Severity of Disease and Clinical Outcomes in Patients With Hospital-Acquired Pneumonia Due to Methicillin-Resistant Staphylococcus aureus Strains Not Influenced by the Presence of the Panton-Valentine Leukocidin Gene
Severity of Disease and Clinical Outcomes in Patients With Hospital-Acquired Pneumonia Due to Methicillin-Resistant Staphylococcus aureus Strains Not Influenced by the Presence of the Panton-Valentine Leukocidin Gene
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DOI：
10.1093/cid/cir541
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发表时间：
2011-10-15
影响因子：
11.8
通讯作者：
Ramirez, Julio A.
中科院分区：
文献类型：
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作者：
Peyrani, Paula;Allen, Marty;Ramirez, Julio A.
背景感染携带Panton-Valentine杀白细胞素（PVL）基因的耐甲氧西林金黄色葡萄球菌（MRSA）菌株的社区获得性肺炎（CAP）患者具有严重的临床表现和不良的临床结局。抑制毒素产生的抗生素已被建议用于这些患者的管理。本研究的目的是比较携带PVL基因的MRSA感染的医院获得性肺炎/呼吸机相关性肺炎（HAP/VAP）患者与不携带PVL基因的MRSA感染患者的疾病严重程度和临床结局。这是一项HAP和VAP患者的多中心观察性研究。对MRSA分离株进行遗传分析，以确定PVL基因、USA型和葡萄球菌盒式染色体mec型的存在。采用急性生理学和慢性健康评估II（APACHE II）评分评估疾病的严重程度。主要临床结局是出院时的死亡率。共对109例MRSAHAP/VAP进行了评价。PVL（+）MRSA的发生率为27%。PVL（+）MRSA诊断HAP/VAP时的APACHE II评分为21 +/- 8，PVL（-）MRSA为20 +/- 6（P = .67）。PVL（+）MRSA患者的死亡率为10%（3/29），PVL（-）MRSA患者的死亡率为10%（8/80）（P> 0.99）。在MRSA引起的HAP或VAP患者中，PVL基因的存在不影响疾病的严重程度和临床结局。针对阻断PVL外毒素的治疗策略可能不会影响这些患者的结局。
Background. Patients with community-acquired pneumonia (CAP) infected with methicillin-resistant Staphylococcus aureus (MRSA) strains carrying the Panton-Valentine leukocidin (PVL) gene have severe clinical presentation and poor clinical outcomes. Antibiotics that suppress toxin production have been suggested for the management of these patients. The objective of this study was to compare the severity of disease and clinical outcomes of patients with hospital-acquired pneumonia/ventilator-associated pneumonia (HAP/VAP) infected with MRSA carrying the PVL gene with those patients infected with MRSA strains that do not carry the PVL gene.Methods. This was a multicenter observational study of patients with HAP and VAP. MRSA isolates were subjected to genetic analysis to define the presence of the PVL gene, the USA type and the staphylococcal cassette chromosome mec type. Severity of disease was evaluated with the Acute Physiology and Chronic Health Evaluation II (APACHE II) score. The primary clinical outcome was mortality at hospital discharge.Results. A total of 109 cases of MRSAHAP/VAP were evaluated. The incidence of PVL(+) MRSA was 27%. APACHE II score at diagnosis of HAP/VAP was 21 +/- 8 for PVL(+) MRSA and 20 +/- 6 for PVL(-) MRSA (P = .67). Mortality was 10% (3/29) for patients with PVL(+) MRSA versus 10% (8/80) for patients with PVL(-) MRSA (P>.99).Conclusions. In patients with HAP or VAP due to MRSA, severity of disease and clinical outcomes are not influenced by the presence of the PVL gene. Therapeutic strategies directed to block PVL exotoxin may not impact outcomes in these patients.