Presence of Genes Encoding Panton-Valentine Leukocidin Is Not the Primary Determinant of Outcome in Patients with Hospital-Acquired Pneumonia Due to Staphylococcus aureus

Batu Sharma-Kuinkel, Sun Ahn, Thomas Rude, Yurong Zhang, Steven Tong, Felicia Ruffin, Fredric Genter, Kevin Braughton, Frank DeLeo, Steven Barriere, Vance Fowler Jr

Research output: Contribution to journalArticleResearchpeer-review

Abstract

The impact of Panton-Valentine leukocidin (PVL) on the outcome in Staphylococcus aureus pneumonia is controversial. We genotyped S. aureus isolates from patients with hospital-acquired pneumonia (HAP) enrolled in two registrational multinational clinical trials for the genetic elements carrying pvl and 30 other virulence genes. A total of 287 isolates (173 methicillin-resistant S. aureus [MRSA] and 114 methicillin-susceptible S. aureus [MSSA] isolates) from patients from 127 centers in 34 countries for whom clinical outcomes of cure or failure were available underwent genotyping. Of these, pvl was detected by PCR and its product confirmed in 23 isolates (8.0%) (MRSA, 18/173 isolates [10.4%]; MSSA, 5/114 isolates [4.4%]). The presence of pvl was not associated with a higher risk for clinical failure (4/23 [17.4%] versus 48/264 [18.2%]; P = 1.00) or mortality. These findings persisted after adjustment for multiple potential confounding variables. No significant associations between clinical outcome and (i) presence of any of the 30 other virulence genes tested, (ii) presence of specific bacterial clone, (iii) levels of alphahemolysin, or (iv) delta-hemolysin production were identified. This study suggests that neither pvl presence nor in vitro level of alpha-hemolysin production is the primary determinant of outcome among patients with HAP caused by S. aureus.
Original languageEnglish
Pages (from-to)848-856
Number of pages9
JournalJournal of Clinical Microbiology
Volume50
Issue number3
DOIs
Publication statusPublished - Mar 2012

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Staphylococcal Pneumonia
Staphylococcus aureus
Pneumonia
Methicillin
Methicillin-Resistant Staphylococcus aureus
Virulence
Genes
Hemolysin Proteins
Confounding Factors (Epidemiology)
Clone Cells
Clinical Trials
Polymerase Chain Reaction
Mortality
Panton-Valentine leukocidin
Staphylococcus aureus delta hemolysin protein
In Vitro Techniques

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Sharma-Kuinkel, Batu ; Ahn, Sun ; Rude, Thomas ; Zhang, Yurong ; Tong, Steven ; Ruffin, Felicia ; Genter, Fredric ; Braughton, Kevin ; DeLeo, Frank ; Barriere, Steven ; Fowler Jr, Vance. / Presence of Genes Encoding Panton-Valentine Leukocidin Is Not the Primary Determinant of Outcome in Patients with Hospital-Acquired Pneumonia Due to Staphylococcus aureus. In: Journal of Clinical Microbiology. 2012 ; Vol. 50, No. 3. pp. 848-856.
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abstract = "The impact of Panton-Valentine leukocidin (PVL) on the outcome in Staphylococcus aureus pneumonia is controversial. We genotyped S. aureus isolates from patients with hospital-acquired pneumonia (HAP) enrolled in two registrational multinational clinical trials for the genetic elements carrying pvl and 30 other virulence genes. A total of 287 isolates (173 methicillin-resistant S. aureus [MRSA] and 114 methicillin-susceptible S. aureus [MSSA] isolates) from patients from 127 centers in 34 countries for whom clinical outcomes of cure or failure were available underwent genotyping. Of these, pvl was detected by PCR and its product confirmed in 23 isolates (8.0{\%}) (MRSA, 18/173 isolates [10.4{\%}]; MSSA, 5/114 isolates [4.4{\%}]). The presence of pvl was not associated with a higher risk for clinical failure (4/23 [17.4{\%}] versus 48/264 [18.2{\%}]; P = 1.00) or mortality. These findings persisted after adjustment for multiple potential confounding variables. No significant associations between clinical outcome and (i) presence of any of the 30 other virulence genes tested, (ii) presence of specific bacterial clone, (iii) levels of alphahemolysin, or (iv) delta-hemolysin production were identified. This study suggests that neither pvl presence nor in vitro level of alpha-hemolysin production is the primary determinant of outcome among patients with HAP caused by S. aureus.",
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Presence of Genes Encoding Panton-Valentine Leukocidin Is Not the Primary Determinant of Outcome in Patients with Hospital-Acquired Pneumonia Due to Staphylococcus aureus. / Sharma-Kuinkel, Batu; Ahn, Sun; Rude, Thomas; Zhang, Yurong; Tong, Steven; Ruffin, Felicia; Genter, Fredric; Braughton, Kevin; DeLeo, Frank; Barriere, Steven; Fowler Jr, Vance.

In: Journal of Clinical Microbiology, Vol. 50, No. 3, 03.2012, p. 848-856.

Research output: Contribution to journalArticleResearchpeer-review

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AU - Sharma-Kuinkel, Batu

AU - Ahn, Sun

AU - Rude, Thomas

AU - Zhang, Yurong

AU - Tong, Steven

AU - Ruffin, Felicia

AU - Genter, Fredric

AU - Braughton, Kevin

AU - DeLeo, Frank

AU - Barriere, Steven

AU - Fowler Jr, Vance

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N2 - The impact of Panton-Valentine leukocidin (PVL) on the outcome in Staphylococcus aureus pneumonia is controversial. We genotyped S. aureus isolates from patients with hospital-acquired pneumonia (HAP) enrolled in two registrational multinational clinical trials for the genetic elements carrying pvl and 30 other virulence genes. A total of 287 isolates (173 methicillin-resistant S. aureus [MRSA] and 114 methicillin-susceptible S. aureus [MSSA] isolates) from patients from 127 centers in 34 countries for whom clinical outcomes of cure or failure were available underwent genotyping. Of these, pvl was detected by PCR and its product confirmed in 23 isolates (8.0%) (MRSA, 18/173 isolates [10.4%]; MSSA, 5/114 isolates [4.4%]). The presence of pvl was not associated with a higher risk for clinical failure (4/23 [17.4%] versus 48/264 [18.2%]; P = 1.00) or mortality. These findings persisted after adjustment for multiple potential confounding variables. No significant associations between clinical outcome and (i) presence of any of the 30 other virulence genes tested, (ii) presence of specific bacterial clone, (iii) levels of alphahemolysin, or (iv) delta-hemolysin production were identified. This study suggests that neither pvl presence nor in vitro level of alpha-hemolysin production is the primary determinant of outcome among patients with HAP caused by S. aureus.

AB - The impact of Panton-Valentine leukocidin (PVL) on the outcome in Staphylococcus aureus pneumonia is controversial. We genotyped S. aureus isolates from patients with hospital-acquired pneumonia (HAP) enrolled in two registrational multinational clinical trials for the genetic elements carrying pvl and 30 other virulence genes. A total of 287 isolates (173 methicillin-resistant S. aureus [MRSA] and 114 methicillin-susceptible S. aureus [MSSA] isolates) from patients from 127 centers in 34 countries for whom clinical outcomes of cure or failure were available underwent genotyping. Of these, pvl was detected by PCR and its product confirmed in 23 isolates (8.0%) (MRSA, 18/173 isolates [10.4%]; MSSA, 5/114 isolates [4.4%]). The presence of pvl was not associated with a higher risk for clinical failure (4/23 [17.4%] versus 48/264 [18.2%]; P = 1.00) or mortality. These findings persisted after adjustment for multiple potential confounding variables. No significant associations between clinical outcome and (i) presence of any of the 30 other virulence genes tested, (ii) presence of specific bacterial clone, (iii) levels of alphahemolysin, or (iv) delta-hemolysin production were identified. This study suggests that neither pvl presence nor in vitro level of alpha-hemolysin production is the primary determinant of outcome among patients with HAP caused by S. aureus.

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