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Pirbonyeh N, Emami A, Bazargani A, Javanmardi F, Hosseini SM, Derakhshan B. Integron-Related Resistance in New Emerged Staphylococcus lugdunensis Infection in Burn Patients. J Burn Care Res 2021; 41:598-603. [PMID: 31867617 DOI: 10.1093/jbcr/irz211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Staphylococcus lugdunensis is a coagulase-negative Staphylococcus species that may cause various infections with unusual severity. In spite of the administration of various antibiotics, infections caused by such bacteria are become resistant significantly. Transmission of antibiotic resistance genes, especially by Integron structures, exacerbates the prevalence of resistant strains. To investigate the antibiotic susceptibility pattern of S. lugdunensis as a new emergence in burns, the presence of integron classes (I, II, III) was performed in recent study. Sampling for this study was carried out over a period of 13 months (January 2017 to February 2018) from Amir-Al-Momenin burn center of southwest of Iran, affiliated with Shiraz University of Medical Sciences. Twenty-eight isolates of S. lugdunensis were confirmed by phenotypic tests. The presence of integron classes was evaluated by PCR technique and specific primers. The majority of studied infectious agents were seen in ICU with 28.57%. The prevalence of class I and II integrons was 7 (25.00%) and 2 (7.14%), respectively, in S. lugdunensis isolates, whereas no integron III was found. No significant association was seen between antibiotic resistance and the present integrons (P > .05). Since the prevalence of S. lugdunensis strains as a new emergence infection is increasing in clinical settings especially burns, preventing drug resistance in these isolates is inevitable. So knowing the epidemiology pattern of new emerging infections and their resistant pattern is very helpful in infection control and save hospitalized patients life.
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Affiliation(s)
- Neda Pirbonyeh
- Burn and Wound Healing Research Center, Microbiology Department, Shiraz University of Medical Sciences, Iran
| | - Amir Emami
- Burn and Wound Healing Research Center, Microbiology Department, Shiraz University of Medical Sciences, Iran
| | - Abdollah Bazargani
- Bacteriology and Virology Department, Medical School, Shiraz University of Medical Sciences, Iran
| | - Fatemeh Javanmardi
- Burn and Wound Healing Research Center, Microbiology Department, Shiraz University of Medical Sciences, Iran
| | - Seyed Mohsen Hosseini
- Burn and Wound Healing Research Center, Microbiology Department, Shiraz University of Medical Sciences, Iran
| | - Bahram Derakhshan
- Burn and Wound Healing Research Center, Microbiology Department, Shiraz University of Medical Sciences, Iran
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Hurvitz N, Cahan LOS, Gross I, Grupel D, Megged O, Pasternak Y, Temper V, Levy R, Weiser G, Hashavya S. The role of Staphylococcus lugdunensis as a pathogen in children: a multicentre retrospective study. J Med Microbiol 2021; 70. [PMID: 34038340 DOI: 10.1099/jmm.0.001357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction: Staphylococcus lugdunensis (SL), a tube coagulase negative Staphylococcus, is known to be pathogenic in adults, causing mainly skin infections.Gap Statement: Previous studies assessing SL's role in paediatric populations are sparse and are mainly limited to case reports.Aim: Present the clinical characteristics consistent with SL infections and its putative role as a pathogen in the paediatric population.Methodology: A retrospective multicentre study was conducted in four paediatric medical centres in Israel. Patients with isolates of SL presenting between 2009-2019 were included.Results: SL was isolated from 40 patients. Average (±SD) age at presentation was 5.9 (±6.2) years, with 22 (55 %) being female. Skin, soft tissue and musculoskeletal infections were the most common (n=20, 50%) followed by ear infections (n=13, 32.5%). Five cases of urine isolates and two isolates from blood culture samples were also reported. Skin abscess was the most common infection among skin and soft tissue isolates, reported in 17 children (85%) with SL being the only pathogen in 15 (75%). Otitis media was the most common ear infection accounting for 12 (92%) of all cases with SL as the only isolate reported in 6 (46%). Five cases of SL isolates from urine specimens were reported, all of which with poor growth of bacteria and normal urinalysis. Two cases of SL growth in blood culture were found in children presenting with signs and symptoms consistent with invasive blood stream infection.Conclusions: In the paediatric population, studied infections caused by SL are increasingly observed. The results of this study highlight its role as a pathogen in soft tissue infections and its putative role in otitis media and invasive blood stream infections. However, the role of SL as an uropathogen was not established.
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Affiliation(s)
- Noa Hurvitz
- Faculty of Medicine, Hadassah-Hebrew University Medical Centre, Jerusalem, Israel
| | | | - Itai Gross
- Department of Paediatric Emergency Medicine, Hadassah-Hebrew University Medical Centre, Jerusalem, Israel
| | - Daniel Grupel
- Department of Infectious Diseases, Samson Assuta Ashdod University Hospital, Ashdod, Israel
| | - Orli Megged
- Faculty of Medicine, Hadassah-Hebrew University Medical Centre, Jerusalem, Israel.,Department of Paediatrics and Paediatric Infectious Diseases Unit, Shaare Zedek Medical centre, Jerusalem, Israel
| | - Yehonatan Pasternak
- Schneider Children's Medical Centre in Israel, Ward A, Paediatrics, Sackler School of Medicine, Tel Aviv University, Petah Tikva, Israel
| | - Violeta Temper
- Department of Microbiology, Hadassah-Hebrew University Medical Centre, Jerusalem, Israel
| | - Rachel Levy
- Schneider Children's Medical Centre in Israel, Ward A, Paediatrics, Sackler School of Medicine, Tel Aviv University, Petah Tikva, Israel
| | - Giora Weiser
- Department of Paediatric Emergency Medicine, Shaare Zedek Medical centre, Jerusalem, Israel
| | - Saar Hashavya
- Department of Paediatric Emergency Medicine, Hadassah-Hebrew University Medical Centre, Jerusalem, Israel
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Douedi S, Upadhyaya VD, Obagi A, Hossain M. Aggressive Staphylococcus lugdunensis Endocarditis in a Young Healthy Patient: A Case Report. Cardiol Res 2020; 11:192-195. [PMID: 32494329 PMCID: PMC7239590 DOI: 10.14740/cr1037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 02/26/2020] [Indexed: 11/11/2022] Open
Abstract
Staphylococcus lugdunensis (S. lugdunensis) is a β-hemolytic coagulase-negative staphylococcus causing skin and soft tissue infections with an increasing incidence. Commonly found as normal flora in the perineal region, S. lugdunensis has been found in rare cases of infective endocarditis causing increased morbidity and mortality. We present a case of a previously healthy young male diagnosed with S. lugdunensis-caused infective endocarditis. A 31-year-old male with no significant past medical history, who presented to the emergency department with acute onset crushing substernal chest pressure and dyspnea with profuse sweating following 1-week-long febrile illness and malaise. The initial electrocardiogram (ECG) showed diffuse ST depressions in all precordial leads, consistent with an acute coronary syndrome. Emergent transthoracic echocardiogram revealed an ejection fraction (EF) of 45% with severe aortic insufficiency with emanating from a torn right coronary cusp. The patient had a cardiac arrest, and recovery of spontaneous circulation (ROSC) was obtained after 13 min. He subsequently underwent mechanical aortic valve replacement surgery. The native valve specimen cultures grew S. lugdunensis. Postoperatively and after a long course of antibiotics, the patient fully recovered without complications. S. lugdunensis is a common organism with increasing incidence that can lead to significant morbidity and mortality if not properly detected and treated. We hope this case presentation would support emergency valve replacement surgery in patients with S. lugdunensis-suspected infective endocarditis.
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Affiliation(s)
- Steven Douedi
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ 07753, USA
| | - Vandan D Upadhyaya
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ 07753, USA
| | - Aref Obagi
- Department of Cardiology, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ 07753, USA
| | - Mohammad Hossain
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ 07753, USA
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Taha L, Stegger M, Söderquist B. Staphylococcus lugdunensis: antimicrobial susceptibility and optimal treatment options. Eur J Clin Microbiol Infect Dis 2019; 38:1449-1455. [PMID: 31144243 PMCID: PMC6647525 DOI: 10.1007/s10096-019-03571-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 04/25/2019] [Indexed: 11/28/2022]
Abstract
Staphylococcus lugdunensis is a coagulase-negative staphylococcus (CoNS) with unusual pathogenicity resembling that of S. aureus. Unlike other CoNS, S. lugdunensis remains susceptible to most antibiotics. The resistance to penicillin varies widely (range, 15–87% worldwide), whereas methicillin resistance is still rare. We aimed to evaluate treatment options for infections caused by S. lugdunensis and more specifically to investigate whether penicillin G could be a better treatment choice than oxacillin. Susceptibility testing was performed using the disc diffusion method for penicillin G, cefoxitin, trimethoprim/sulfamethoxazole, erythromycin, clindamycin, gentamicin, norfloxacin, fusidic acid, rifampicin, and fosfomycin. Isolates susceptible to penicillin G were further tested with a gradient test for penicillin G and oxacillin. Of the 540 clinical isolates tested, 74.6% were susceptible to penicillin G. Among these penicillin-susceptible isolates, the MIC50 and MIC90 values for penicillin G were threefold lower than that for oxacillin. A majority of the isolates were susceptible to all other antibiotics tested. Breakpoints for fosfomycin have not yet been defined, and so no conclusions could be drawn. Two isolates were resistant to cefoxitin and carried the mecA gene; whole-genome sequencing revealed that both harbored the SCCmec element type IVa(2B). S. lugdunensis isolated in Sweden were susceptible to most tested antibiotics. Penicillin G may be a more optimal treatment choice than oxacillin. Although carriage of the mecA gene is rare among S. lugdunensis, it does occur.
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Affiliation(s)
- Lana Taha
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Marc Stegger
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Bo Söderquist
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden. .,Department of Laboratory Medicine, Clinical Microbiology, Örebro University Hospital, SE-701 85, Örebro, Sweden.
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Heilmann C, Ziebuhr W, Becker K. Are coagulase-negative staphylococci virulent? Clin Microbiol Infect 2018; 25:1071-1080. [PMID: 30502487 DOI: 10.1016/j.cmi.2018.11.012] [Citation(s) in RCA: 151] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 11/06/2018] [Accepted: 11/11/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Progress in contemporary medicine is associated with an increasing number of immunocompromised individuals. In this vulnerable group, the underlying disease together with long-term hospitalization and the use of medical devices facilitate infections by opportunistic pathogens, of which coagulase-negative staphylococci (CoNS) represent a prime example. OBJECTIVES The diversity of CoNS with species- and strain-specific differences concerning virulence and clinical impact is highlighted. A focus is on the ability of CoNS to generate biofilms on biotic and abiotic surfaces, which enables skin and mucosa colonization as well as establishment of CoNS on indwelling foreign bodies. SOURCES Literature about the virulence of CoNS listed in PubMed was reviewed. CONTENT Most catheter-related and prosthetic joint infections as well as most other device-related infections are caused by CoNS, specifically by Staphylococcus epidermidis and Staphylococcus haemolyticus. A common theme of CoNS infections is a high antibiotic resistance rate, which often limits treatment options and contributes to the significant health and economic burden imposed by CoNS. IMPLICATIONS Breaching the skin barrier along with the insertion of medical devices offers CoNS opportunities to gain access to host tissues and to sustain there by forming biofilms on foreign body surfaces. Biofilms represent the perfect niche to protect CoNS from both the host immune response and the action of antibiotics. Their particular lifestyle, combined with conditions that facilitate host colonization and infection, has led to the growing impact of CoNS as pathogens. Moreover, CoNS may serve as hidden reservoirs for antibiotic resistance and virulence traits.
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Affiliation(s)
- C Heilmann
- Institute of Medical Microbiology, University Hospital Münster, Münster, Germany
| | - W Ziebuhr
- Institute for Molecular Infection Biology, University of Würzburg, Würzburg, Germany
| | - K Becker
- Institute of Medical Microbiology, University Hospital Münster, Münster, Germany.
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Arciola CR, Campoccia D, An YH, Baldassarri L, Pirini V, Donati ME, Pegreffi F, Montanaro L. Prevalence and Antibiotic Resistance of 15 Minor Staphylococcal Species Colonizing Orthopedic Implants. Int J Artif Organs 2018; 29:395-401. [PMID: 16705608 DOI: 10.1177/039139880602900409] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Several species belonging to Staphylococcus genus (nonSau/nonSep species) exhibit increasing abilities as opportunistic pathogens in colonisation of periprosthesis tissues. Here we report on antibiotic resistance of 193 strains, belonging to nonSau/nonSep species, consecutively collected from orthopedic implant infections in a period of about 40 months. The 193 strains (representing 17% of all staphylococci isolated) were analysed for their antibiotic resistance to 16 different drugs. Five species turned out more prevalent, ranging from 1 to 5%: S. hominis (4.2%), S. haemolyticus (3.7%), S. capitis (2.7%), S. warneri (2.6%), and S. cohnii (1.6%). Among these, the prevalence of antibiotic resistance to penicillins was similar, ranging from 51% to 66%. Conversely, significant differences were observed for all the remaining antibiotics. For S. haemolyticus the resistances to oxacillin and imipenem, the four aminoglycosides and erythromycin were at least twice that of the other three species which were compared. S. warneri was on the contrary the species with the lowest occurrence of resistant strains. Ten species appeared only rarely at the infection sites: S. lugdunensis, S. caprae, S. equorum, S. intermedius, S. xylosus, S. simulans, S. saprophyticus, S. pasteuri, S. sciuri, and S. schleiferi. The behaviours of these species, often resistant to penicillins, were individually analysed. Differences in both the frequencies and the panels of antibiotic resistances observed among the nonSau/nonSep species: i) suggest that horizontal spreading of resistance factors, if acting, was not sufficient per se to level their bio-diversities; ii) highlight and confirm the worrisome appearance within the Staphylococcus genus of emerging “new pathogens”, not homogeneous for their virulence and antibiotic resistance prevalence, which deserve to be recognised and treated individually.
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Affiliation(s)
- C R Arciola
- Research Unit on Implant Infections, Rizzoli Orthopedic Institute, Bologna, Italy.
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Yen TY, Sung YJ, Lin HC, Peng CT, Tien N, Hwang KP, Lu JJ. Emergence of oxacillin-resistant Staphylococcus lugdunensis carrying staphylococcal cassette chromosome mec type V in central Taiwan. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2016; 49:885-891. [DOI: 10.1016/j.jmii.2014.11.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 11/12/2014] [Accepted: 11/29/2014] [Indexed: 11/26/2022]
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Chaparro J, Murphy E, Davis C, Viani RM, Pong A. Chest Pain and Shortness of Breath in a Previously Healthy Teenager. J Pediatric Infect Dis Soc 2015; 4:171-3. [PMID: 26407419 DOI: 10.1093/jpids/piu036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 03/29/2014] [Indexed: 11/14/2022]
Affiliation(s)
- Juan Chaparro
- Department of Pediatrics, Division of Infectious Diseases Department of Pediatrics
| | | | - Christopher Davis
- Department of Pediatrics Department of Pediatrics, Division of Cardiology, University of California San Diego School of Medicine - Rady Children's Hospital San Diego
| | - Rolando M Viani
- Department of Pediatrics, Division of Infectious Diseases Department of Pediatrics
| | - Alice Pong
- Department of Pediatrics, Division of Infectious Diseases Department of Pediatrics
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Htwe TH, Khardori NM. Cardiac emergencies: infective endocarditis, pericarditis, and myocarditis. Med Clin North Am 2012; 96:1149-69. [PMID: 23102482 DOI: 10.1016/j.mcna.2012.09.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Cardiac infections presenting as emergencies include complications of infective endocarditis, including congestive heart failure, chordae tendinae rupture, cardiac arrhythmias, and embolic phenomenon; acute pericarditis, including cardiac tamponade; and acute myocarditis presenting with malignant cardiac arrhythmias or congestive heart failure. Most of these emergent infectious disease manifestations of the cardiovascular system have a good prognosis if diagnosed early and managed appropriately. Newer diagnostic modalities and combined treatment guidelines are available from the European Society of Cardiology and the American Heart Association.
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Affiliation(s)
- Tin Han Htwe
- Division of Infectious Diseases, Sentara Medical Group, Norfolk, VA 23502-3979, USA
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Babu E, Oropello J. Staphylococcus lugdunensis: the coagulase-negative staphylococcus you don't want to ignore. Expert Rev Anti Infect Ther 2012; 9:901-7. [PMID: 21973302 DOI: 10.1586/eri.11.110] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Staphylococcus lugdunensis is a virulent coagulase-negative staphylococcus (CoNS) that behaves like Staphylococcus aureus. Toxic shock syndrome, osteomyelitis, septic arthritis and postoperative endopthalmitis have been observed. Endocarditis complicated by heart failure, periannular abscess formation and embolic phenomenon have brought particular attention to this CoNS. Mortality rates for endocarditis appear higher when compared with other CoNS. Owing to the laboratory methods used, identification may be misleading. β-lactam antimicrobials are recommended pending sensitivities. Evaluation for endocarditis should be pursued in bacteremic patients due to its pathogenic potential.
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Affiliation(s)
- Elizabeth Babu
- Department of Surgery, Division of Critical Care Medicine, The Mount Sinai School of Medicine, New York, NY 10029, USA
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Abstract
OBJECTIVE To evaluate the clinical relevance and impact of an emerging bacterial pathogen, Staphylococcus lugdunensis, in a large teaching hospital. METHODS Three-year retrospective microbiological and clinical review of all S. lugdunensis isolates from a single medical center. RESULTS Seventy-seven isolates were identified; 70 had complete data. Soft tissue, bone, joint, central nervous system, urine and bloodstream infections occurred. Soft tissue infections were primarily abscesses. There were four infections of prosthetic joints and nine cases of osteomyelitis. There were 21 bacteremias, 5 of which were associated with endocarditis; 2 died. Most isolates were penicillin resistant. CONCLUSION S. lugdunensis has emerged as a major human pathogen, capable of causing significant infections at many sites. It should never be dismissed as a contaminant without careful review.
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Patil R, Patil T, Hussain KMA. Staphylococcus lugdunensis native tricuspid valve endocarditis: a case report and review of literature. J Gen Intern Med 2011; 26:1209-11. [PMID: 21538169 PMCID: PMC3181301 DOI: 10.1007/s11606-011-1718-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2009] [Revised: 03/24/2010] [Accepted: 03/29/2011] [Indexed: 11/24/2022]
Abstract
Coagulase negative staphylococci are skin commensals and are generally disregarded as contaminants in clinical specimens. Repeated isolation of coagulase negative staphylococci in blood cultures should warrant a species identification to recognize unusually virulent organisms that demand aggressive treatment, such as Staphylococcus lugdunensis. Staphylococcus lugdunensis is known to cause a wide variety of infections, including a predominant left-sided endocarditis. We report a rare case of native tricuspid valve Staphylococcus lugdunensis endocarditis in a non-intravenous drug user and include a brief literature review.
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Affiliation(s)
- Ritesh Patil
- Millard Fillmore Gates Circle Hospital, Buffalo, NY 14209, USA.
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Chopra A, Gulati D, Woldenberg N, Singh M. Intracardiac lead endocarditis due to Staphylococcus lugdunensis. Int J Infect Dis 2011; 14 Suppl 3:e291-3. [PMID: 20434383 DOI: 10.1016/j.ijid.2009.12.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2009] [Revised: 12/04/2009] [Accepted: 12/11/2009] [Indexed: 10/19/2022] Open
Abstract
Staphylococcus Lugdunensis is a rare but potentially aggressive pathogen in the family of coagulase negative staphylococcus (CoNS). It can cause a wide variety of infections ranging from superficial skin to fulminant infections like endocarditis. Both native and prosthetic valve endocarditis due to S. lugdunensis have been documented in the English literature. Eight cases of pacemaker lead endocarditis due to S. lugdunensis have been described so far. We present the ninth case of pacemaker lead and first case of automatic implantable cardioverter defibrillator (AICD) lead endocarditis due to S. lugdunensis.
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Affiliation(s)
- Anish Chopra
- Department of Internal Medicine, Case Western Reserve University at Metrohealth Medical Center, 2500 Metrohealth Drive, Cleveland, Ohio 44109, USA
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Woznowski M, Quack I, Bölke E, Peiper M, Matuschek C, Gatermann SG, Rump LC, Schieren G. Fulminant staphylococcus lugdunensis septicaemia following a pelvic varicella-zoster virus infection in an immune-deficient patient: a case report. Eur J Med Res 2010; 15:410-4. [PMID: 20952351 PMCID: PMC3351909 DOI: 10.1186/2047-783x-15-9-410] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION the deadly threat of systemic infections with coagulase negative Staphylococcus lugdunensis despite an appropriate antibiotic therapy has only recently been recognized. The predominant infectious focus observed so far is left-sided native heart valve endocarditis, but bone and soft tissue infections, septicaemia and vascular catheter-related bloodstream infections have also been reported. We present a patient with a fatal Staphylococcus lugdunensis septicaemia following zoster bacterial superinfection of the pelvic region. case presentation: a 71-year old male diagnosed with IgG kappa plasmocytoma presented with a conspicuous weight loss, a hypercalcaemic crisis and acute renal failure. After initiation of haemodialysis treatment his condition improved rapidly. However, he developed a varicella-zoster virus infection of the twelfth thoracic dermatome requiring intravenous acyclovir treatment. Four days later the patient presented with a fulminant septicaemia. Despite an early intravenous antibiotic therapy with ciprofloxacin, piperacillin/combactam and vancomycin the patient died within 48 hours, shortly before the infective isolate was identified as Staphylococcus lugdunensis by polymerase chain reaction. CONCLUSION despite S. lugdunensis belonging to the family of coagulase-negative staphylococci with an usually low virulence, infections with S. lugdunensis may be associated with an aggressive course and high mortality. This is the first report on a Staphylococcus lugdunensis septicaemia following a zoster bacterial superinfection of the pelvic region.
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Affiliation(s)
- M Woznowski
- Department of Nephrology, Heinrich-Heine University, Duesseldorf, Germany
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Staphylococcus lugdunensis Infective Endocarditis: A Literature Review and Analysis of Risk Factors. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2010; 43:478-84. [DOI: 10.1016/s1684-1182(10)60074-6] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2009] [Revised: 06/20/2009] [Accepted: 08/25/2009] [Indexed: 11/21/2022]
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Recurrent Staphylococcus lugdunensis Infective Endocarditis and Review of the Literature. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2010. [DOI: 10.1097/ipc.0b013e3181ab2e78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Microbiological characteristics, presumptive identification, and antibiotic susceptibilities of Staphylococcus lugdunensis. J Clin Microbiol 2008; 46:2393-5. [PMID: 18480221 DOI: 10.1128/jcm.00740-08] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
This study validated abbreviated methods for the presumptive identification of Staphylococcus lugdunensis and studied the antibiotic susceptibilities of 106 isolates. The combination of positive responses to ornithine and pyrrolidonyl arylamidase identified all S. lugdunensis isolates. Resistance to penicillin and methicillin was detected in 27 and 5% of isolates, respectively.
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From clinical microbiology to infection pathogenesis: how daring to be different works for Staphylococcus lugdunensis. Clin Microbiol Rev 2008; 21:111-33. [PMID: 18202439 DOI: 10.1128/cmr.00036-07] [Citation(s) in RCA: 236] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Staphylococcus lugdunensis has gained recognition as an atypically virulent pathogen with a unique microbiological and clinical profile. S. lugdunensis is coagulase negative due to the lack of production of secreted coagulase, but a membrane-bound form of the enzyme present in some isolates can result in misidentification of the organism as Staphylococcus aureus in the clinical microbiology laboratory. S. lugdunensis is a skin commensal and an infrequent pathogen compared to S. aureus and S. epidermidis, but clinically, infections caused by this organism resemble those caused by S. aureus rather than those caused by other coagulase-negative staphylococci. S. lugdunensis can cause acute and highly destructive cases of native valve endocarditis that often require surgical treatment in addition to antimicrobial therapy. Other types of S. lugdunensis infections include abscess and wound infection, urinary tract infection, and infection of intravascular catheters and other implanted medical devices. S. lugdunensis is generally susceptible to antimicrobial agents and shares CLSI antimicrobial susceptibility breakpoints with S. aureus. Virulence factors contributing to this organism's heightened pathogenicity remain largely unknown. Those characterized to date suggest that the organism has the ability to bind to and interact with host cells and to form biofilms on host tissues or prosthetic surfaces.
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Bera A, Biswas R, Herbert S, Götz F. The presence of peptidoglycan O-acetyltransferase in various staphylococcal species correlates with lysozyme resistance and pathogenicity. Infect Immun 2006; 74:4598-604. [PMID: 16861647 PMCID: PMC1539615 DOI: 10.1128/iai.00301-06] [Citation(s) in RCA: 125] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Human-pathogenic bacteria that are able to cause persistent infections must have developed mechanisms to resist the immune defense system. Lysozyme, a cell wall-lytic enzyme, is one of the first defense compounds induced in serum and tissues after the onset of infection. Recently, we showed that Staphylococcus aureus is resistant to lysozyme by O acetylating its peptidoglycan (PG) by O-acetyltransferase (OatA). We asked the question of which staphylococcal species PG is O acetylated. We applied various methods, such as genome analysis, PCR, Southern blotting, lysozyme sensitivity assay, and verification of O acetylation of PG by high-performance liquid chromatography (HPLC) analysis. PCR analysis using S. aureus-derived oatA primers and Southern blotting did not yield reliable results with other staphylococcal species. Therefore, we used the HPLC-based assay to directly detect PG O acetylation. Our studies revealed that the muramic acid was O acetylated only in pathogenic, lysozyme-resistant staphylococci (e.g., S. aureus, S. epidermidis, S. lugdunensis, and others). All nonpathogenic species were lysozyme sensitive. They can be divided into sensitive species (e.g., S. carnosus, S. gallinarum, and S. xylosus) and hypersensitive species (e.g., S. equorum, S. lentus, and S. arlettae). In all lysozyme-sensitive species, the analyzed PG was de-O-acetylated. When we transformed the oatA gene from lysozyme-resistant S. aureus into S. carnosus, the corresponding transformants also became lysozyme resistant.
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Affiliation(s)
- Agnieszka Bera
- Microbial Genetics, University of Tübingen, Auf der Morgenstelle 28, D-72076 Tübingen, Germany
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