Prognostic factors of severe community-acquired staphylococcal pneumonia in France

Yves Gillet (1, 2) , Anne Tristan (1, 2) , Jean-Philippe Rasigade (1, 3) , Mitra Saadatian-Elahi (1) , Coralie Bouchiat (1) , Michele Bes (1, 3) , Oana Dumitrescu (1, 2) , Marie Leloire (1, 3) , Céline Dupieux (2, 1) , Frederic Laurent (2, 1) , Gerard Lina (2, 1) , Jerome Etienne (2, 1) , Philippe Vanhems (4, 1) , Laurent Argaud (5, 1) , François Vandenesch (2, 1)

1 HCL - Hospices Civils de Lyon
2 StaPath - Pathogénie des Staphylocoques – Staphylococcal Pathogenesis
3 CIRI - Center for Interdisciplinary Research and Innovation
4 PHE3ID - Santé publique, épidémiologie et écologie évolutive des maladies infectieuses
5 CIRI - Centre International de Recherche en Infectiologie

Purpose: Staphylococcus aureus causes severe forms of community-acquired pneumonia (CAP), namely staphylococcal pleuropneumonia in young children and staphylococcal necrotising pneumonia in older patients. Methicillin resistance, the Panton-Valentine leukocidin (PVL) toxin, as well as less specific factors have been associated with poor outcome in severe CAP, but their respective roles are unclear. Methods A prospective multicentre cohort study of severe staphylococcal CAP was conducted in 77 paediatric and adult intensive care units in France between January 2011 and December 2016. After age-clustering, risk factors for mortality, including pre-existing conditions, clinical presentation, laboratory features, strain genetic lineage, PVL, other virulence factors, and methicillin resistance were assessed using univariate and multivariable Cox and LASSO regressions. Results: Of 163 included patients, aged one month to 87 years, 85 (52.1%) had PVL-positive CAP; there were 20 (12.3%) patients aged <3 years (hereafter “toddlers”), among whom 19 (95%) had PVL-positive CAP. The features of PVL-positive CAP in toddlers matched with the historical description of staphylococcal pleuropneumonia, with a lower mortality (n=3/19, 15%) compared to PVL-positive CAP in older patients (n=31/66, 47%). Mortality in older patients was independently predicted by PVL-positivity (hazard ratio 1.81, 95% CI, 1.03 to 3.17) and methicillin resistance (2.37, 95% CI 1.29 to 4.34) independently from S. aureus lineages and the presence of other virulence determinants. Conclusion: PVL was associated with staphylococcal pleuropneumonia in toddlers and was a risk factor for mortality in older patients with severe CAP, independently of methicillin resistance, S. aureus genetic background and other virulence factors.

Mots clés: Severity; Mortality; Community-acquired pneumonia; Staphylococcus aureus; Panton Valentine leucocidin; Sepsis

Domaines: Maladies infectieuses; Pneumologie et système respiratoire; Santé publique et épidémiologie

Yves Gillet, Anne Tristan, Jean-Philippe Rasigade, Mitra Saadatian-Elahi, Coralie Bouchiat, et al.. Prognostic factors of severe community-acquired staphylococcal pneumonia in France. European Respiratory Journal, inPress. ⟨hal-03276134⟩