Should we screen and decolonise contacts of patients with Panton Valentine leukocidin associated Staphylococcus aureus infection?

In the past decade Staphylococcus aureus associated with a toxin called Panton Valentine leukocidin (PVL-SA) has emerged worldwide, mainly causing severe skin and soft tissue infections in patients in the community. Multidrug resistant strains have rapidly spread across parts of North America and Australia, resulting in increasingly limited treatment options. In most of Europe surveillance data suggest that PVL associated disease is rare, which may underestimate the role of PVL in mild to moderate skin infections, for which samples for testing are not routinely taken in primary care.

The main strategy to prevent reinfection with or transmission of PVL-SA is stringent hygiene combined with decolonisation treatment. In the United States, where PVL associated strains of meticillin resistant S aureus (MRSA) are commonplace, testing for the PVL toxin is not recommended (table⇓). Decolonisation is considered only when standard infection prevention methods have failed, in recognition of the lack of efficacy data to support eradication of S aureus.1 In England the Health Protection Agency advises a relatively aggressive approach to the management of PVL-SA infection, based on the assumption that cases are mainly rare and severe.2 No international consensus has been reached on whether decolonisation treatment should depend on PVL status, meticillin resistance, or simply the presence of severe and recurrent S aureus infection.