Staphylococcus lugdunensis , a Common Cause of Skin and Soft Tissue Infections in the Community

Abstract

Staphylococcus lugdunensis, a rare cause of severe infections such as native valve endocarditis, often causes superficial skin infections similar to Staphylococcus aureus infections. We initiated a study to optimize the identification methods in the routine laboratory, followed by a population-based epidemiologic analysis of patients infected with S. lugdunensis in Viborg County, Denmark. Recognition of a characteristic Eikenella corrodens-like odor on Columbia sheep blood agar combined with colony pleomorphism and prominent ␤-hemolysis after 2 days of incubation, confirmed by API-ID-32 Staph, led to an 11-fold increase in the detection of S. lugdunensis. By these methods we found 491 S. lugdunensis infections in 4 years, corresponding to an incidence of 53 per 100,000 per year, an increase from 5 infections per 100,000 inhabitants in the preceding years. Seventy-five percent of the cases were found in general practice; these were dominated by skin abscesses (36%), wound infections (25%), and paronychias (13%). Fifty-six percent of the infections occurred below the waist, and toes were the most frequently infected site (21%). Only 3% of the patients suffered from severe invasive infections. The median age was 52 years, and the male/female ratio was 0.69. Our study shows that S. lugdunensis is a common cause of skin and soft-tissue infections (SSTI) and is probably underrated by many laboratories. S. lugdunensis should be accepted as a significant pathogen in SSTI and should be looked for in all routine bacteriological examinations, and clinicians should be acquainted with the name and the pathology of the bacterium.Staphylococcus lugdunensis, one of the coagulase-negative staphylococci (CoNS), was first described by Freney et al. 20 years ago (8). It causes severe infections similar to Staphylococcus aureus infections, especially acute endocarditis in prosthetic and native valves (14,24,29,30,36). Other infections such as osteomyelitis (17, 23), peritonitis (28), intravascular catheter infections (5, 32), prosthetic joint infections (26), and urinary tract infections have also been reported (10). S. lugdunensis has been reported as an important cause also of skin and soft tissue infections (SSTI), primarily in the groin (1, 39) and mammae (13,22,25,37,41).S. lugdunensis is part of the normal human skin flora and commonly colonizes the perineal region (1, 37, 39); however, carriage rates of different CoNS are not comprehensively accounted for, and only a few have looked for S. lugdunensis carriage (13, 16, 39).Our study was undertaken after two serious cases of S. lugdunensis infection, a fatal case of endocarditis with protracted bacterial identification but correct antibiotic treatment and a case of late-diagnosed osteomyelitis, which prompted an optimization of our routine microbiological methods for identification of S. lugdunensis. This subsequently increased the number of S. lugdunensis isolates significantly, especially in samples from patients in general practice, and encouraged us to conduct a prospectiv...

Staphylococcus lugdunensis: case report and discussion

“…It was postulated that the preferred niche for S. lugdunensis might be in areas that contain apocrine sweat glands, specifically the anogenital region, axillae, mammary areolae, eyelids and auditory canals. 7 Unlike S. aureus and more recently coagulasenegative S. epidermidis, 15 S. lugdunensis is yet to be implicated as a triggering or complicating factor in atopic dermatitis.…”

Real-Time PCR Testing for mecA Reduces Vancomycin Usage and Length of Hospitalization for Patients Infected with Methicillin-Sensitive Staphylococci

“…The staphylococci are some of the most common agents of community-acquired and nosocomial infections (4,6). Staphylococcus aureus is the most virulent staphylococcal species and causes disease in virtually any tissue site, most notably, skin and wound infections, as well as pneumonia, osteomyelitis, and sepsis (6).…”

Catalase-Negative Staphylococcus lugdunensis Strain with a Novel Point Mutation in the Catalase Gene Isolated from a Patient with Chronic Suppurative Otitis Media

“…In addition, the isolate showed negative results for the slide and tube coagulase tests (performed with EDTAhuman plasma) with the primary and subculturing cultures. In the tube coagulase test, the isolate tested negative at every time point (1,2,3,4,6,8,10,12, and 24 h). Staphylococcus aureus (ATCC 25923) was used as the positive control.…”