Institute of Medical Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany.
Interdisciplinary workgroup on PVL-positive S. aureus, Charité Universitätsmedizin Berlin, Berlin, Germany.
PLoS One. 2020 Apr 21;15(4):e0231772. doi: 10.1371/journal.pone.0231772. eCollection 2020.
Recurrent skin abscesses are often associated with Panton-Valentine leukocidin-producing strains of S. aureus (PVL-SA). Decolonization measures are required along with treatment of active infections to prevent re-infection and spreading. Even though most PVL-SA patients are treated as outpatients, there are few studies that assess the effectiveness of outpatient topical decolonization in PVL-SA patients.
We assessed the results of topical decolonization of PVL-SA in a retrospective review of patient files and personal interviews. Successful decolonization was defined as the absence of any skin abscesses for at least 6 months after completion of the final decolonization treatment. Clinical and demographic data was assessed. An intention-to-treat protocol was used.
Our cohort consisted of 115 symptomatic patients, 66% from PVL-positive MSSA and 19% from PVL-positive MRSA. The remaining 16% consisted of symptomatic patients with close contact to PVL-SA positive index patients but without detection of PVL-SA. The majority of patients were female (66%). The median age was 29.87% of the patients lived in multiple person households. Our results showed a 48% reduction in symptomatic PVL-SA cases after the first decolonization treatment. The results also showed that the decrease continued with each repeated decolonization treatment and reached 89% following the 5th treatment. A built multivariable Cox proportional-hazards model showed that the absence of PVL-SA detection (OR 2.0) and living in single person households (OR 2.4) were associated with an independently increased chance of successful decolonization.
In our cohort, topical decolonization was a successful preventive measure for reducing the risk of PVL-SA skin abscesses in the outpatient setting. Special attention should be given to patients living in multiple person households because these settings could confer a risk that decolonization will not be successful.
复发性皮肤脓肿常与产 Panton-Valentine 白细胞溶素的金黄色葡萄球菌（PVL-SA）有关。需要采取去定植措施，同时治疗活动性感染，以防止再次感染和传播。尽管大多数 PVL-SA 患者接受门诊治疗，但很少有研究评估门诊局部去定植在 PVL-SA 患者中的有效性。
我们通过回顾患者病历和个人访谈评估了 PVL-SA 局部去定植的结果。成功去定植定义为完成最后一次去定植治疗后至少 6 个月内无任何皮肤脓肿。评估了临床和人口统计学数据。采用意向治疗方案。
我们的队列包括 115 例有症状的患者，66%来自 PVL 阳性 MSSA，19%来自 PVL 阳性 MRSA。其余 16%由与 PVL-SA 阳性索引患者密切接触但未检测到 PVL-SA 的有症状患者组成。大多数患者为女性（66%）。中位年龄为 29.87%，有 48%的患者居住在多人家庭中。我们的结果显示，第一次去定植治疗后，有症状的 PVL-SA 病例减少了 48%。结果还表明，随着每次重复去定植治疗，这种减少持续存在，第 5 次治疗后减少了 89%。构建的多变量 Cox 比例风险模型显示，未检测到 PVL-SA（OR 2.0）和居住在单人家庭（OR 2.4）与成功去定植的机会独立增加相关。
在我们的队列中，局部去定植是一种成功的预防措施，可以降低门诊环境中 PVL-SA 皮肤脓肿的风险。应特别关注居住在多人家庭中的患者，因为这些环境可能会增加去定植不成功的风险。
