Diagnostic et traitement des infections dues aux souches de Staphylococcus aureus, productrices de toxines

Staphylococcus aureus is a major human pathogen that can produce a wide range of virulence factors. In particular, toxigenic strains may be responsible for life-threatening distinctive clinical features. Panton-Valentine leukocidin (PVL) may be involved in skin and soft-tissue infections and more rarely in severe necrotizing pneumonia in young healthy people. Superantigenic toxins may induce staphylococcal toxic shock syndrome (STSS) while exfoliative toxins may cause exfoliative diseases. The interest for these pathologies has recently increased since the emergence and the worldwide diffusion of toxin-producing S. aureus isolates. The rapid recognition of these syndromes on simple clinical features constitutes a true challenge since an early-targeted therapy is likely to improve the outcome of the patients. Recent fundamental data suggested the potent benefit of agents that decrease toxin synthesis, such as linezolid or clindamycin. In addition to supportive measures, a parenteral appropriate antimicrobial therapy should include an agent with antitoxinic activity in association with a β-lactam or vancomycin in case of documented methicillin-resistant strain. Surgical treatment is common in PVL-mediated infections. Early use of intravenous immunoglobulin may be indicated as adjunctive therapy in case of severe infection. The clinical benefits of the different therapeutic propositions should be more thoroughly evaluated.