Closer Interdisciplinary Networking Is Important

Letter to the Editor Skin Infections Due to Panton-Valentine Leucocidin–Producing S. Aureus by PD Dr. med. Rasmus Leistner, Dr. med. Leif G. Hanitsch, PD Dr. med. Renate Krüger, Dr. med. Andreas K. Lindner, MSc., Dr. med. Miriam S. Stegemann, and Prof. Dr. med. Dennis Nurjadi, in issue 45/2022

We welcome the article and thank the authors for the overview/review (1). From our perspective, however, it is important to add details to this CME article and correct it as regards certain items.

The therapeutic recommendation reflects mainly the authors’ opinion, is not confirmed by studies, and therefore should be scrutinized critically. Panton-Valentine leucocidin (PVL) is often associated with resistance to trimethoprim/sulfamethoxazole, and the use of these antibiotics may be a selection advantage of PVL positive isolates (2). Furthermore it was shown that clindamycin and not trimethoprim/sulfamethoxazole or tetracycline inhibits PVL production in subinhibitory concentrations (which can absolutely occur in abscesses) (3). For this reason, the current CASSETTE Study investigates the benefits/utility of additional administration of clindamycin, and therefore an evidence based recommendation is most likely to be expected for this substance in the near future.

The authors recommend decolonization to prevent recurrences and deduct the effectiveness primarily from the results regarding decolonization of methicillin resistant Staphylococcus aureus (MRSA). A systematic review concludes, however, that pathogen eradication is not effective in eradicating and preventing recurrent infections with PVL positive S. aureus strains. It therefore does not apply that decolonization has “thus already been established internationally as the main treatment strategy.”

To date it is not known how to confer a protective immune response. High antibody titers against PVL can, however, neutralize the cytotoxic effect of PVL on granulocytes and therefore probably contribute to immunity against PVL (4).It would be desirable for all relevant specialties in future to form closer networks so as to be able to tackle all aspects of PVL associated S. aureus infections (for example, pathogenesis, epidemiology, therapy, prevention) adequately.

DOI: 10.3238/arztebl.m2023.0022

Prof. Dr. med. Frieder Schaumburg

Institut für Medizinische Mikrobiologie

Universitätsklinikum Münster

Prof. Dr. med. Bettina Löffler

Institut für Medizinische Mikrobiologie

Universitätsklinikum Jena

Prof. Dr. med. Karsten Becker

Friedrich Loeffler-Institut für Medizinische Mikrobiologie

Universitätsmedizin Greifswald

References

1. Leistner R, Hanitsch LG, Krüger R, Lindner AK, Stegemann MS, Nurjadi D: Skin infections due to Panton-Valentine leucocidin–producing S. aureus. Dtsch Arztebl Int 2022; 119: 775–84

2. Kraef C, Alabi AS, Peters G, et al.: Co-detection of panton-valentine leukocidin encoding genes and cotrimoxazole resistance in Staphylococcus aureus in gabon: implications for HIV-patients‘ care. Front Microbiol 2015; 6: 60

3. Dumitrescu O, Badiou C, Bes M, et al.: Effect of antibiotics, alone and in combination, on panton-valentine leukocidin production by a Staphylococcus aureus reference strain. Clin Microbiol Infect 2008; 14: 384–8

4. Grebe T, Rudolf V, Gouleu CS, et al.: Neutralization of the Staphylococcus aureus panton-valentine leukocidin by African and caucasian sera. BMC Microbiology 2022; 22: 219