Panton-Valentine leukocidin expressing Staphylococcus aureus pneumonia managed with extracorporeal membrane oxygenation: experience and outcome.
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.
Noah
Moronke A
MA
Heart Link ECMO Unit, Glenfield General Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK. moronke.noah@uhl-tr.nhs.uk
Dawrant
Michael
M
Faulkner
Gail M
GM
Hill
Anne-Marie
AM
Harvey
Chris
C
Hussain
Abid
A
Jenkins
David R
DR
Nichani
Sanjiv
S
Peek
Giles J
GJ
Sosnowski
Andrew W
AW
Firmin
Richard K
RK
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
D001427:Bacterial Toxins; D005098:Exotoxins; D007956:Leukocidins; C078284:Panton-Valentine leukocidin