柳叶刀系统评价研究：MRSA PVL

蓝鱼o_0

The Lancet Infectious Diseases, Volume 13, Issue 1, Pages 43 - 54, January 2013
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doi:10.1016/S1473-3099(12)70238-4

                               
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This article can be found in the following collections: Infectious Diseases (Healthcare-associated infections, Paediatric infections, Respiratory tract infections, Infectious diseases-other); Paediatrics (Paediatric infections); Respiratory Medicine (Respiratory tract infections)
Published Online: 26 October 2012
The role of the Panton-Valentine leucocidin toxin in staphylococcal disease: a systematic review and meta-analysisOriginal Text
Dr Laura J Shallcross MBBS a

                               
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, Ellen Fragaszy MSc a b, Prof Anne M Johnson MD a, Andrew C Hayward MD a
SummaryBackgroundInvasive 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.

MethodsWe 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.

ResultsOf 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.

InterpretationPVL 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.

FundingNone.

蓝鱼o_0

研究发现，PVL基因与SSIT紧密相关，但是倾入性感染中并不多见。他们的这个研究对过去的认识是个颠覆：
以往的研究认为，PVL可能去倾入性感染紧密相关导致不良预后。

阡陌

高手把它翻译成中文的吧

蓝鱼o_0

为了更好的了解这篇文章，我把图片做了剪切，并上传全文共大家学习。我自己喜欢纸质版，我打出来看了。

蓝鱼o_0

结果很好啊，都很显著。

蓝鱼o_0

Prof A M Johnson MD,
E Fragaszy MSc,
A C Hayward MD); and
Department of Infectious
Disease Epidemiology, London
School of Hygiene and Tropical
Medicine, London, UK
(E Fragaszy)
Correspondence to:
Dr Laura J Shallcross, Research
Department of Infection and
Population Health, University
College London,
London WC1E 6JB, UK
l.shallcross@ucl.ac.uk

我去PUBMED检索了一下，发现以“Laura J Shallcross”只有一篇。就是这篇柳叶刀的文章。重新以“Shallcross LJ”检索：
发现她在PVL研究中发表了一系列成果。在2011年就发表了文章在BMJ，这篇杂志的影响因子也很高（2009年是8分以上）。

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

Shallcross LJ, Fragaszy E, Johnson AM, Hayward AC.

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

PMID: 23103172 [PubMed - in process]

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2.

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

Shallcross LJ, Mbeledogu CN, Hayward AC.

BMJ. 2011 Sep 9;343:d5479. doi: 10.1136/bmj.d5479. No abstract available.

PMID: 21908526 [PubMed - indexed for MEDLINE]

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3.

Panton-Valentine leukocidin associated staphylococcal disease: a cross-sectional study at a London hospital, England.

Shallcross LJ, Williams K, Hopkins S, Aldridge RW, Johnson AM, Hayward AC.

Clin Microbiol Infect. 2010 Nov;16(11):1644-8. doi: 10.1111/j.1469-0691.2010.03153.x.

PMID: 20969671 [PubMed - indexed for MEDLINE]

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4.

Kikuchi-Fujimoto disease--a diagnosis to consider.

Shallcross LJ, Birns J, Kalra L.

Eur J Intern Med. 2005 Sep;16(5):375. No abstract available.

PMID: 16137558 [PubMed]

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Supplemental Content

佳蕙淼淼

蓝鱼o_0 发表于 2012-12-27 15:17

                               
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研究发现，PVL基因与SSIT紧密相关，但是倾入性感染中并不多见。他们的这个研究对过去的认识是个颠覆：
以往 ...

您好！何谓倾入性感染？

蓝鱼o_0

题目：The role of the Panton-Valentine leucocidin toxin in staphylococcal disease: a systematic review and meta-analysis
作者：Laura J Shallcross, Ellen Fragaszy, Anne M Johnson, Andrew C Hayward
作者：
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 metaanalyses
to estimate odds of infection or colonisation with a PVL-positive strain with fi xed-eff ects or random-eff ects
models, depending on the results of tests for heterogeneity.
Results Of 509 articles identifi ed 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 identifi ed no evidence that PVL aff ects outcome.
Interpretation PVL genes are consistently associated with skin and soft-tissue infections and are comparatively rare in
invasive disease. This fi nding challenges the view that PVL mainly causes invasive disease with poor prognosis.
Population-based studies are needed to defi ne the role of PVL in mild, moderate, and severe disease and to inform
control strategies.

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

蓝鱼o_0

在柳叶刀2013年发表了这样一篇非常有价值的META分析。

揭示了PVL与葡萄球菌疾病关联。

蓝鱼o_0

这篇文章的精华在于，将基因型与疾病进行了结合。这在感控的研究中并不多见。但是在肿瘤研究中非常常见。这些也给我们提供很好的研究思路。

希望能引起更多的感控同仁的关注。

蓝鱼o_0

里面还发现了一个很有价值的结论，就是PVL基因是SSTI的重要危险因素。对侵入性疾病无显著关联，这与以前的研究相违背。