Staphylococcus lugdunensis Carrying the mecA Gene Causes Catheter-Associated Bloodstream Infection in Premature Neonate

Abstract

A premature neonate had a catheter-associated bloodstream infection due to Staphylococcus lugdunensis. The MIC of oxacillin for the strain was >256 g/ml, and the mecA gene of S. lugdunensis was detected by PCR. The infection was resolved after removal of the line and treatment with vancomycin for 2 weeks. CASE REPORTA baby boy was delivered by caesarean section at 29 weeks of gestation with a birth weight of 980 g. Initial problems included grade III hyaline membrane disease, patent ductus arteriosus, and pulmonary hemorrhage. On day 8 of life, a long line was inserted into the left cubital fossa. On day 23, the baby developed sepsis. He had recurrent apnea and bradycardia requiring him to receive assisted ventilation. The level of Creactive protein was elevated, at 125.5 mg/liter. The total white cell count was 14 ϫ 10 9 /liter, and the immature neutrophil-tototal neutrophil ratio was 0.04. Thrombocytopenia (platelet count, 67 ϫ 10 9 /liter) was also present. Based on empirical evidence, the baby was started on cloxacillin and gentamicin. Two species of staphylococci were isolated from blood cultures taken before antibiotic administration. Both strains were resistant to cloxacillin. Treatment was changed to vancomycin after the baby had been on cloxacillin and gentamicin for 3 days. The long line was removed on the fifth day of infection, when one of the isolated organisms was confirmed to be Staphylococcus lugdunensis; the other isolate was reported to be a coagulasenegative staphylococcus. The culture of the long line tip also yielded S. lugdunensis. The chest X ray showed right upper lobe pneumonia. The results of a cranial ultrasound and a two-dimensional echocardiogram were normal. The baby showed good response to treatment with vancomycin. The level of C-reactive protein decreased to 7.3 mg/liter (on day 13 of vancomycin treatment), and the platelet count increased to 141 ϫ 10 9 /liter (on day 9 of vancomycin treatment). A repeat blood culture was still positive 48 h after vancomycin treatment was started but was negative by day 7. Vancomycin treatment was continued for a total of 2 weeks, with good clinical response. This is the first case report in the English-language literature of an infection due to an S. lugdunensis isolate carrying the mecA gene. Kawaguchi et al. detected mecA in one of two strains of S. lugdunensis in 1996 during a survey of staphylococcal isolates, but no description of clinical infection was given (5). As far as we are aware, this is also the first documentation of S. lugdunensis causing bloodstream infection in a neonate.As noted above, there were two isolates from the first blood culture. Both were characterized as staphylococci by Gram stain, colonial morphology, and a positive catalase reaction. The first isolate was a coagulase-negative staphylococcus with a typical negative reaction in both the latex agglutination test for clumping factor and protein A (BACTi Staph; Remel, Lenexa, Kans.) and the tube coagulase test with rabbit plasma. The second isolate had slightly yellow...

Clinical and Microbiological Characteristics of Community-Acquired Staphylococcus lugdunensis Infections in Southern Taiwan

“…The overall oxacillin-resistant rate was 5% (3/58), which was similar to that in previous reports (12). All three oxacillin-resistant S. lugdunensis isolates had the mecA gene in this study, in contrast to other reports that most oxacillin-resistant S. lugdunensis strains lacked the mecA gene (9,13). For the three mecA gene-positive isolates in this study, one had an oxacillin MIC of м4 g/ml, and two had MICs of 2 g/ml; two had cefoxitin MICs of м8 g/ml, and one had a MIC of 4 g/ml.…”

“…Its clinical course and microbiological characteristics may resemble those of the coagulase-positive Staphylococcus aureus (4,6) and has been associated with more invasive infections (2,4,8,11,13). The purpose of this study was to investigate the clinical and microbiological characteristics of S. lugdunensis isolates at a tertiary hospital in southern Taiwan.…”

Colonization pattern of coagulase-negative staphylococci in preterm neonates and the relation to bacteremia

“…Except for one case report (27), S. lugdunensis is not known to cause neonatal bacteraemia, though this species appears to be more virulent than most other CoNS species (28). It was not possible to determine if this finding of S. lugdunensis represents true sepsis or a contaminant transferred by the NICU staff.…”

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

“…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).…”