Staphylococcus pseudintermedius is a veterinary pathogen that has seldom been described as an agent of human disease. Features of this probably underreported coagulase-positive Staphylococcus species are depicted here through the description of a graftversus-host disease-related wound infection caused by a multidrug-resistant strain. CASE REPORTA 65-year-old male patient who had received (3 years previously) an allogeneic bone marrow transplant (BMT) for chronic lymphoblastic leukemia was admitted to the Pescara Civic Hospital (Italy) because of a wound infection, located in the periumbilical region and showing two different purulent discharges. The lesion was due to chronic graft-versus-host disease (GvHD) that complicated the BMT. The patient affirmed that he lived in proximity to a pet dog and farm cows.Pus staining revealed Gram-positive cocci within leukocytes, while cultures yielded a massive growth of mannitol-nonfermenting coagulase-positive staphylococci (CPS). Based on colony aspect (brightness of the white-gray color), two different isolates (named S32 and S33) were recognized, sharing a double-zone hemolysis on the sheep blood agar plate (Fig. 1). They were identified as Staphylococcus intermedius by both the Vitek2 and the API system (bioMérieux, Marcy l'Etoile, France). However, S. intermedius is the only species belonging to the so-called Staphylococcus intermedius group included in these systems' databases. The S. intermedius group includes S. intermedius, cultured from a wide variety of animals, Staphylococcus pseudintermedius, which recent studies indicate is the prevalent S. intermedius group species harbored by dogs and cats, and Staphylococcus delphini, first isolated from dolphins but later collected from several terrestrial animals (1, 2). Thus, we did not consider this identification as conclusive. Moreover, since the absence of mannitol fermentation, along with the double-zone hemolysis, was highly suggestive for S. intermedius/S. pseudintermedius, the patient was screened for S. intermedius group nasal and skin colonization. Five phenotypically similar organisms were grown from the nasal and the hand skin swabs. Again, they were identified as S. intermedius by the Vitek2 and the API system. Different tests (both phenotypic and genotypic) were performed to confirm the identification. Phenotypically, all the strains were colistin resistant and showed a slow positivity to the Voges-Proskauer reaction (suggesting that the isolates were S. pseudintermedius rather than S. intermedius). Among genotypic assays, 16S rRNA sequencing did not provide a definitive discrimination among S. intermedius, S. pseudintermedius, and S. delphini. The isolates were then analyzed through automated ribotyping (RiboPrinter; Qualicon DuPont, USA). The instrument provided identical fingerprints for all of the strains and identified them as S. intermedius. A specific multiplex PCR was performed, as previously described (3). The isolates were identified as S. pseudintermedius, since a clear band was obtained at 926 ...

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Through a CAMP test, we first observed a Staphylococcus delphini strain (ATCC 49172) to release beta-haemolysin. Production of the latter in this coagulase-positive species of the 'Staphylococcus intermedius Group', in fact, has been labeled to be undetermined, thus far. Of course, a wider number of strains have to be investigated in order to define whether this property is constitutive (like in Staphylococcus (pseud)intermedius), or strain-dependent (like in Staphylococcus aureus), and which clinical impact it has; nevertheless, we can state that S. delphini ATCC 49172 indeed produces this toxin.

Enterococcus hirae is rarely collected from man, while it is a common pathogen in mammals and birds. We describe the first isolation of the organism (strain DSM 27815) from human umbilical cord blood (UCB), thus emphasizing the risk of contamination of UCB units for clinical use. In this context, we also highlight the importance of an extensive training of the collecting personnel as to the observance of the disinfection protocol ensuring UCB units sterility.

A beta-hemolytic Lancefield antigen A-, B-, C-, D-, F-, and G-positive Enterococcus durans strain was cultivated from the rectovaginal swab of a pregnant woman who underwent antenatal screening for Streptococcus agalactiae. The isolate raised concern as to what extent similar strains are misrecognized and lead to false diagnosis of group B streptococci. Streptococcus agalactiae (group B Streptococcus [GBS]) inhabits the human gut, from where it can then colonize the genitourinary tract (1). Up to 30% of pregnant women are asymptomatic GBS carriers, and neonates can therefore acquire the organism vertically at the time of birth unless penicillin or ampicillin is given intravenously as intrapartum antibiotic prophylaxis (IAP). Newborn colonization may establish in 50% of the cases and involves different mucosal and skin sites. One percent to 2% of neonates develop early GBS infection, including bacteremia and/or pneumonia and/or meningitis (1, 2). For these reasons, the CDC (Centers for Disease Control and Prevention) has suggested that women between the 35th and 37th weeks of gestation be screened for GBS carriage through rectovaginal cultures. As IAP has been shown to reduce the risk of vertical S. agalactiae transmission, all GBS-positive women receive prophylaxis as soon as labor begins or when rupture of the amniotic membranes occurs (1).GBS screening is based on the recognition of Gram-positive catalase-negative cocci, mostly beta-hemolytic (on sheep blood agar), showing the Lancefield group B antigen. Nonhemolytic (gamma-hemolytic) variants have been described, however, and may be missed because they are not easily detected. Hence, the CDC recommends the use of chromogenic media that are designed to highlight GBS growth through species-specific coloration of colonies (that may vary depending on the manufacturer) (1).A pregnant woman attending the Spirito Santo Hospital in Pescara, Italy, was screened for rectovaginal GBS colonization according to the CDC guidelines. On Trypticase soy agar (Liofilchem, Italy), beta-hemolytic (Fig. 1) catalase-negative colonies were grown. The isolate formed pairs and chains and showed group B antigen agglutination (detected with the Liofilchem Strepto B latex kit). It was therefore believed to be GBS. Nevertheless, it grew in purple colonies (Fig. 1) on Chromatic StrepB (Liofilchem), whereas this chromogenic medium is designed to support GBS growth in light blue-green colonies (based on the manufacturer's indication, the purple color we observed instead placed the isolate within the Enterococcus genus). Accordingly, the strain was found to produce a negative CAMP reaction (10) (mild enhancing of hemolysis was observed, however).Identification as Enterococcus durans was provided by the Vitek 2 GP card (bioMérieux, France) and matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) using Bruker Biotyper software 2.0 (Bruker Daltonics, Germany) and the Vitek MS v2.0 system (bioMérieux). Sequencing of a 16S rRNA gene 1,458-bp amplicon, analyze...