Clinical Significance of<i>Staphylococcus lugdunensis</i>Isolated from Routine Cultures

Kleiner, Elizabeth; Monk, Alastair B.; Archer, Gordon L.; Forbes, Betty A.

doi:10.1086/656280

Cited by 52 publications

(65 citation statements)

References 12 publications

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“…The presence of an iron-regulated surface determinant protein, common only to S. lugdunensis and S. aureus (16,17), and a potent cytolytic streptolysin S-like toxin suggests the capacity for skin colonization and possible virulence (16,18). Despite the reputation of S. lugdunensis causing aggressive endocarditis, our findings support those from other reports suggesting that bacteremia does not necessarily always equate to a clinical syndrome or sepsis (5,19,20).…”

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confidence: 84%

Unbiased Species-Level Identification of Clinical Isolates of Coagulase-Negative Staphylococci: Does It Change the Perspective on Staphylococcus lugdunensis?

2015

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Unbiased species-level identification of coagulase-negative staphylococci (CoNS) using matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) identified Staphylococcus lugdunensis to be a more commonly isolated CoNS in our laboratory than previously observed. It has also highlighted the possibility of vertical transmission. C oagulase-negative staphylococci (CoNS) have been mostly considered insignificant contaminants when isolated from clinical samples. This, in turn, has led to a lack of universal agreement on the importance of identifying them to the species level (1, 2).The introduction of matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) to routine clinical laboratories has made it feasible to rapidly and accurately identify clinical isolates without adding significant costs (3, 4).MALDI-TOF MS has been in routine diagnostic use at our laboratory since 2010. We identify all clinical isolates, irrespective of site or clinical details. In an attempt to assess the value of unbiased species-level identification of CoNS, we investigated the epidemiology and clinical correlates associated with the isolation of Staphylococcus lugdunensis, a relatively virulent CoNS that causes a spectrum of disease similar to that of Staphylococcus aureus (5).S. lugdunensis isolates were identified from the laboratory information management system (LIMS). Specimen request forms, electronic clinical records, and written clinical records were reviewed (for hospital and community samples). Only the isolates with a MALDI-TOF MS spectral score of Ն2 (which reflects high confidence in identification to the species level) were included. A total of 20,806 CoNS isolates were identified using MALDI-TOF MS in a 24-month period. Of those, 559 were identified as S. lugdunensis (Table 1), whereas 31 isolates were identified in the preceding 24 months using conventional techniques. Duplicate results from the same patient were removed (n ϭ 81). In total, 478 individual isolates were reviewed ( Table 2). The clinical data we collected included demographics, sample type, sample site, clinical symptoms, diagnosis, comorbidities, antibiotic usage, surgical procedures, and indwelling and prosthetic devices.A total of 121 isolates (25.3%) were from primary care. The male-to-female ratio was 0.84, and the median age was 42 years, with a calculated incidence of 30.5 cases per 100,000 persons in the local population. Twenty-two isolates (4.6%) were from neonates (Ͻ30 days old), with 10 isolated in the first 7 days of life. Of the 22 neonatal isolates, 5 were from sterile sites (blood, n ϭ 3; cerebrospinal fluid [CSF], n ϭ 1; and urine, n ϭ 1) and the rest were from swabs ( Table 3).The commonest infections were skin and soft tissue infections (SSTI), with a total of 237 episodes; of these, 99 (41.8%) were abscesses, and 79 (79.8%) required drainage. Abscesses were equally distributed between the upper and lower halves of the body. The commonest abscess sites were the axilla (n ...

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confidence: 84%

Unbiased Species-Level Identification of Clinical Isolates of Coagulase-Negative Staphylococci: Does It Change the Perspective on Staphylococcus lugdunensis?

2015

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“…taphylococcus lugdunensis is a coagulase-negative staphylococcus (CoNS) belonging to the normal human skin flora (1) that is increasingly recognized as a virulent pathogen in both community-acquired and nosocomial infections (2)(3)(4). It colonizes several distinct niches primarily in the lower part of the body (such as perineal and inguinal areas) but also the lower extremities (including feet and nails) (1).…”

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confidence: 99%

Multi-Virulence-Locus Sequence Typing of Staphylococcus lugdunensis Generates Results Consistent with a Clonal Population Structure and Is Reliable for Epidemiological Typing

et al. 2014

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cStaphylococcus lugdunensis is an emergent virulent coagulase-negative staphylococcus responsible for severe infections similar to those caused by Staphylococcus aureus. To understand its potentially pathogenic capacity and have further detailed knowledge of the molecular traits of this organism, 93 isolates from various geographic origins were analyzed by multi-virulence-locus sequence typing (MVLST), targeting seven known or putative virulence-associated loci (atlL R2 , atlL R3 , hlb, isdJ, SLUG_09050, SLUG_16930, and vwbl). The polymorphisms of the putative virulence-associated loci were moderate and comparable to those of the housekeeping genes analyzed by multilocus sequence typing (MLST). However, the MVLST scheme generated 43 virulence types (VTs) compared to 20 sequence types (STs) based on MLST, indicating that MVLST was significantly more discriminating (Simpson's index [D], 0.943). No hypervirulent lineage or cluster specific to carriage strains was defined. The results of multilocus sequence analysis of known and putative virulence-associated loci are consistent with a clonal population structure for S. lugdunensis, suggesting a coevolution of these genes with housekeeping genes. Indeed, the nonsynonymous to synonymous evolutionary substitutions (d N /d S ) ratio, the Tajima's D test, and Single-likelihood ancestor counting (SLAC) analysis suggest that all virulence-associated loci were under negative selection, even atlL R2 (AtlL protein) and SLUG_16930 (FbpA homologue), for which the d N /d S ratios were higher. In addition, this analysis of virulence-associated loci allowed us to propose a trilocus sequence typing scheme based on the intragenic regions of atlL R3 , isdJ, and SLUG_16930, which is more discriminant than MLST for studying short-term epidemiology and further characterizing the lineages of the rare but highly pathogenic S. lugdunensis.

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“…It is a non-motile, facultative anerobe that may demonstrate hemolysis on blood agar [8]. The frequency of S. lugdunensis infection is probably underappreciated, since many clinical laboratories do not routinely speciate CoNS [6,7]. The presence of clumping factor and variable performance characteristics of slide and rapid latex agglutination tests makes tube coagulation test important in distinguishing it from S. aureus [9][10][11].…”

Section: Discussionmentioning

confidence: 99%

“…S. lugdunensis is unique among CoNS because of its propensity for causing aggressive native valve infective endocarditis (IE). The frequency of S. lugdunensis infection is probably underappreciated, since many clinical laboratories do not routinely speciate CoNS [6,7].…”

Section: Introductionmentioning

confidence: 99%

The Long CoN(S): A Case of Staphylococcus lugdunensis Endocarditis With Cerebral and Coronary Embolism

2014

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Staphylococcus lugdunensis is a coagulase-negative staphylococcus, which in humans can cause virulent infections frequently attributable to Staphylococcus aureus including superficial skin/soft tissue infections, infective endocarditis, osteomyelitis and endophthalmitis. A 61-year-old male with history of recent fixation of C1-C2 neck fracture, presented with sudden onset of right-sided weakness and fever. Examination revealed dense hemiplegia with UMN facial palsy of right side, and a pan-systolic murmur in the mitral area, radiating to the axilla. He had an elevated troponin-I of 18.8 ng/mL with right bundle branch block on EKG. Echocardiogram revealed mobile vegetation on the anterior leaflet of the mitral valve with ejection fraction of 55% and no regional wall motion abnormality. He continued to have persistent high-grade fevers in spite of appropriate antibiotic therapy and blood cultures were persistently positive for S. lugdunensis for 5 days. He developed weakness of his left side after 2 weeks of hospital admission and MRA revealed left carotid dissection and complete occlusion of the right middle cerebral artery distal to the M1 segment which was embolic in nature. The frequency of S. lugdunensis infection is underappreciated and biofilm formation plays a major role in the pathogenesis. This is the first reported case of S. lugdunensis endocarditis complicated by NSTEMI from coronary embolism and simultaneous stroke from cerebral embolism. Due to the early, frequent and fatal complications from S. lugdunensis bacteremia, we might have to consider early surgical intervention in the absence of class I or IIa recommendation.

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Clinical Significance ofStaphylococcus lugdunensisIsolated from Routine Cultures

Cited by 52 publications

References 12 publications

Unbiased Species-Level Identification of Clinical Isolates of Coagulase-Negative Staphylococci: Does It Change the Perspective on Staphylococcus lugdunensis?

Unbiased Species-Level Identification of Clinical Isolates of Coagulase-Negative Staphylococci: Does It Change the Perspective on Staphylococcus lugdunensis?

Multi-Virulence-Locus Sequence Typing of Staphylococcus lugdunensis Generates Results Consistent with a Clonal Population Structure and Is Reliable for Epidemiological Typing

The Long CoN(S): A Case of Staphylococcus lugdunensis Endocarditis With Cerebral and Coronary Embolism

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