Outbreak of Staphylococcus schleiferi Wound Infections: Strain Characterization by Randomly Amplified Polymorphic DNA Analysis, PCR Ribotyping, Conventional Ribotyping, and Pulsed-Field Gel Electrophoresis

Abstract

Within a 1-year period, six surgical-site infections (SSI) caused by Staphylococcus schleiferi were observed in the department of cardiac surgery of Ignatius Hospital, Breda, The Netherlands. Since outbreaks caused by this species of coagulase-negative staphylococci have not been described before, an extensive environmental survey and a case control study were performed in combination with molecular typing of the causative microorganism in order to identify potential sources of infection. Variability, as detected by four different genotyping methods (random amplification of polymorphic DNA [RAPD], conventional and PCR-mediated ribotyping, and pulsed-field gel electrophoresis [PFGE] of DNA macro restriction fragments), appeared to be limited both among the clinical isolates and among several control strains obtained from various unrelated sources. Among unrelated strains, RAPD and PCR-mediated ribotyping identified two types only, whereas seven different types were identified in a relatively concordant manner by conventional ribotyping and PFGE. The latter two procedures proved to be the most useful tools for tracking the epidemiology of S. schleiferi. Four of the outbreak-related strains were identical by both methods, and two isolates showed limited differences. In the search for a potential source of S. schleiferi infection, two slightly different PFGE types were encountered on several occasions in the nose of a single surgeon. These strains were, however, clearly different from the outbreak type. In contrast, S. schleiferi cultures remained negative for two persons identified on the basis of case control analysis. It was demonstrated that SSI caused by S. schleiferi had a clinical impact for patients comparable to that of a wound infection caused by Staphylococcus aureus. This report describes the first well-documented outbreak of S. schleiferi infection. A source of the outbreak was not detected.

Case of Staphylococcus schleiferi Endocarditis and a Simple Scheme To Identify Clumping Factor-Positive Staphylococci

“…These findings fulfilled the Duke clinical criteria for definite endocarditis (4). A recent paper (9) suggested that endocarditis due to S. schleiferi has been previously reported. The references given were two that reported blood culture isolates of S. schleiferi.…”

Case of Staphylococcus schleiferi subspecies coagulans endocarditis and metastatic infection in an immune compromised host

“…The phenotypic similarities of S. schleiferi with S. aureus, in addition to the positive coagulase test, have resulted in misidenti¢cation of these species as S. aureus (2,5). Biochemical markers, which can be used to identify the subspecies of S. schleiferi as unique from S. aureus, include their limited fermentation of maltose, lactose, mannitol, sucrose, and turanose (2,5,7 ). The Staph-Plus test initially used in identi¢cation, which simultaneously detects both clumping factor and protein A, cannot help to distinguish subsp.…”

“…schleiferi from subsp. coagulans (6,7 ). As a result of these subtle variations, misidenti¢cation is common.…”

Recommendations for approaches to meticillin‐resistant staphylococcal infections of small animals: diagnosis, therapeutic considerations and preventative measures.

“…There is an ever‐present risk of MRS exposure for patients and humans in a veterinary hospital. Staphylococcus aureus and S. schleiferi are well‐documented human pathogens, so potential for cross‐species transmission exists. Although not considered to be a human pathogen, S. pseudintermedius can be detected by culture of nasal swabs from dog owners and veterinarians .…”