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Meta-Analysis
. 2013 Jan;13(1):43-54.
doi: 10.1016/S1473-3099(12)70238-4. Epub 2012 Oct 26.

The role of the Panton-Valentine leucocidin toxin in staphylococcal disease: a systematic review and meta-analysis

Laura J Shallcross  1 , Ellen Fragaszy, Anne M Johnson, Andrew C Hayward
Affiliations
Meta-Analysis

The role of the Panton-Valentine leucocidin toxin in staphylococcal disease: a systematic review and meta-analysis

Laura J Shallcross et al. Lancet Infect Dis. 2013 Jan.

Abstract

Background: Invasive community-onset staphylococcal disease has emerged worldwide associated with Panton-Valentine leucocidin (PVL) toxin. Whether PVL is pathogenic or an epidemiological marker is unclear. We investigate the role of PVL in disease, colonisation, and clinical outcome.

Methods: We searched Medline and Embase for original research reporting the prevalence of PVL genes among Staphylococcus aureus pneumonia, bacteraemia, musculoskeletal infection, skin and soft-tissue infection, or colonisation published before Oct 1, 2011. We calculated odds ratios (ORs) to compare patients with PVL-positive colonisation and each infection relative to the odds of PVL-positive skin and soft-tissue infection. We did meta-analyses to estimate odds of infection or colonisation with a PVL-positive strain with fixed-effects or random-effects models, depending on the results of tests for heterogeneity.

Results: Of 509 articles identified by our search strategy, 76 studies from 31 countries met our inclusion criteria. PVL strains are strongly associated with skin and soft-tissue infections, but are comparatively rare in pneumonia (OR 0·37, 95% CI 0·22-0·63), musculoskeletal infections (0·44, 0·19-0·99), bacteraemias (0·10, 0·06-0·18), and colonising strains (0·07, 0·01-0·31). PVL-positive skin and soft-tissue infections are more likely to be treated surgically than are PVL-negative infections, and children with PVL-positive musculoskeletal disease might have increased morbidity. For other forms of disease we identified no evidence that PVL affects outcome.

Interpretation: PVL genes are consistently associated with skin and soft-tissue infections and are comparatively rare in invasive disease. This finding challenges the view that PVL mainly causes invasive disease with poor prognosis. Population-based studies are needed to define the role of PVL in mild, moderate, and severe disease and to inform control strategies.

Funding: None.

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Figures

Figure 1
Figure 1
Study selection
Figure 2
Figure 2
Fixed-effects meta-analysis comparing the odds of infection with Panton-Valentine leucocidin-producing strain for Staphylococcus aureus pneumonia versus skin and soft-tissue disease OR=odds ratio
Figure 3
Figure 3
Random-effects meta-analysis comparing the odds of infection with a Panton-Valentine leucocidin-producing strain for Staphylococcus aureus musculoskeletal disease versus skin and soft-tissue infection OR=odds ratio.
Figure 4
Figure 4
Fixed-effects meta-analysis comparing the odds of infection with a Panton-Valentine leucocidin-producing strain for Staphylococcus aureus bacteraemia versus skin and soft-tissue disease OR=odds ratio.
Figure 5
Figure 5
Fixed-effects meta-analysis comparing the odds of infection with a Panton-Valentine leucocidin-producing strain for Staphylococcus aureus abscesses or furuncles to all other presentations of S aureus disease OR=odds ratio.
Figure 6
Figure 6
Random-effects meta-analysis comparing the odds of colonisation with Panton-Valentine leucocidin-producing Staphylococcus aureus versus Panton-Valentine leucocidin-positive skin and soft-tissue infection OR=odds ratio.
Figure 7
Figure 7
Clinical iceberg of Panton-Valentine leucocidin-associated infection
See this image and copyright information in PMC

Comment in

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