Extracorporeal circuit for Panton-Valentine leukocidin-producing Staphylococcus aureus necrotizing pneumonia

Med Mal Infect. 2016 Sep;46(6):314-7. doi: 10.1016/j.medmal.2016.04.004. Epub 2016 Jul 7.

Abstract

Objective: To describe two cases of Panton-Valentine leukocidin-producing Staphylococcus aureus (PVL-SA) necrotizing pneumonia treated with ECMO, and complete pulmonary evaluation at six months.

Methods: Retrospective analysis of two patients presenting with severe PVL-SA pneumonia who both underwent complete respiratory function testing and chest CT scan six months after hospital discharge.

Results: Indications for ECMO were refractory hypoxia and left ventricular dysfunction associated with right ventricular dilatation. Patients were weaned off ECMO after 52 and 5 days. No ECMO-related hemorrhagic complication was observed. Pulmonary function tests performed at six months were normal and the CT scan showed complete regression of pulmonary injuries.

Conclusion: PVL-SA pneumonia is characterized by extensive parenchymal injuries, including necrotic and hemorrhagic complications. ECMO may be used as a salvage treatment without any associated hemorrhagic complication, provided anticoagulant therapy is carefully monitored, and may lead to complete pulmonary recovery at six months.

Keywords: Acute respiratory distress syndrome; ECMO; Panton-Valentine leukocidin-producing Staphylococcus aureus; Pneumopathie à Staphylococcus aureus; Staphylococcal pneumonia; Staphylococcus aureus producteur de la leucocidine de Panton-Valentine; Syndrome de détresse respiratoire aiguë.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Adult
  • Anticoagulants / administration & dosage
  • Anticoagulants / therapeutic use
  • Bacterial Toxins / analysis*
  • Exotoxins / analysis*
  • Extracorporeal Membrane Oxygenation*
  • Female
  • Follow-Up Studies
  • Hemorrhage / chemically induced
  • Hemorrhage / etiology
  • Hemorrhage / prevention & control
  • Humans
  • Leukocidins / analysis*
  • Lung / diagnostic imaging
  • Lung Diseases / chemically induced
  • Lung Diseases / etiology
  • Lung Diseases / prevention & control
  • Methicillin-Resistant Staphylococcus aureus / chemistry
  • Methicillin-Resistant Staphylococcus aureus / isolation & purification
  • Pneumonia, Necrotizing / complications
  • Pneumonia, Necrotizing / diagnostic imaging
  • Pneumonia, Necrotizing / microbiology
  • Pneumonia, Necrotizing / therapy*
  • Pneumonia, Staphylococcal / complications
  • Pneumonia, Staphylococcal / diagnostic imaging
  • Pneumonia, Staphylococcal / microbiology
  • Pneumonia, Staphylococcal / therapy*
  • Remission Induction
  • Respiratory Function Tests
  • Retrospective Studies
  • Salvage Therapy
  • Staphylococcus aureus / chemistry*
  • Staphylococcus aureus / isolation & purification
  • Tomography, X-Ray Computed
  • Vasoconstrictor Agents / therapeutic use

Substances

  • Anticoagulants
  • Bacterial Toxins
  • Exotoxins
  • Leukocidins
  • Panton-Valentine leukocidin
  • Vasoconstrictor Agents