Infections - microbiology; Staphylococcus aureus; Staphylococcus aureus - genetics; Staphylococcus aureus - pathogenicity; Statistical Distributions; Toxins; Virulence Factors - genetics; Young Adult; England; United Kingdom; Great Britain; Europe; epidemiology; risk factors; infection control; Staphylococcus aureus; Community-acquired infection; Cytokine; Check; Epidemiology; Infection; Prevention; Panton-Valentine leukocidin; Community acquired infection; Cross sectional study; Risk factor; Bacteriosis; Bacteria; Micrococcales; Micrococcaceae; Hospital; Staphylococcal infection
• ISSN: 1198-743X; 1469-0691
• DOI: 10.1111/j.1469-0691.2010.03153.x

Recently, there has been international concern at the rapid emergence of highly pathogenic strains of Staphylococcus aureus associated with a toxin called Panton–Valentine leukocidin (PVL). In the UK, these strains are considered to be rare and mainly severe. We estimate the proportion of staphylococcal infections that are caused by strains containing the PVL genes, and describe risk factors for these infections. Three hundred and ninety consecutive S. aureus clinical isolates, submitted for routine diagnostic purposes were screened for PVL genes. Risk factors for infection were identified from the patient medical record. 9.7% (95% CI 7.0–13.1%) of clinical isolates and 20.8% of skin and soft tissue specimens contained the genes for PVL. Methicillin-resistant S. aureus with PVL was rare (0.8% of all isolates) but PVL with methicillin-sensitive S. aureus was common (9.0% of all specimens). PVL infection was more frequent in males (OR 3.0, 95% CI 1.3–7.0), and in young adults aged 20–39 years (OR 3.7, 95% CI 1.3–10.4). Over half of PVL positive S. aureus infections originated in patients based in the community. Community-onset PVL-associated disease is common in the UK and mainly causes skin and soft tissue infections that do not require admission to hospital. Consideration should be given to current infection control strategy, which advocates household contact screening and decolonization on the assumption that PVL-associated disease is rare.