title: Epidemiological, clinical, outcome and antibiotic susceptibility differences between PVL positive and PVL negative Staphylococcus aureus infections in Western Australia: a case control study.
abstract: BACKGROUND
  Panton Valentine Leukocidin (PVL) has been associated with invasive Staphylococcus aureus soft tissue and pneumonic infections.
  
  
  METHODS
  From September 2007 to January 2009 at Royal Perth Hospital we tested for the PVL gene in S. aureus isolates from an invasive site, a suspected PVL-related soft tissue infection and all MRSA isolates. We could access medical records for 141 PVL positive (PVL + ve) infections and compared these to a control group comprised of 148 PVL negative (PVL-ve) infections.
  
  
  RESULTS
  In the PVL + ve group 62 isolates were MRSA (48 were ST93-MRSA-IV) and 79 isolates were methicillin-sensitive S. aureus, and in the PVL-ve group 56 were MRSA (50 were WA-MRSA strains) and 92 were methicillin-sensitive S. aureus. We found the presence of PVL to be significantly associated with younger age, aboriginality, intravenous drug use, community acquisition, shorter length of hospital stay and lower mortality at 1 year. Overall PVL + ve infections more often required surgical intervention (73.0% versus 44.6%, p < 0.001) and were less often polymicrobial (8.5% versus 41.2%, p < 0.001). PVL + ve isolates were more often susceptible to clindamycin (87.9% versus 73.0%, p = 0.002).
  
  
  CONCLUSIONS
  This study demonstrates that PVL + ve infections are associated with a distinct clinical picture, predominantly pyogenic skin and soft tissue infections often requiring surgery, disproportionately affecting patients who are younger, indigenous or with fewer health-care risk factors.
authors.affiliation: Department of Microbiology and Infectious Diseases and PathWest Laboratory Medicine WA, Royal Perth Hospital, Wellington St, Perth, WA, 6000, Australia. Peter.Boan@health.wa.gov.au.
authors.forename: Peter
authors.initials: P
authors.lastname: Boan
authors.affiliation: Department of Microbiology and Infectious Diseases and PathWest Laboratory Medicine WA, Royal Perth Hospital, Wellington St, Perth, WA, 6000, Australia. HuiLeen.Tan@health.wa.gov.au.|Australian Collaborating Centre for Enterococcus and Staphylococcus Species (ACCESS) Typing and Research, PathWest Laboratory Medicine WA and Curtin University of Technology, GPO Box X2213, Perth, WA, 6847, Australia. HuiLeen.Tan@health.wa.gov.au.
authors.forename: Hui-Leen
authors.initials: HL
authors.lastname: Tan
authors.affiliation: Department of Microbiology and Infectious Diseases and PathWest Laboratory Medicine WA, Royal Perth Hospital, Wellington St, Perth, WA, 6000, Australia. Julie.Pearson@health.wa.gov.au.|Australian Collaborating Centre for Enterococcus and Staphylococcus Species (ACCESS) Typing and Research, PathWest Laboratory Medicine WA and Curtin University of Technology, GPO Box X2213, Perth, WA, 6847, Australia. Julie.Pearson@health.wa.gov.au.
authors.forename: Julie
authors.initials: J
authors.lastname: Pearson
authors.affiliation: Department of Microbiology and Infectious Diseases and PathWest Laboratory Medicine WA, Royal Perth Hospital, Wellington St, Perth, WA, 6000, Australia. Geoffrey.Coombs@health.wa.gov.au.|Australian Collaborating Centre for Enterococcus and Staphylococcus Species (ACCESS) Typing and Research, PathWest Laboratory Medicine WA and Curtin University of Technology, GPO Box X2213, Perth, WA, 6847, Australia. Geoffrey.Coombs@health.wa.gov.au.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Coombs
authors.affiliation: Department of Microbiology and Infectious Diseases and PathWest Laboratory Medicine WA, Royal Perth Hospital, Wellington St, Perth, WA, 6000, Australia. Chris.Heath@health.wa.gov.au.
authors.forename: Christopher H
authors.initials: CH
authors.lastname: Heath
authors.affiliation: Department of Microbiology and Infectious Diseases and PathWest Laboratory Medicine WA, Royal Perth Hospital, Wellington St, Perth, WA, 6000, Australia. Owen.Robinson@health.wa.gov.au.|Australian Collaborating Centre for Enterococcus and Staphylococcus Species (ACCESS) Typing and Research, PathWest Laboratory Medicine WA and Curtin University of Technology, GPO Box X2213, Perth, WA, 6847, Australia. Owen.Robinson@health.wa.gov.au.
authors.forename: James Owen
authors.initials: JO
authors.lastname: Robinson
mesh_terms: D000328:Adult; D001427:Bacterial Toxins / Q000235:genetics; D016022:Case-Control Studies; D002981:Clindamycin / Q000494:pharmacology / Q000627:therapeutic use*; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D005098:Exotoxins / Q000235:genetics; D005260:Female; D006801:Humans; D007956:Leukocidins / Q000235:genetics; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification*; D008875:Middle Aged; D012141:Respiratory Tract Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D012307:Risk Factors; D018461:Soft Tissue Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D014904:Western Australia / Q000453:epidemiology
chemical_list: D001427:Bacterial Toxins; D005098:Exotoxins; D007956:Leukocidins; C078284:Panton-Valentine leukocidin; D002981:Clindamycin