Progression to bacteremia in critical care patients colonized with methicillin-resistant Staphylococcus aureus expressing Panton–Valentine leukocidin

The role of Panton–Valentine leukocidin (PVL) in methicillin-resistant Staphylococcus aureus (MRSA) infections is unclear. PVL has been long associated with soft tissue infections and necrotizing pneumonia, but inconsistently with other site infections or mortality. The retrospective cohort study explores the association between PVL and bacteremia in colonized medical intensive care unit (ICU) patients with surveillance isolates and blood cultures. A total of 840 patients were screened by nasal swab, with 266 patients found to be colonized and 46 with bacteremia. Colonization by PVL+ MRSA increased the odds of bacteremia (odds ratio, 2.40; confidence interval, 1.23–4.57), and invasive infection developed earlier in these patients (relative risk, 0.44; confidence interval 0.25–0.85) compared to those colonized with PVL0 MRSA. PVL was not associated with infections at other sites, length of ICU stay, or mortality. PVL decreases the time to bacteremia in colonized patients but does not otherwise contribute to disease course or clinical outcome.