# Difficult-to-Treat Skin and Soft Tissue Infections Caused by Panton-Valentine Leukocidin-Producing Community-Associated Methicillin-Resistant Staphylococcus aureus: A Case Series

## TL;DR

This paper presents five difficult-to-treat skin infections caused by a specific type of antibiotic-resistant bacteria, highlighting the need for combined surgical and antibiotic treatments.

## Contribution

The study provides clinical insights into managing PVL-positive CA-MRSA infections using long-acting lipoglycopeptides and comprehensive decolonization.

## Key findings

- PVL-positive CA-MRSA infections often recur and fail standard oral treatments.
- Long-acting lipoglycopeptides helped achieve clinical resolution in some cases.
- Decolonization of patients and close contacts is essential for effective management.

## Abstract

Background: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has emerged as a genetically distinct lineage from healthcare-associated MRSA (HA-MRSA), often producing Panton-Valentine leukocidin (PVL) and causing severe skin and soft tissue infections (SSTIs) in otherwise healthy individuals. Methods: We describe five cases of PVL-positive CA-MRSA SSTIs admitted to the Infectious Diseases Unit of the University Hospital “Paolo Giaccone,” Palermo, Italy, between 2024 and 2025. Case inclusion followed the CDC criteria for CA-MRSA. Microbiological identification was performed using MALDI-TOF mass spectrometry, and antimicrobial susceptibility testing followed EUCAST standards. PVL gene presence was confirmed by polymerase chain reaction. Results: Clinical management included surgical drainage, systemic antibiotic therapy, and decolonization of both patients and close contacts. Long-acting lipoglycopeptides (oritavancin or dalbavancin) were evaluated as therapeutic options to achieve clinical resolution. Conclusions: PVL-positive CA-MRSA infections are characterized by recurrence, intrafamilial clustering, and frequent therapeutic failure with standard oral agents. Effective management requires an integrated approach combining prompt surgical drainage; systemic therapy, preferably including long-acting lipoglycopeptides; and comprehensive decolonization of all close contacts.