Association of PVL with staphylococcal pyogenic skin infections
Abstract number: O341
Kearns A.M., Ganner M., McCormick Smith I., Perry C., Cookson B.D., Ellington M.J.
Objectives: Whilst the role of PVL in staphylococcal disease remains contentious, the association of PVL-positive S. aureus (PVL-SA) with recurrent skin and soft tissue infections is compelling. Following the introduction of initiatives for enhanced ascertainment of PVL-related disease in England, we sought to investigate the clinical and epidemiological features of pyogenic skin infections cause by PVL-positive versus PVL-negative S. aureus.
Methods: Isolates of S. aureus submitted referred to the national Staphylococcus Reference Unit (SRU) recovered from pyogenic skin infections (boils, abscesses, carbuncles etc) from patients throughout England, Wales and Northern Ireland during 2008 were included for study. Isolates were characterised by toxin gene profiling (including PVL), mecA testing and DNA fingerprinting by pulsed-field gel electrophoresis. Patient demographic data and clinical features including the site of the lesion(s) and recurrence of infection were analysed.
Results: During 2008, a total of 1230 isolates of S. aureus from pyogenic skin infections were submitted to the SRU for characterisation. Of these, 835 were MSSA and 395 were MRSA (68 and 32% respectively). Patients were aged 0 to 95y (median 30y); the male:female ratio was 1:1.
A total of 800 (65%) isolates were PVL-positive; the majority of which (523; 65%) were MSSA. Comparison of cases according to PVL status showed PVL-SA were recovered from younger cohorts (median 26y) and were commonly associated with buttock, thigh and/or axilla lesions (50% cases). In contrast, PVL-negative SA were associated with older individuals (median 38y) with lesions from a wide range of body sites, the commonest sites being breast or back (11% each). Recurrent infections were more apparent among the PVL group (30 vs 20% cases). A multiplicity of strains/lineages was identified. Of 10 different clones of PVL-MRSA identified, 3 lineages (USA300, European and South West Pacific clones) predominated.
Conclusion: PVL-SA from pyogenic skin infections predominantly occurred in younger individuals, most commonly affecting the buttocks and/or axillae; a third of infections were recurrent. These data have important implications for recognising, diagnosing and managing such infections in the community.
|Session name:||Abstracts 20th European Congress of Clinical Microbiology and Infectious Diseases|
|Location:||Vienna, Austria, 10 - 13 April 2010|
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