Severity of disease and clinical outcomes in patients with hospital-acquired pneumonia due to methicillin-resistant Staphylococcus aureus strains not influenced by the presence of the Panton-Valentine leukocidin gene

Clin Infect Dis. 2011 Oct;53(8):766-71. doi: 10.1093/cid/cir541. Epub 2011 Aug 31.


Background: Patients with community-acquired pneumonia (CAP) infected with methicillin-resistant Staphylococcus aureus (MRSA) strains carrying the Panton-Valentine leukocidin (PVL) gene have severe clinical presentation and poor clinical outcomes. Antibiotics that suppress toxin production have been suggested for the management of these patients. The objective of this study was to compare the severity of disease and clinical outcomes of patients with hospital-acquired pneumonia/ventilator-associated pneumonia (HAP/VAP) infected with MRSA carrying the PVL gene with those patients infected with MRSA strains that do not carry the PVL gene.

Methods: This was a multicenter observational study of patients with HAP and VAP. MRSA isolates were subjected to genetic analysis to define the presence of the PVL gene, the USA type and the staphylococcal cassette chromosome mec type. Severity of disease was evaluated with the Acute Physiology and Chronic Health Evaluation II (APACHE II) score. The primary clinical outcome was mortality at hospital discharge.

Results: A total of 109 cases of MRSA HAP/VAP were evaluated. The incidence of PVL(+) MRSA was 27%. APACHE II score at diagnosis of HAP/VAP was 21 ± 8 for PVL(+) MRSA and 20 ± 6 for PVL(-) MRSA (P = .67). Mortality was 10% (3/29) for patients with PVL(+) MRSA versus 10% (8/80) for patients with PVL(-) MRSA (P > .99).

Conclusions: In patients with HAP or VAP due to MRSA, severity of disease and clinical outcomes are not influenced by the presence of the PVL gene. Therapeutic strategies directed to block PVL exotoxin may not impact outcomes in these patients.

Publication types

  • Comparative Study
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Bacterial Toxins / genetics*
  • Cross Infection / epidemiology
  • Cross Infection / microbiology*
  • Cross Infection / mortality
  • Exotoxins / genetics*
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Leukocidins / genetics*
  • Male
  • Methicillin-Resistant Staphylococcus aureus / genetics*
  • Middle Aged
  • Pneumonia, Staphylococcal / epidemiology
  • Pneumonia, Staphylococcal / microbiology*
  • Pneumonia, Staphylococcal / mortality
  • Pneumonia, Ventilator-Associated / epidemiology
  • Pneumonia, Ventilator-Associated / microbiology*
  • Pneumonia, Ventilator-Associated / mortality
  • Severity of Illness Index
  • United States / epidemiology
  • Virulence Factors / genetics


  • Bacterial Toxins
  • Exotoxins
  • Leukocidins
  • Panton-Valentine leukocidin
  • Virulence Factors