[Community-associated MRSA and Panton-Valentine leukocidin (PVL): novel trends in epidemiology and forensic implications].

The propagation of multi-resistant bacteria, especially methicilline-resistant Staphylococcus aureus strains (MRSA), in hospitals and nursing homes is a well-known sanitary and therapeutic problem (Healthcare-associated MRSA, HA-MRSA). For some years, an increasing incidence of MRSA outside the hospital environment (Community-acquired or Community-Associated MRSA, CA-MRSA) has been observed all over the world, which, contrary to the hospital strains, produces the leukocytotoxic toxin PVL and causes purulent inflammations of the skin and necrotizing pneumonia. In previously healthy children and adolescents these pneumonias are fatal in most cases. The authors report a case of fatal necrotizing S. aureus pneumonia in a 16-year-old girl observed in 2001. The suspicion that the infection had been caused by a CA-MRSA strain following an influenza A infection was confirmed by the bacteriological investigation of a heart blood specimen stored for more than 2 years at 4 degrees C. In view of the bad prognosis and the fulminat course of these special pneumonias the attending physician could not be accused of having caused the death of the girl by omitting the indicated antibiotic treatment. This case of pneumonia caused by CA-MRSA was one of the first seen in Germany. The epidemiological situation suggests that a higher incidence has to be expected in the future.