Identifying and Understanding PVL Staphylococcus aureus Infections
- Suspect PVL Infections:
- Consider PVL-positive S. aureus (MSSA/MRSA) in patients with multiple or recurrent boils/abscesses.
- Also suspect PVL if multiple household members are affected either consecutively or simultaneously.
- Risk Factors:
- Overcrowding and close contact
- Poor hygiene and skin breaks
- High-Risk Groups:
- Healthcare workers, care home staff, and nursery workers
- Military personnel
- Contact sports athletes (e.g., rugby, judo, wrestling)
- Food handlers
- Characteristics of PVL Lesions:
- Typically larger than 5 cm in diameter
- Often necrotic and more painful than usual abscesses
Flucloxacillin Limitation
- Flucloxacillin has poor penetration into necrotic tissue and can increase PVL toxin production.
- It is not recommended for managing PVL pneumonia or skin infections due to poor efficacy in necrotic tissue.
Preferred Antibiotic Treatment
- Dermatologists prefer a combination of clindamycin + rifampicin or linezolid + rifampicin for treating PVL skin infections (MSSA/MRSA).
- Clindamycin and linezolid inhibit PVL toxin production, leading to better outcomes.
- Rifampicin effectively penetrates soft tissue and works synergistically with clindamycin and linezolid.
Dosage Guidelines
- Rifampicin: 300 mg twice daily (BD)
- Clindamycin: 300 mg BD to 450 mg three times daily (TDS)
- Linezolid: 600 mg BD for 2-4 weeks
- Duration of treatment should be tailored based on clinical response.
Severe Infections
- Severe PVL infections may need parenteral antibiotics such as vancomycin, teicoplanin, daptomycin, linezolid, or tigecycline.
Decolonization:
- Wash skin with chlorhexidine 4% or Triclosan 1% daily for 5 days.
- After treatment, decolonization should be performed on the patient and close contacts.
- Use nasal mupirocin (small amount in each nostril) 3 times daily (TDS) for 5 days.
#PVL Staphylococcus aureus Furuncles