[Osteoarticular infections with staphylococcus aureus secreting Panton-Valentine leucocidin].
Panton-Valentine Leucocidin (PVL) is associated in the USA with community-acquired meticillin resistant strains of Staphylococcus aureus (CA-MRSA). Bone and joint infection due to such strains appears to be more severe, necessiting longer antibiotic course and various surgical procedure. Our study of 14 PVL positive bone and joint infection, performed in France where PVL is rarely (2/14) associated with meticillin resistance, demonstrates that severity is linked with PVL secretion more than with resistance. Considering PVL associated bone and joint infections as a toxin-mediated disease, prompt diagnosis is needed in order to start specific therapeutic procedures. PVL mediated infection could be evoked in front of severe acute osteomyelitis or arthritis, with radiological abnormalities present in the first days of evolution and with pejorative evolution despite antibiotic treatment. Evolution toward multifocal osteomyelitis and/or multiple abscesses seems to be a major characteristic of such infection. Therapeutic approach should use an association of parenteral antibiotics with at least one molecule active against protein synthesis like Clindamycin, associated with betalactams or Vancomycin in area of high incidence of CA-MRSA. Surgical procedure should be considered whenever focal abscesses of bones or adjacent tissue is detected and should be repeated in most cases.
Gillet
Y
Y
Service d'urgences et réanimation pédiatrique, Hôpital Edouard-Herriot, Lyon, France. yves.gillet@chu-lyon.fr
Dohin
B
B
Dumitrescu
O
O
Lina
G
G
Vandenesch
F
F
Etienne
J
J
Floret
D
D
D000038:Abscess / Q000188:drug therapy* / Q000382:microbiology / Q000601:surgery; D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001427:Bacterial Toxins; D001847:Bone Diseases / Q000188:drug therapy* / Q000382:microbiology / Q000601:surgery; D002648:Child; D002981:Clindamycin / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000188:drug therapy*; D005098:Exotoxins; D005602:France; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007956:Leukocidins; D016106:Methicillin Resistance; D010019:Osteomyelitis / Q000188:drug therapy* / Q000382:microbiology; D011500:Protein Synthesis Inhibitors / Q000627:therapeutic use; D013203:Staphylococcal Infections / Q000188:drug therapy*; D013211:Staphylococcus aureus / Q000187:drug effects* / Q000472:pathogenicity; D014481:United States; D014640:Vancomycin / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D001427:Bacterial Toxins; D005098:Exotoxins; D016756:Immunoglobulins, Intravenous; D007956:Leukocidins; C078284:Panton-Valentine leukocidin; D011500:Protein Synthesis Inhibitors; D002981:Clindamycin; D014640:Vancomycin