Outpatient decolonization after recurrent skin infection with Panton-Valentine leukocidin (PVL)-producing S. aureus-The importance of treatment repetition.
Abscess
/ therapy
Adolescent
Adult
Aged
Anti-Infective Agents, Local
/ pharmacology
Bacterial Toxins
/ metabolism
Child
Child, Preschool
Cohort Studies
Exotoxins
/ metabolism
Female
Humans
Infant
Infant, Newborn
Leukocidins
/ metabolism
Male
Methicillin-Resistant Staphylococcus aureus
/ drug effects
Middle Aged
Outpatients
Recurrence
Retrospective Studies
Staphylococcal Skin Infections
/ therapy
Young Adult
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2020
2020
Historique:
received:
01
11
2019
accepted:
31
03
2020
entrez:
22
4
2020
pubmed:
22
4
2020
medline:
21
7
2020
Statut:
epublish
Résumé
Recurrent skin abscesses are often associated with Panton-Valentine leukocidin-producing strains of S. aureus (PVL-SA). Decolonization measures are required along with treatment of active infections to prevent re-infection and spreading. Even though most PVL-SA patients are treated as outpatients, there are few studies that assess the effectiveness of outpatient topical decolonization in PVL-SA patients. We assessed the results of topical decolonization of PVL-SA in a retrospective review of patient files and personal interviews. Successful decolonization was defined as the absence of any skin abscesses for at least 6 months after completion of the final decolonization treatment. Clinical and demographic data was assessed. An intention-to-treat protocol was used. Our cohort consisted of 115 symptomatic patients, 66% from PVL-positive MSSA and 19% from PVL-positive MRSA. The remaining 16% consisted of symptomatic patients with close contact to PVL-SA positive index patients but without detection of PVL-SA. The majority of patients were female (66%). The median age was 29.87% of the patients lived in multiple person households. Our results showed a 48% reduction in symptomatic PVL-SA cases after the first decolonization treatment. The results also showed that the decrease continued with each repeated decolonization treatment and reached 89% following the 5th treatment. A built multivariable Cox proportional-hazards model showed that the absence of PVL-SA detection (OR 2.0) and living in single person households (OR 2.4) were associated with an independently increased chance of successful decolonization. In our cohort, topical decolonization was a successful preventive measure for reducing the risk of PVL-SA skin abscesses in the outpatient setting. Special attention should be given to patients living in multiple person households because these settings could confer a risk that decolonization will not be successful.
Sections du résumé
BACKGROUND
Recurrent skin abscesses are often associated with Panton-Valentine leukocidin-producing strains of S. aureus (PVL-SA). Decolonization measures are required along with treatment of active infections to prevent re-infection and spreading. Even though most PVL-SA patients are treated as outpatients, there are few studies that assess the effectiveness of outpatient topical decolonization in PVL-SA patients.
METHODS
We assessed the results of topical decolonization of PVL-SA in a retrospective review of patient files and personal interviews. Successful decolonization was defined as the absence of any skin abscesses for at least 6 months after completion of the final decolonization treatment. Clinical and demographic data was assessed. An intention-to-treat protocol was used.
RESULTS
Our cohort consisted of 115 symptomatic patients, 66% from PVL-positive MSSA and 19% from PVL-positive MRSA. The remaining 16% consisted of symptomatic patients with close contact to PVL-SA positive index patients but without detection of PVL-SA. The majority of patients were female (66%). The median age was 29.87% of the patients lived in multiple person households. Our results showed a 48% reduction in symptomatic PVL-SA cases after the first decolonization treatment. The results also showed that the decrease continued with each repeated decolonization treatment and reached 89% following the 5th treatment. A built multivariable Cox proportional-hazards model showed that the absence of PVL-SA detection (OR 2.0) and living in single person households (OR 2.4) were associated with an independently increased chance of successful decolonization.
CONCLUSION
In our cohort, topical decolonization was a successful preventive measure for reducing the risk of PVL-SA skin abscesses in the outpatient setting. Special attention should be given to patients living in multiple person households because these settings could confer a risk that decolonization will not be successful.
Identifiants
pubmed: 32315364
doi: 10.1371/journal.pone.0231772
pii: PONE-D-19-30440
pmc: PMC7173765
doi:
Substances chimiques
Anti-Infective Agents, Local
0
Bacterial Toxins
0
Exotoxins
0
Leukocidins
0
Panton-Valentine leukocidin
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0231772Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
BMJ. 2011 Sep 09;343:d5343
pubmed: 21908525
Eur J Clin Microbiol Infect Dis. 2019 Apr;38(4):683-688
pubmed: 30684163
J Infect Dis. 2005 Feb 1;191(3):444-52
pubmed: 15633104
Int J Antimicrob Agents. 2018 Jan;51(1):16-25
pubmed: 29174420
J Infect Public Health. 2011 Aug;4(3):145-53
pubmed: 21843861
BMC Infect Dis. 2018 Aug 6;18(1):371
pubmed: 30081842
Clin Infect Dis. 2014 Jul 15;59(2):e10-52
pubmed: 24973422
Int J Antimicrob Agents. 2011 Dec;38(6):457-64
pubmed: 21733661
Proc Natl Acad Sci U S A. 2014 May 6;111(18):6738-43
pubmed: 24753569
Clin Infect Dis. 2012 Feb 15;54(4):483-92
pubmed: 22104084
Clin Infect Dis. 1999 Nov;29(5):1128-32
pubmed: 10524952
J Infect Dis. 2017 Feb 15;215(suppl_1):S71-S77
pubmed: 28375517
Trends Microbiol. 2015 Jul;23(7):437-44
pubmed: 25864883
Eur J Clin Microbiol Infect Dis. 2009 Sep;28(9):1113-21
pubmed: 19484277
J Clin Microbiol. 2004 Dec;42(12):5578-81
pubmed: 15583284
Int J Antimicrob Agents. 2012 Mar;39(3):193-200
pubmed: 22226649
Clin Microbiol Rev. 2016 Apr;29(2):201-22
pubmed: 26817630
J Clin Microbiol. 2010 Jan;48(1):202-7
pubmed: 19923490
N Engl J Med. 2017 Jun 29;376(26):2545-2555
pubmed: 28657870
J Clin Microbiol. 2014 Apr;52(4):1192-200
pubmed: 24501033
Clin Microbiol Infect. 2016 Aug;22(8):739.e5-8
pubmed: 27283147
Lancet Infect Dis. 2012 Sep;12(9):703-16
pubmed: 22917102
Sci Transl Med. 2017 Oct 25;9(413):
pubmed: 29070701
Infect Control Hosp Epidemiol. 2008 Jun;29(6):510-6
pubmed: 18510460
J Hosp Infect. 2018 Nov;100(3):359-360
pubmed: 29577992
Clin Microbiol Infect. 2010 Nov;16(11):1644-8
pubmed: 20969671
Infect Control Hosp Epidemiol. 2003 Jun;24(6):422-6
pubmed: 12828318
Lancet Infect Dis. 2013 Jan;13(1):43-54
pubmed: 23103172
J Infect Dis. 2010 May 15;201(10):1589-97
pubmed: 20367458
J Hosp Infect. 2019 Dec;103(4):461-464
pubmed: 31513882
Clin Infect Dis. 2007 Jun 1;44(11):e88-95
pubmed: 17479931