Native-valve endocarditis caused by Staphylococcus lugdunensis

Abstract

Coagulase-negative staphylococci cause about 5% of native-valve endocarditis. Staphylococcus lugdunensis, a recently-described species of coagulase-negative staphylococci, has been reported to cause destructive native-valve endocarditis with a high mortality. We report four consecutive cases of definite Staphylococcus lugdunensis native-valve endocarditis by the Duke criteria over a 4-year period. All patients required urgent aortic valve replacement 1-5 days after admission, and recovered. An intriguing, aspect in the presentation of these patients was a history of vasectomy and inguinal skin breaks in the immediate period preceding the occurrence of endocarditis.

Diagnosis and Management of Infective Endocarditis and Its Complications

“…This CNS organism tends to cause a substantially more virulent form of IE than other CNS, with high rates of perivalvular extension of infection and metastatic seeding to distant organs, despite uniform susceptibility in vitro to most antibiotics. [61][62][63] Most experts recommend that IE caused by this organism be treated with standard regimens based on the in vitro susceptibility profiles of the strain and that the patient be monitored carefully for development of periannular extension or extracardiac spread of infection. The differentiation of S lugdunensis from other CNS may be difficult in the microbiology laboratory with routine commercial identification schema and may require referral to a reference laboratory.…”

Staphylococcus lugdunensis Infections: High Frequency of Inguinal Area Carriage

“…These results are consistent with the suggestion that the preferred site of S. lugdunensis carriage may be the perineum rather than the entire skin surface. Associations have been reported between S. lugdunensis endocarditis and inguinal skin breaks occurring in the context of vasectomy (7), scrotal wounds (24), renal transplantation (24), continuous ambulatory peritoneal dialysis (14), femoral arterial catheterization, total-knee arthroplasty (24), prostatic cancer (8), and inguinal furuncle (17,25). Several cases of ventriculoperitoneal shunt infection caused by S. lugdunensis have also been reported (5,27).…”

Frequency of Isolation of Staphylococcus lugdunensis in Consecutive Urine Cultures and Relationship to Urinary Tract Infection

“…Patients infected with the organism have a clinical presentation much like that of patients infected with Staphylococcus aureus. Reports have associated S. lugdunensis with skin and soft tissue infections (3, 5), respiratory infections (3), bacteremia, including endocarditis (1,2,3,6,7,8,11), intravascular catheter or pacemaker infections (3), prosthetic joint infections (9), and peritonitis (10).We are aware of only one study which has determined the frequency of S. lugdunensis in consecutive clinical cultures. Herchline and Ayers (3) surveyed S. lugdunensis isolates from clinical specimens in their laboratory over a 63-month period.…”

“…Patients infected with the organism have a clinical presentation much like that of patients infected with Staphylococcus aureus. Reports have associated S. lugdunensis with skin and soft tissue infections (3,5), respiratory infections (3), bacteremia, including endocarditis (1,2,3,6,7,8,11), intravascular catheter or pacemaker infections (3), prosthetic joint infections (9), and peritonitis (10).…”

“…As this organism can be part of the "normal" perineal flora (3,6), it may contaminate urine during the collection process. Additional studies are required to determine whether larger versus smaller colony counts of S. lugdunensis in urine cultures are more clinically relevant.…”