Traitement par ECMO d'une pneumopathie nécrosante à Staphylococcus aureus producteur de la leucocidine de Panton-Valentine [Extracorporeal circuit for Panton-Valentine leukocidin-producing Staphylococcus aureus necrotizing pneumonia]

S. Lavoue (1) , G. Le Gac (1) , A. Gacouin (1, 2) , M. Revest (2, 1, 3) , L. Sohier (4) , J. Mouline (4) , S. Jouneau (2, 5) , E. Flécher (6) , P. Tattevin (1, 3, 2) , J.-M. Tadié (1, 2)

1 Service des maladies infectieuses et réanimation médicale [Rennes] = Infectious Disease and Intensive Care [Rennes]
2 CIC - Centre d'Investigation Clinique [Rennes]
3 Fonction, structure et inactivation d'ARN bactériens
4 CH Lorient - Centre Hospitalier de Lorient
5 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
6 Service de chirurgie thoracique cardiaque et vasculaire [Rennes] = Thoracic and Cardiovascular Surgery [Rennes]

Objective To describe two cases of Panton-Valentine leukocidin-producing Staphylococcus aureus (PVL-SA) necrotizing pneumonia treated with ECMO, and complete pulmonary evaluation at six months. Methods Retrospective analysis of two patients presenting with severe PVL-SA pneumonia who both underwent complete respiratory function testing and chest CT scan six months after hospital discharge. Results Indications for ECMO were refractory hypoxia and left ventricular dysfunction associated with right ventricular dilatation. Patients were weaned off ECMO after 52 and 5 days. No ECMO-related hemorrhagic complication was observed. Pulmonary function tests performed at six months were normal and the CT scan showed complete regression of pulmonary injuries. Conclusion PVL-SA pneumonia is characterized by extensive parenchymal injuries, including necrotic and hemorrhagic complications. ECMO may be used as a salvage treatment without any associated hemorrhagic complication, provided anticoagulant therapy is carefully monitored, and may lead to complete pulmonary recovery at six months. © 2016 Elsevier Masson SAS

Mots clés: Staphylococcal pneumonia; Pneumopathie à Staphylococcus aureus; Acute respiratory distress syndrome; ECMO; Panton-Valentine leukocidin-producing Staphylococcus aureus; Staphylococcus aureus producteur de la leucocidine de Panton-Valentine; Syndrome de détresse respiratoire aiguë

Domaines: Santé

S. Lavoue, G. Le Gac, A. Gacouin, M. Revest, L. Sohier, et al.. Traitement par ECMO d'une pneumopathie nécrosante à Staphylococcus aureus producteur de la leucocidine de Panton-Valentine [Extracorporeal circuit for Panton-Valentine leukocidin-producing Staphylococcus aureus necrotizing pneumonia]. Médecine et Maladies Infectieuses, 2016, 46 (6), pp.314--317. ⟨10.1016/j.medmal.2016.04.004⟩. ⟨hal-01392110⟩