The role of the Panton-Valentine leucocidin toxin in staphylococcal disease: a systematic review and meta-analysis.
The role of the Panton-Valentine leucocidin toxin in staphylococcal disease: a systematic review and meta-analysis.
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DOI：
10.1016/s1473-3099(12)70238-4
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发表时间：
2013-01
影响因子：
56.3
通讯作者：
Hayward, Andrew C.
中科院分区：
文献类型：
--
作者：
Shallcross, Laura J.;Fragaszy, Ellen;Johnson, Anne M.;Hayward, Andrew C.
世界范围内出现了与Panton-Valentine杀白细胞素（PVL）毒素相关的侵袭性社区发病葡萄球菌病。PVL是致病性还是流行病学标志物尚不清楚。我们研究PVL在疾病、定植和临床结果中的作用。我们在Medline和Embase中检索了2011年10月1日之前发表的关于PVL基因在金黄色葡萄球菌肺炎、菌血症、肌肉骨骼感染、皮肤和软组织感染或定植中的患病率的原始研究。我们计算了比值比（OR），以比较PVL阳性定植和每种感染的患者相对于PVL阳性皮肤和软组织感染的比值。我们进行了荟萃分析，根据异质性检验的结果，采用固定效应或随机效应模型估计PVL阳性菌株感染或定植的几率。在我们的检索策略识别的509篇文章中，来自31个国家的76项研究符合我们的纳入标准。PVL菌株与皮肤和软组织感染密切相关，但在肺炎（OR 0·37，95% CI 0·22 - 0·63）、肌肉骨骼感染（0·44，0·19 - 0·99）、菌血症（0·10，0·06 - 0·18）和定植菌株（0·07，0·01 - 0·31）中相对罕见。与PVL阴性感染相比，PVL阳性皮肤和软组织感染更有可能通过手术治疗，并且PVL阳性肌肉骨骼疾病的儿童可能会增加发病率。对于其他形式的疾病，我们没有发现PVL影响结局的证据。PVL基因始终与皮肤和软组织感染相关，在侵袭性疾病中相对罕见。这一发现挑战了PVL主要导致预后不良的侵袭性疾病的观点。需要进行以人群为基础的研究，以确定PVL在轻度、中度和重度疾病中的作用，并为控制策略提供信息。没有。
Invasive community-onset staphylococcal disease has emerged worldwide associated with Panton-Valentine leucocidin (PVL) toxin. Whether PVL is pathogenic or an epidemiological marker is unclear. We investigate the role of PVL in disease, colonisation, and clinical outcome. We searched Medline and Embase for original research reporting the prevalence of PVL genes among Staphylococcus aureus pneumonia, bacteraemia, musculoskeletal infection, skin and soft-tissue infection, or colonisation published before Oct 1, 2011. We calculated odds ratios (ORs) to compare patients with PVL-positive colonisation and each infection relative to the odds of PVL-positive skin and soft-tissue infection. We did meta-analyses to estimate odds of infection or colonisation with a PVL-positive strain with fixed-effects or random-effects models, depending on the results of tests for heterogeneity. Of 509 articles identified by our search strategy, 76 studies from 31 countries met our inclusion criteria. PVL strains are strongly associated with skin and soft-tissue infections, but are comparatively rare in pneumonia (OR 0·37, 95% CI 0·22–0·63), musculoskeletal infections (0·44, 0·19–0·99), bacteraemias (0·10, 0·06–0·18), and colonising strains (0·07, 0·01–0·31). PVL-positive skin and soft-tissue infections are more likely to be treated surgically than are PVL-negative infections, and children with PVL-positive musculoskeletal disease might have increased morbidity. For other forms of disease we identified no evidence that PVL affects outcome. PVL genes are consistently associated with skin and soft-tissue infections and are comparatively rare in invasive disease. This finding challenges the view that PVL mainly causes invasive disease with poor prognosis. Population-based studies are needed to define the role of PVL in mild, moderate, and severe disease and to inform control strategies. None.