Late Periprosthetic Joint Infection due toStaphylococcus lugdunensisIdentified by Matrix-Assisted Laser Desorption/Ionisation Time of Flight Mass Spectrometry: A Case Report and Review of the Literature

Abstract

Staphylococcus lugdunensis, member to the group of coagulase-negative staphylococci, is previously thought to be rarely isolated. Recently other staphylococci have been described, which were supposedly related to S. lugdunensis, such as Staphylococcus pseudolugdunensis and Staphylococcus pettenkoferi. To decrease the rate misidentifications, an accurate identification method, such as matrix-assisted laser desorption ionization time of flight mass spectrometry or molecular methods, should be used. S. lugdunensis is usually associated with severe infections similar to those caused by S. aureus. Moreover, it has been described that skin infections due to S. lugdunensis are severely underreported and could be also underreported in periprosthetic joint infections. Ours is the first case of a late periprosthetic infection of the hip due to S. lugdunensis, identified by matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry. A periprosthetic infection due to S. lugdunensis should be treated according to protocols of S. aureus periprosthetic infections, and therefore an accurate species identification is desirable.

Evaluation of species-specific score cut-off values for various Staphylococcus species using a MALDI Biotyper-based identification

“…CoNS are increasingly observed as causes of infections of intravascular devices as well as of prosthetic infections (Szabados et al, 2011c). These bacteria must be identified at the species level using reliable and reproducible methods.…”

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

“…Described as a "wolf in sheep's clothing," S. lugdunensis resembles Staphylococcus aureus in its clinical presentation and course of infection (tissue destruction and aggressive clinical course) (2). Even if it can cause many types of infections ranging from localized to systemic (2,5,6), this opportunistic pathogen has been mainly associated with serious infections, such as skin and soft tissue infections (SSTI) (3,4,7,8), infective endocarditis (5, 6, 9, 10), abscesses (11,12), and bone and joint infections (13,14). S. lugdunensis SSTI have been reported to be superficial, painful, often prolonged, and recurrent in patients with skin diseases or after trauma or surgery (7,15).…”

“…Endocarditis is typically characterized by an aggressive and a rapidly progressive clinical course, with mortality rates higher than those for S. aureus (14.5%) or Staphylococcus epidermidis (20%), ranging from 18.2% (10) to 75% (5,18). Of note, the prevalence of S. lugdunensis infections is low but may be underestimated due to a frequent lack of reliable identification of staphylococcal species (2,7,14) before the matrix-assisted laser desorption ionization-time of flight mass spectrometry-based approach was used (19).…”

Small-colony variant of Staphylococcus lugdunensis in prosthetic joint infection

“…This misidentification has been reported in literature and can be compounded by yellow pigment and DNAse production by some strains [9]. The appearance of SCV can also give an impression of mixed culture, with possible interpretation of contamination.…”