title: Panton-Valentine leukocidin expressing Staphylococcus aureus pneumonia managed with extracorporeal membrane oxygenation: experience and outcome.
abstract: OBJECTIVE
  Panton-Valentine leukocidin expressing Staphylococcus aureus pneumonia, an infection that affects predominantly young people, has a mortality rate of > 70% despite aggressive conventional management. Little information is available on the management of patients with Panton-Valentine leukocidin expressing S. aureus pneumonia with extracorporeal membrane oxygenation support. As a large extracorporeal membrane oxygenation center, we reviewed our experience and outcomes with Panton-Valentine Leukocidin expressing S. aureus pneumonia.
  
  
  METHODS
  Locally held register of all extracorporeal membrane oxygenation patients at Glenfield Hospital.
  
  
  METHODS
  Retrospective study including all patients with sputum-positive Panton-Valentine leukocidin expressing S. aureus pneumonia managed with extracorporeal membrane oxygenation support at a single extracorporeal membrane oxygenation center.
  
  
  RESULTS
  On review of our database held from September 1989 until date, there were four patients with sputum-confirmed Panton-Valentine leukocidin expressing S. aureus pneumonia managed with extracorporeal membrane oxygenation. Refractory hypoxemia and/or uncompensated hypercapnia despite optimal conventional management were the indications for extracorporeal membrane oxygenation. After varying periods on extracorporeal membrane oxygenation with appropriate antibiotic and ancillary care, all four patients were discharged home.
  
  
  CONCLUSIONS
  Panton-Valentine leukocidin expressing S. aureus pneumonia can cause severe, necrotizing pneumonia associated with acute respiratory distress syndrome, which can be particularly challenging to manage. Extracorporeal membrane oxygenation support permits low pressure lung ventilation, avoiding barotrauma to lungs made friable by Panton-Valentine leukocidin expressing S. aureus infection. Although this is a small number of patients, the results are encouraging.
authors: Heart Link ECMO Unit, Glenfield General Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK. moronke.noah@uhl-tr.nhs.uk
authors: Moronke A
authors: MA
authors: Noah
authors: Michael
authors: M
authors: Dawrant
authors: Gail M
authors: GM
authors: Faulkner
authors: Anne-Marie
authors: AM
authors: Hill
authors: Chris
authors: C
authors: Harvey
authors: Abid
authors: A
authors: Hussain
authors: David R
authors: DR
authors: Jenkins
authors: Sanjiv
authors: S
authors: Nichani
authors: Giles J
authors: GJ
authors: Peek
authors: Andrew W
authors: AW
authors: Sosnowski
authors: Richard K
authors: RK
authors: Firmin
mesh_terms: D000293:Adolescent; D000328:Adult; D001427:Bacterial Toxins / Q000096:biosynthesis*; D005098:Exotoxins / Q000096:biosynthesis*; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006801:Humans; D007956:Leukocidins / Q000096:biosynthesis*; D008297:Male; D011023:Pneumonia, Staphylococcal / Q000382:microbiology / Q000628:therapy*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000382:microbiology / Q000628:therapy; D013211:Staphylococcus aureus / Q000378:metabolism*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D001427:Bacterial Toxins; D005098:Exotoxins; D007956:Leukocidins; C078284:Panton-Valentine leukocidin