Correspondence
In Reply
We thank Schaumburg et al. for their constructive comments in response to our article (1) and wish to clarify the following. The recommended antimicrobial substances are included in the consensus based guideline on skin and soft tissue infections and are effective against Staphylococcus aureus. The CME article stresses on several occasions that insufficient studies of Panton-Valentine producing S. aureus (PVA-SA) exist.
Trimethoprim/sulfamethoxazole (TMP-SMX) resistance data from Germany showed extreme variations, and no supraregional/ studies exist. Schaumburg et al refer to data from central Africa, which do not reflect our local resistance situation. We therefore do not see any need to generally advise against TMP-SMX and emphasize once again the need for microbiological sensitivity tests.
Topical decolonization as secondary prevention is mentioned in all known international recommendations for recurrent PVL-SA skin infections. The named meta-analysis suffers from a lack of high quality evidence (1). Numerous clinical examples have indicated that decolonization is a successful treatment option with few adverse effects, which can be employed to avoid antibiotic treatment. In our view, it is a suitable, necessary, and appropriate measure. At the same time we wish to point out that this will have to be substantiated in controlled studies.
Schaumburg et al. mention specific antibodies as the explanation of some people’s biological resilience to PVL-SA. This question was investigated in a study in symptomatic, post-infectious, and PVA-SA naive persons (2). The authors of that study concluded that neutralizing antibodies do not constitute protection against recurrence.
Schaumburg et al. recommend closer networking among relevant specialties so as to shed a balanced light on PVL-SA infections. Our working group consists of colleagues from dermatology, immunology, clinical infectious diseases, hospital hygiene, microbiology, pediatrics, and tropical medicine. All are involved in the care for patients with PVL-SA infections and research into this pathology, and are open for further cooperation and interdisciplinarity.
DOI: 10.3238/arztebl.m2023.0023
On behalf of the authors:
PD Dr. med. Rasmus Leistner
Medizinische Klinik für Gastroenterologie, Infektiologie und Rheumatologie
Charité – Universitätsmedizin Berlin
Freie Universität Berlin und Humboldt-Universität zu Berlin
rasmus.leistner@charite.de
Conflict of interest statement
The authors of both contributions declare that no conflict of interest exists.
| 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 VOLLTEXT |
| 2. | Lynch L, Shrotri M, Brown CS, Heathcock RT: Is decolonization to prevent Panton–Valentine leukocidin-positive Staphylococcus aureus infection in the population effective? A systematic review. J Hosp Infect 2022; 121: 91–104 CrossRef MEDLINE |
| 3. | Hermos CR, Yoong P, Pier GB: High levels of antibody to panton-valentine leukocidin are not associated with resistance to Staphylococcus aureus—associated skin and soft-tissue infection. Clin Infect Dis 2010; 51: 1138–46 CrossRef MEDLINE PubMed Central |
