Panton-Valentine Leukocidin Is Not the Primary Determinant of Outcome for Staphylococcus aureus Skin Infections: Evaluation from the CANVAS Studies

Amy Tong, Steven Tong, Yurong Zhang, Supaporn Lamlertthon, Batu Sharma-Kuinkel, Thomas Rude, Sun Ahn, Felicia Ruffin, Lily Llorens, Ganesh Tamarana, Donald Biek, Ian Critchley, Vance Fowler Jr

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    Abstract

    The impact of Panton-Valentine leukocidin (PVL) on the severity of complicated skin and skin structure infections (cSSSI) caused by Staphylococcus aureus is controversial. We evaluated potential associations between clinical outcome and PVL presence in both methicillin-resistant S. aureus (MRSA) and methicillin-susceptible S. aureus (MSSA) isolates from patients enrolled in two large, multinational phase three clinical trials assessing ceftaroline fosamil for the treatment of cSSSI (the CANVAS 1 and 2 programs). Isolates from all microbiologically evaluable patients with monomicrobial MRSA or MSSA infections (n = 473) were genotyped by PCR for pvl and underwent pulsed-field gel electrophoresis (PFGE). Genes encoding pvl were present in 266/473 (56.2%) isolates. Infections caused by pvl-positive S. aureus were associated with younger patient age, North American acquisition, and presence of major abscesses (P>;0.001 for each). Cure rates of patients infected with pvl-positive and pvl-negative S. aureus were similar overall (93.6% versus 92.8%; P = 0.72), and within MRSA-infected (94.5% vs. 93.1%; P = 0.67) and MSSA-infected patients (92.2% vs. 92.7%; P = 1.00). This finding persisted after adjustment for multiple patient characteristics. Outcomes were also similar when USA300 PVL+ and non-USA300 PVL+ infections were compared. The results of this contemporary, international study suggest that pvl presence was not the primary determinant of outcome in patients with cSSSI due to either MRSA or MSSA. 
    Original languageEnglish
    Article numbere37212
    Pages (from-to)1-7
    Number of pages7
    JournalPLoS One
    Volume7
    Issue number5
    DOIs
    Publication statusPublished - 2012

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    Tong, A., Tong, S., Zhang, Y., Lamlertthon, S., Sharma-Kuinkel, B., Rude, T., Ahn, S., Ruffin, F., Llorens, L., Tamarana, G., Biek, D., Critchley, I., & Fowler Jr, V. (2012). Panton-Valentine Leukocidin Is Not the Primary Determinant of Outcome for Staphylococcus aureus Skin Infections: Evaluation from the CANVAS Studies. PLoS One, 7(5), 1-7. [e37212]. https://doi.org/10.1371/journal.pone.0037212