Five cases of bacterial endocarditis after furunculosis and the ongoing saga of community-acquired methicillin-resistant Staphylococcus aureus infections

Abstract

Bacterial endocarditis secondary to Panton-Valentine leukocidin producing community-acquired methicillin-resistant Staphylococcus aureus (MRSA) infections is rare. We report 5 previously healthy patients who presented with endocarditis after developing furunculosis due to CA-MRSA. A retrospective chart review of all patients with MRSA positive blood cultures was conducted over a 12-month period. Patients with multiple positive blood cultures within 72 h of admission and who had no risk factors for MRSA acquisition were included. Modified Duke's criteria were used to define bacterial endocarditis. PCR detection of Panton-Valentine leukocidin (PVL) genes as well as SCCmec typing was performed. In addition, strain typing of MRSA isolates was performed utilizing pulsed-field gel electrophoresis. Five out of a total of 193 patients had features consistent with CA-MRSA infections and met modified Duke's criteria for bacterial endocarditis. Blood culture isolates were found to be PVL gene positive and carried the type IV SCCmec element. PFGE confirmed that skin isolate was identical to the isolate cultured from his blood. Bacterial endocarditis in patients with CA-MRSA furunculosis is an emerging entity. In areas where CA-MRSA skin infections are prevalent, inappropriate initial antibiotics remain a major problem and may result in significant morbidity.

Infective endocarditis caused by USA300 methicillin-resistant Staphylococcus aureus (MRSA)

“…Although PVL-positive CA-MRSA endocarditis following furunculosis has been reported in the literature [9], this is the first report of IE in IDUs caused by MRSA of the USA300 genotype.…”

Staphylococcus aureus Strains Isolated from Bloodstream Infections Changed Significantly in 2006

“…Given the emergence of Panton-Valentine leukocidinand toxic shock syndrome toxin 1-producing MRSA strains worldwide (1,9,10,13,23,25) and in France since 2002 (7,28), we sought sequences corresponding to the lukS-PV and lukF-PV genes encoding Panton-Valentine leukocidin and to the tst gene encoding toxic shock syndrome toxin 1. Genomic DNA was extracted from staphylococcal cultures and used as a template for PCR amplification by using a procedure and primers previously described (16).…”

A Fatal Case of Infective Endocarditis Caused by Community-Associated Methicillin-ResistantStaphylococcus aureusST72 in Korea

“…Infective endocarditis (IE) caused by CA-MRSA was known to be a rare condition [9,10]. Several cases have been reported recently in developed countries.…”

“…The majority of CA-MRSA IE had preceding SSTIs, such as furunculosis or cellulitis, caused by the PVL-positive USA 300 clone. The PVL-positive USA 300 clone is thought to cause CA-MRSA SSTIs and subsequently CA-MRSA IE [9,11]. Also, there were a few cases without preceding SSTIs, however, they had previous histories of IDU [10].…”