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PVL Necrotising Pneumonia — SCE Infectious Diseases MCQ

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HardRespiratory InfectionPVL Necrotising PneumoniaSCE Infectious Diseases

A previously well adult develops rapidly progressive cavitating pneumonia after influenza. Blood and respiratory cultures grow PVL-positive meticillin-susceptible Staphylococcus aureus despite adequate flucloxacillin. Which addition is most appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Add intravenous clindamycin or linezolid for toxin suppression

The best answer is “Add intravenous clindamycin or linezolid for toxin suppression”. Necrotising PVL disease needs active antistaphylococcal therapy plus a protein-synthesis inhibitor to suppress toxin, alongside critical care and drainage of any collection. Severe toxin-mediated staphylococcal disease requires active bactericidal therapy, source control and consideration of a protein-synthesis inhibitor to reduce toxin production. Current UK pneumonia care uses severity, microbiology and host risk to select prompt empirical therapy and then narrow treatment.

Reference: Updated UK MRSA treatment guideline: https://academic.oup.com/jacamr/article/3/1/dlaa114/6127118 NICE NG250: pneumonia diagnosis and management: https://www.nice.org.uk/guidance/ng250/chapter/recommendations