Infectious diseases specialist consultation in Staphylococcus lugdunensis bacteremia

Background

Commensal coagulase negative Staphylococcus lugdunensis may cause severe bacteremia (SLB) and complications. Treatment of SLB is not fully established and we wanted to evaluate if infectious diseases specialist consultation (IDSC) would improve management and prognosis.

Methods

Multicenter retrospective study of SLB patients followed for 1 year. Patients were stratified according to bedside (formal), telephone (informal) or lack of IDSC within 7 days of SLB diagnosis.

Results

Altogether, 104 SLB patients were identified: 24% received formal bedside and 52% informal telephone IDSC whereas 24% were managed without any IDSC. No differences in demographics, underlying conditions or severity of illness were observed between the groups. Patients with bedside IDSC, compared to telephone IDSC or lack of IDSC, had transthoracic echocardiography more often performed (odds ratio [OR] 4.00; 95% confidence interval [CI] 1.31–12.2; p = 0.012) and (OR 16.0; 95% CI, 4.00–63.9; P<0.001). Bedside IDSC was associated with more deep infections diagnosed compared to telephone IDSC (OR, 7.44; 95% CI, 2.58–21.4; p<0.001) or lack of IDSC (OR, 9.56; 95% CI, 2.43–37.7; p = 0.001). The overall mortality was 7%, 10% and 17% at 28 days, 90 days and 1 year, respectively. Considering all prognostic parameters, patients with IDSC, compared to lack of IDSC, had lower 90 days and 1 year mortality (OR, 0.11; 95% CI, 0.02–0.51; p = 0.005) and (OR, 0.22; 95% CI, 0.07–0.67; p = 0.007).

Conclusion

IDSC may improve management and outcome of Staphylococcus lugdunensis bacteremia.

Clinical Characteristics and Outcomes of Staphylococcus lugdunensis Prosthetic Joint Infections: A Multicenter Retrospective Analysis

Staphylococcus lugdunensis has been increasingly recognized as a cause of serious infections, particularly prosthetic joint infections (PJIs). The aim of this study was to describe the clinical characteristics, treatments, and outcomes of S lugdunensis PJIs. This was a retrospective multicenter study of consecutive adult patients with S lugdunensis PJIs from January 2007 through December 2017; 28 patients met inclusion criteria. The knee was the most commonly affected joint (67.9%), followed by the hip (25%). Clinical and microbiologic characteristics, treatment modalities, and outcomes were evaluated. Thirteen (46.4%) patients had two-stage revision, 9 (32.1%) had debridement with or without revision, 5 (21.4%) had no surgical intervention, and 1 (3.6%) had one-stage revision. Twenty-four (85.7%) patients had monomicrobial infection with S lugdunensis, whereas 4 had polymicrobial. Two patients had concomitant bacteremia. All isolates, except 1, were susceptible to oxacillin. Three patients with no surgical intervention received oral antibiotics, 2 were not treated, and 1 was discharged to hospice. Relapse was observed in 2 of 13 (15%) patients who had two-stage revision, 4 of 9 (44%) who had debridement, and 6 of 6 (100%) who had no surgical intervention or one-stage revision regardless of antibiotic treatment regimen. There was a significant difference in cure rate for patients who underwent two-stage revision compared with other treatment modalities (85% vs 33%, P=.009). Appropriate management of S lugdunensis PJI includes both aggressive surgical treatment and a prolonged course of antibiotics and is associated with excellent clinical response. Regardless of route or duration of antibiotic therapy, relapse is high for patients not treated with two-stage revision. [Orthopedics. 2020;43(6):345-350.].

Epidemiology and antimicrobial susceptibility of Staphylococcus lugdunensis in a Greek tertiary-care hospital

Staphylococcus lugdunensis is considered more pathogenic than other coagulase-negative Staphylococci (CoNS), with its virulence resembling that of Staphylococcus aureus. We report a retrospective study of all S. lugdunensis infection cases during a 3.5-year period in a large tertiary university hospital in Greece. S.lugdunensis was susceptible to most tested antibiotics, although a high resistance percentage was found to clindamycin (27%) and erythromycin (25%). The susceptibility rate to penicillin was 49%, much lower than previously reported elsewhere, indicating that penicillin may not be an optimal treatment choice for S. lugdunensis infections in our region.

Staphylococcus lugdunensis from gluteal abscess to destructive native triple valve endocarditis

We herein present the case of a 43-year-old male diabetic patient who presented with an aggressive form of infective endocarditis involving the tricuspid, mitral and aortic valves following a gluteal abscess due to infection with Staphylococcus lugdunensis. This coagulase-negative organism which is generally considered a component of the normal flora of the skin has however recently emerged as an unusually virulent pathogen responsible for both nosocomial and community-acquired infections. The case demonstrates the importance of paying utmost attention and ensuring a logical conclusion to the identification of persistent coagulase-negative blood cultures. In addition, it also shows the importance of early identification of this organism and aggressive antibiotic administration to avert endocarditis because of the unusual virulence of the organism. Staphylococcus lugdunensis is rarely a clinical specimen contaminant, and its isolation warrants further investigation and concerted treatment.

Cutaneous Staphylococcus lugdunensis infection: an emerging bacterial pathogen

Staphylococcus lugdunensis is a part of the normal skin flora. However, this organism can be a pathogen in certain situations such as advanced age or immunosuppression. Further study regarding situations in which this bacterium becomes a pathogen is warranted.

Isolated tricuspid valve Staphylococcus lugdunensis endocarditis in patient with a KBG syndrome

Both KBG syndrome (approximately 50 patients worldwide) and isolated tricuspid valve Staphylococcus lugdunensis endocarditis are very rare entities. The KBG syndrome is a multiple congenital anomaly characterized by short stature, distinctive craniofacial features, and neurologic/developmental/cognitive delay and is only associated to congenital heart defects in 9% of patients. Staphylococcus lugdunesis is an aggressive cause of infective endocarditis. Herein is described a case of a patient presenting both diseases, despite the absence of any known infection, congenital heart defect, heart device or any other entry port which could explain this scenario. The unusual findings in this young patient raised questions regarding the, as-yet unexplained, etiopathogenesis of the KBG syndrome, the possibility of it being related to this rare and concerning clinical presentation and the unclear and undefined management and surgical approach associated to right side endocarditis.

Staphylococcus lugdunensis Septic Arthritis of a Native Knee A Case Report

A 67-year-old man presented to orthopaedic care with a painful knee. Workup was consistent with septic arthritis of a native knee, and the patient underwent operative treatment. Cultures from the operating room were speciated to Staphylococcus lugdunensis. To the investigators' knowledge, this is the first reported S. lugdunensis infection in a peripheral joint in the absence of an orthopaedic prosthesis. Although traditionally associated with infectious endocarditis, S. lugdunensis has been identified as a causative agent in many organ systems, including orthopaedic infections. This case report emphasizes the importance of familiarity with this emerging pathogen in the treatment of a septic joint.

[A blood culture containing coagulase-negative staphylococci: not always due to contamination]

Staphylococcus lugdunensis (SL) is a species belonging to the group of coagulase-negative staphylococci (CNS). It can cause severe infections such as endocarditis. Three cases of endocarditis caused by SL are presented. The first case describes a 71-year-old man with a fever and endogenous endophthalmitis. The second case describes delirium in an 87-year-old woman, thought to be due to pneumonia. The third case describes a 76-year-old man with an infection of unknown origin. In all cases, the first blood cultures drawn were positive for CNS and considered to be contaminated. However, all three patients were finally diagnosed as having severe endocarditis caused by SL. Two patients underwent valve replacement, one patient died due to ongoing sepsis. The first CNS-positive blood cultures drawn were wrongly denoted as being contaminated. Physicians should be aware of the pathogenic potential of SL and rule out contamination.

Embolic Stroke Caused by Staphylococcus lugdunensis Endocarditis Complicating Vasectomy in a 36-Year-Old Man

Staphylococcus lugdunensis is part of the native flora in the inguinal region of the body. Inguinal surgeries, such as vasectomy, place carriers of this aggressive pathogen at risk for contamination. Native-valve endocarditis caused by coagulase-negative S. lugdunensis has a rapid and complicated clinical course. The pathogenicity of this organism is not limited to cardiac valvular destruction. We report the case of a 36-year-old man who presented with S. lugdunensis endocarditis, dysarthria, and hemiparesis 5 weeks after a vasectomy. To our knowledge, this is the first report of embolic stroke caused by S. lugdunensis endocarditis. In addition, we discuss the relevant medical literature.

Molecular Characteristics of Disease-Causing and Commensal Staphylococcus lugdunensis Isolates from 2003 to 2013 at a Tertiary Hospital in Taiwan

Objectives

Staphylococcus lugdunensis can cause community- and healthcare-associated infections. This study investigated the molecular characteristics of S. lugdunensis isolates collected at our hospital and compared the characteristics of the infectious and commensal isolates.

Methods

We collected the S. lugdunensis isolates between 2003 and 2013. The antimicrobial resistance test, SCCmec typing, accessory gene regulator (agr) typing, pulsed-field gel electrophoresis (PFGE), and δ-like hemolysin activity were performed.

Results

In total, 118 S. lugdunensis isolates were collected, of which 67 (56.8%) were classified into the infection group and 51 (43.2%) into the commensal group. The oxacillin resistance rate was 36.4%. The most common SCCmec types were SCCmec types V (51.4%) and II (32.6%). In total, 34 pulsotypes were identified. The PFGE typing revealed five clones (pulsotypes A, J, M, N, and P) at our hospital. Pulsotypes A and N caused the spread of high oxacillin resistance. In total, 10.2% (12 of 118) of the isolates lacked δ-like hemolysin activity. Compared with the infection group, the commensal group showed a higher percentage of multiple drug resistance and carried a higher percentage of SCCmec type II (11 of 22, 50% and 3 of 21, 14.3%) and a lower percentage of SCCmec type V (8 of 22, 36.4% and 14 of 21, 66.7%). The commensal group (27 PFGE types) showed higher genetic diversity than did the infection group (20 PFGE types). No difference was observed in the distribution of the five main pulsotypes, agr typing, and the presence of δ-like hemolysin activity between the two groups.

Conclusions

Five main clones were identified at our hospital. The commensal group showed higher genetic diversity, had a higher percentage of multidrug resistance, and carried a higher percentage of SCCmec type II and a lower percentage of SCCmec type V than did the infection group.

Coagulase negative staphylococci - a fast emerging threat

OBJECTIVE

To determine the frequency of isolation of coagulase-negative staphylococci and their resistance to methicillin over a period of time.

METHODS

The descriptive cross-sectional study was carried out at Army Medical College, Rawalpindi, from June 2009 to May 2012, and comprised clinical samples mostly from patients admitted to the intensive care unit. They were inoculated onto appropriate culture media depending upon the specimen. After 24-hour incubation at 35°C, coagulase-negative staphylococci were identified on the basis of colony morphology, gram staining, a positive catalase and a negative tube coagulase test.Methicillin resistance among the isolated staphylococci was determined using a 30µg Cefoxitin disc as per the Clinical and Laboratory Standards Institute protocol. Number of coagulase-negative staphylococci for each year and their methicillin resistance rates were calculated. A comparison was made with methicillin resistant staphylococcus aureus) isolated during the same period.

RESULTS

Of the total 1331 specimens studies over three years, 581(43.65%) were coagulase-negative staphylococci. The rate of coagulase-negative staphylococci and methicillin resistance was higher each year; 110(26.6%) in May 2009-Jun 2010, 134(36.5%) in 2011, and 337(61%) in 2012. Methicillin resistance rates also increased from 25(22.7%) to 46(34.3%) and then to 201(59.6%) in 2012.Maximum isolated specimens came from blood 311(53.5%), followed by pus/swabs 204(35.1%).

CONCLUSIONS

The frequency of isolation of coagulase-negative staphylococci and its methicillin resistance among hospitalised patients is on the rise.

Severe hospital acquired pneumonia and septicemia due TO methicillin resistant Staphylococcus lugdunensis in a newborn in Northwestern Ethiopia

Staphylococcus lugdunensis can cause virulent infections in immunosuppressed individuals. This report describes the first known case of hospital acquired pneumonia and septicemia due to methicillin-resistant Staphylococcus lugdunensis in a newborn at Felege Hiwot Referral Hospital, North Western Ethiopia. The strain was simultaneously resistant to trimethoprim-sulfamethoxazole, tetracycline (30 ug), chloramphenicol (30 ug), gentamycin (10ug) and ciprofloxacin (5ug) but sensitive to erythromycin (15ug) and clindamycin (10ug).

Staphylococcus lugdunensis endophthalmitis after intravitreal injection: a case series

PURPOSE

To report the clinical features and visual and anatomical outcomes in three patients with Staphylococcus lugdunensis endophthalmitis after intravitreal injection.

METHODS

This study was a retrospective, interventional case series conducted at a single, tertiary care retina referral practice under the approval of Western Institutional Review Board. Records of three eyes with culture-positive S. lugdunensis endophthalmitis after intravitreal injection with Lucentis or Avastin were reviewed. All patients were treated between November 2011 and March 2012.

RESULTS

All three patients developed symptoms of endophthalmitis 2 to 3 days after intravitreal injection and were culture positive for S. lugdunensis. Initial visual acuity ranged from 20/200 to light perception. Final visual acuity ranged from 20/100 to hand motion. Duration of follow-up ranged from 4 months to 10 months. One patient was treated with vitreous tap and injection of ceftazidime and vancomycin. Two patients underwent immediate vitrectomy and injection of intravitreal ceftazidime and vancomycin. One patient developed a retinal detachment requiring pars plana vitrectomy and silicone oil. All three patients demonstrated an early and aggressive course.

CONCLUSION

This case series demonstrates that S. lugdunensis endophthalmitis can follow an aggressive course atypical for coagulase-negative organisms. Accurate identification of S. lugdunensis is important for management and prognosis. However, identification of S. lugdunensis is confounded by potential false-positive coagulase tests and the lack of routine speciation by microbiology laboratories.

Subungual abscess caused by Staphylococcus lugdunensis

Although Staphylococcus lugdunensis is a constituent of the normal human skin flora, it does have pathogenic potential. Infections can range from severe (eg, endocarditis, osteomyelitis) to less invasive skin and soft-tissue infections. We report a case of a subungual abscess in a patient with S lugdunensis infection.

Staphylococcus lugdunensis cultured from the amniotic fluid at Caesarean Section

Staphylococcus lugdunensis is a virulent coagulase-negative staphylococcus. It behaves like and can be mistaken in culture for Staphylococcus aureus. While originally thought to be a skin commensal rarely responsible for opportunistic infection, it was rapidly established as a significant human pathogen. It has been mainly associated with native and prosthetic valve endocarditis, osteomyelitis, and skin and soft tissue cellulitis, but has also been reported as a cause of fasciitis as well as peritonitis. Staphylococcus lugdunensis has been reported as a cause of endometritis but has not been previously isolated from amniotic fluid. Here, amniotic fluid samples were collected in the course of a larger study on amniotic fluid bacteriology, with prior ethical approval and informed patient consent. Amniotic fluid was obtained at Caesarean Section by direct needle aspiration from the intact amnion. Analysis with Staphylococcal API test kits led to identification of Staphylococcus lugdunensis in two cases. The clinical significance of the finding in these reported cases is undetermined. Staphylococcus lugdunensis has been shown to be a cause of serious and potentially fatal morbidities, but this is the first report of its culture from amniotic fluid. As caesarean delivery is accepted as the single most important factor associated with post-partum infectious complications in both mother and neonate, the identification of this pathogen is a new concern.

Unusually virulent coagulase-negative Staphylococcus lugdunensis is frequently associated with infective endocarditis: a Waikato series of patients

BACKGROUND

Staphylococcus lugdunensis, a species of coagulase-negative staphylococci is associated with a wide variety of infections ranging from mild skin and soft tissue infections to serious infections which include brain abscess, chronic osteomyelitis and infective endocarditis. The aim of this study was to review cases of S. lugdunensis bacteraemia isolated from a New Zealand tertiary institution and describe the clinical presentation, diagnosis and treatment of the patients.

METHODS

All blood cultures reported positive for S. lugdunensis from the Microbiology Laboratory, Waikato Hospital, New Zealand between March 2006 to April 2011 were reviewed.

RESULTS

A total of 11 cases of S. lugdunensis bacteraemia were identified during the 5-year period. Three (27%) cases were due to infective endocarditis with one delayed diagnosis due to the failure of recognize the coagulase-negative Staphylococcus. Transthoracic or transoesophageal echocardiography was performed in 6 (55%) of the patients. One patient with endocarditis required early surgery and the other two were managed successfully with intravenous antibiotics. There was no in hospital mortality in the patients with endocarditis. The remaining 8 cases included 1 (9%) necrotizing fasciitis, 1 (9%) immunocompromised nosocomial multiple organism sepsis, 1 (9%) deep tissue infection requiring 6 weeks of intravenous antibiotics, 2 (18.5%) superficial skin infection, 1 (9%) nosocomial post-pacemaker insertion infection and 2 (18.5%) had fever of unknown origin. All isolates were sensitive to Flucloxacillin and Vancomycin. Overall the survival rate of the acute presentation and treatment was 91% (10/11).

CONCLUSION

Three of our 11 patients (27%) with S. lugdunensis bacteraemia were diagnosed with infective endocarditis. Evaluation for endocarditis is therefore advised in patients who have positive blood culture for this organism.

Acute necrotizing sinusitis caused by Staphylococcus lugdunensis

Staphylococcus lugdunensis is most commonly associated with infections arising from the inguinal region, but here we report this organism as a cause of bacterial sinusitis, highlighting its potential niche as a commensal of the upper airways. The severity of necrosis demonstrates the potential for destructive pathology mimicking Staphylococcus aureus disease.