Investigations on staphylococcal infection of transvenous endocardial pacemaker electrodes

Peters, Georg; Saborowski, F; Locci, R.; Pulverer, G.

doi:10.1016/0002-8703(84)90625-2

Cited by 68 publications

(26 citation statements)

References 14 publications

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“…By the 1980s, the range of infections believed to be caused by CNS, and especially by S. epidermidis, was quite wide and included bacteremia (24,207); native valve endocarditis (NVE) and prosthetic valve endocarditis (7,11,260); osteomyelitis (204,233); pyoarthritis (204); peritonitis during continuous ambulatory dialysis (182,267); mediastinitis (34); prostatitis (45,310); infections of permanent pacemakers (48), vascular grafts and intravascular catheters (242,243), cerebrospinal fluid shunts (100), and prosthetic joints and a variety of orthopedic devices (38,54,218); and UTIs (148,156,192). The CNS species S. saprophyticus was often regarded as a more important opportunistic pathogen than S. epidermidis in human UTIs, especially in young, sexually active females (3,206,307).…”

Section: Introductionmentioning

confidence: 99%

Update on clinical significance of coagulase-negative staphylococci

1994

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The clinical significance of coagulase-negative Staphylococcus species (CNS) continues to increase as strategies in medical practice lead to more invasive procedures. Hospitalized patients that are immunocompromised and/or suffering from chronic diseases are the most vulnerable to infection. Since CNS are widespread on the human body and are capable of producing very large populations, distinguishing the etiologic agent(s) from contaminating flora is a serious challenge. For this reason, culture identification should proceed to the species and strain levels. A much stronger case can be made for the identification of a CNS etiologic agent if the same strain is repeatedly isolated from a series of specimens as opposed to the isolation of different strains of one or more species. Strain identity initially can be based on colony morphology, and then one or more molecular approaches can be used to gain information on the genotype. Many of the CNS species are commonly resistant to antibiotics that are being indicated for staphylococcal infections, with the exception of vancomycin. The widespread use of antibiotics in hospitals has provided a reservoir of antibiotic-resistant genes. The main focus on mechanisms of pathogenesis has been with foreign body infections and the role of specific adhesins and slime produced by Staphylococcus epidermidis. Slime can reduce the immune response and opsonophagocytosis, thereby interfering with host defense mechanisms. As we become more aware of the various strategies used by CNS, we will be in a better position to compromise their defense mechanisms and improve treatment.

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Section: Introductionmentioning

confidence: 99%

Update on clinical significance of coagulase-negative staphylococci

1994

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“…Although Staphylococcus aureus is an important cause of CDI, 4,7,10,[12][13][14][15][16][17][18] the risk of developing CDI after S aureus bacteremia (SAB) is inadequately defined. This uncertainty complicates patient management.…”

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Staphylococcus aureus Bacteremia in Patients With Permanent Pacemakers or Implantable Cardioverter-Defibrillators

et al. 2001

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Background-Although cardiac device infections (CDIs) are a devastating complication of permanent pacemakers or implantable cardioverter-defibrillators, the incidence of CDI in patients with bacteremia is not well defined. The objective of this study was to determine the incidence of CDI among patients with permanent pacemakers or implantable cardioverter-defibrillators who develop Staphylococcus aureus bacteremia (SAB). Methods and Results-A cohort of all adult patients with SAB and permanent pacemakers or implantable cardioverterdefibrillators over a 6-year period was evaluated prospectively. The overall incidence of confirmed CDI was 15 of 33 (45.4%). Confirmed CDI occurred in 9 of the 12 patients (75%) with early SAB (Ͻ1 year after device placement). Fifteen of 21 patients (71.5%) with late SAB (Ն1 year after device placement) had either confirmed (6 of 21, 28.5%) or possible (9 of 21, 43%) CDI. In 60% of the patients (9 of 15) with confirmed CDI, no local signs or symptoms suggesting generator pocket infection were noted. Conclusions-The incidence of CDI among patients with SAB and cardiac devices is high. Neither physical examination nor echocardiography can exclude the possibility of CDI. In patients with early SAB, the device is usually involved, and Ϸ40% of these patients have obvious clinical signs of cardiac device involvement. Conversely, in patients with late SAB, the cardiac device is rarely the initial source of bacteremia, and there is a paucity of local signs of device involvement. The cardiac device is involved, however, in Ն28% of these patients.

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“…Although Staphylococcus epidermidis accounts for most CNS infections, many other species have been identified in association with human infections (3, 27, 29). The importance of CNS as major nosocomial pathogens is mainly associated with prosthetic and indwelling devices such as prosthetic joints, heart valves, pacemaker implants, ventricular-peritoneal shunts, and peritoneal dialysis catheters and with specific clinical disease settings such as postoperative sternotomy, wound infections, urinary tract infections, chronic prostatitis, native valve endocarditis, and septicemia in immunocompromised patients (10,22,24). CNS are nosocomial pathogens associated with multiple antimicrobial resistance mechanisms including, in particular, methicillin resistance (25).…”

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Five-Test Simple Scheme for Species-Level Identification of Clinically Significant Coagulase-Negative Staphylococci

et al. 2003

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A working scheme developed in our laboratory for identification (by species group and species) of coagulasenegative staphylococci (CNS) was evaluated with 201 consecutive isolates and then validated by using the reference method of Kloos and Schleifer (W. E. Kloos and K. H. Schleifer, J. Clin. Microbiol. 1: [82][83][84][85][86][87][88] 1975). This five-test simple scheme (referred to here as the simple scheme) combines the novobiocin susceptibility test with tests for urease, pyrrolidonyl arylamidase, ornithine decarboxylase, and aerobic acid from mannose. The addition of one or two tests within a particular species group could then positively identify the isolate. Two commercial systems, Staph-Zym (Rosco) and API-Staph (bioMérieux), along with results obtained by using Rosco diagnostic tablets (nongrowth tests), were also compared with the reference method. One isolate could not be identified even by the reference method. Of the remaining 200 strains, 191 (95.5%) strains were correctly identified with Staph-Zym and 171 strains (85.5%) were correctly identified with API-Staph. The most frequent clinical CNS species isolated were Staphylococcus epidermidis (50.5%), S. haemolyticus (18.5%), S. saprophyticus subsp. saprophyticus (16.0%), S. lugdunensis (6.0%), and S. warneri (2.5%). The simple scheme validated with the reference method has demonstrated an excellent correlation in the identification of the three most frequent species isolated: S. epidermidis, S. haemolyticus, and S. saprophyticus subsp. saprophyticus. With the simple scheme, identification of CNS was possible within 24 h after the enzymatic tests were used, whereas up to 72 h is necessary for the growth tests. This methodology would be very useful in any clinical microbiology laboratory for the presumptive identification of CNS species groups and species.Many studies have been initiated since 1958 as a result of the growing recognition that coagulase-negative staphylococci (CNS) are clinically important (28) in an attempt to classify these organisms (1, 21). In the 1970s, W. E. Kloos and K. H. Schleifer determined the natural relationships of CNS based on systematic studies that allowed these researchers to resolve and characterize different CNS species (14). Species were identified based on an ensemble of morphological, physiological, and biochemical characteristics, antibiotic susceptibility patterns, and cell wall composition.In the last decade, molecular studies contributed to a notable progress in the classification of staphylococci and in the development of methods for identifying them at the genus, species, subspecies, and strain levels (5). Although Staphylococcus epidermidis accounts for most CNS infections, many other species have been identified in association with human infections (3, 27, 29). The importance of CNS as major nosocomial pathogens is mainly associated with prosthetic and indwelling devices such as prosthetic joints, heart valves, pacemaker implants, ventricular-peritoneal shunts, and peritoneal dialysis catheters and with s...

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Investigations on staphylococcal infection of transvenous endocardial pacemaker electrodes

Cited by 68 publications

References 14 publications

Update on clinical significance of coagulase-negative staphylococci

Update on clinical significance of coagulase-negative staphylococci

Staphylococcus aureus Bacteremia in Patients With Permanent Pacemakers or Implantable Cardioverter-Defibrillators

Five-Test Simple Scheme for Species-Level Identification of Clinically Significant Coagulase-Negative Staphylococci

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