Skin infections due to Panton-Valentine leukocidin (PVL)-producing S. aureus—Cost effectiveness of outpatient treatment

Abstract

Introduction Skin and soft tissue infections (SSTI) caused by Panton-Valentine leukocidin (PVL)-producing strains of Staphylococcus aureus (PVL-SA) are associated with recurrent skin abscesses. Secondary prevention, in conjunction with primary treatment of the infection, focuses on topical decolonization. Topical decolonization is a standard procedure in cases of recurrent PVL-SA skin infections and is recommended in international guidelines. However, this outpatient treatment is often not fully reimbursed by health insurance providers, which may interfere with successful PVL-SA decolonization. Aim Our goal was to estimate the cost effectiveness of outpatient decolonization of patients with recurrent PVL-SA skin infections. We calculated the average cost of treatment for PVL-SA per outpatient decolonization procedure as well as per in-hospital stay. Methods The study was conducted between 2014 and 2018 at a German tertiary care university hospital. The cohort analyzed was obtained from the hospital’s microbiology laboratory database. Data on medical costs, DRG-based diagnoses, and ICD-10 patient data was obtained from the hospital’s financial controlling department. We calculated the average cost of treatment for patients admitted for treatment of PVL-SA induced skin infections. The cost of outpatient treatment is based on the German regulations of drug prices for prescription drugs. Results We analyzed a total of n = 466 swabs from n = 411 patients with recurrent skin infections suspected of carrying PVL-SA. PVL-SA was detected in 61.3% of all patients included in the study. Of those isolates, 80.6% were methicillin-susceptible, 19.4% methicillin-resistant. 89.8% of all patients were treated as outpatients. In 73.0% of inpatients colonized with PVL-SA the main diagnosis was SSTI. The median length of stay was 5.5 days for inpatients colonized with PVL-SA whose main diagnosis SSTI; the average cost was €2,283. The estimated costs per decolonization procedure in outpatients ranged from €50-€110, depending on the products used. Conclusion Our data shows that outpatient decolonization offers a highly cost-effective secondary prevention strategy, which may prevent costly inpatient treatments. Therefore, health insurance companies should consider providing coverage of outpatient treatment of recurrent PVL-SA skin and soft tissue infections.

A 6-Year Update on the Diversity of Methicillin-Resistant Staphylococcus aureus Clones in Africa: A Systematic Review

“…The high prevalence (median: 33%) of PVL-positive MRSA, particularly among nasal samples of hospitalized patients and non-hospitalized individuals in Africa ( Supplementary Table 3 ), is of public health concern. Recurrent SSTIs are associated with S. aureus carriers colonized with PVL-positive S. aureus ( Rentinck et al, 2021 ). So far, the burden of PVL-positive S. aureus is not well known despite its high prevalence in Africa.…”

Staphylococcus schweitzeri—An Emerging One Health Pathogen?

“…The pathogenicity of S. argenteus appears to be comparable to that of S. aureus, and 76.6% of the virulence genes of S. aureus have also been found in S. argenteus [24]. Some isolates also produce Panton-Valentine leukocidin (PVL) [15,25], a toxin associated with S. aureus isolates causing skin and soft tissue infections [26,27]. The absence of the pigment staphyloxanthin in S. argenteus results in the whitish color of the colonies [4,28].…”

Predominance of t355/ST152/SCCmec V clonal type among PVL-positive MRSA isolates in a tertiary care hospital in Belgrade, Serbia

“…PVL is a bi-component toxin encoded by the lukF-PV and lukS-PV genes carried on a lysogenic bacteriophage, with the ability to lyse leukocytes. Production of PVL is connected with severe MRSA skin and soft tissue infections such as recurrent furunculosis, necrotising pneumonia and fasciitis [ 4 ].…”