Pathogenic Mechanisms and Host Interactions in Staphylococcus epidermidis Device-Related Infection

Abstract

Staphylococcus epidermidis is a permanent member of the normal human microbiota, commonly found on skin and mucous membranes. By adhering to tissue surface moieties of the host via specific adhesins, S. epidermidis is capable of establishing a lifelong commensal relationship with humans that begins early in life. In its role as a commensal organism, S. epidermidis is thought to provide benefits to human host, including out-competing more virulent pathogens. However, largely due to its capacity to form biofilm on implanted foreign bodies, S. epidermidis has emerged as an important opportunistic pathogen in patients receiving medical devices. S. epidermidis causes approximately 20% of all orthopedic device-related infections (ODRIs), increasing up to 50% in late-developing infections. Despite this prevalence, it remains underrepresented in the scientific literature, in particular lagging behind the study of the S. aureus. This review aims to provide an overview of the interactions of S. epidermidis with the human host, both as a commensal and as a pathogen. The mechanisms retained by S. epidermidis that enable colonization of human skin as well as invasive infection, will be described, with a particular focus upon biofilm formation. The host immune responses to these infections are also described, including how S. epidermidis seems to trigger low levels of pro-inflammatory cytokines and high levels of interleukin-10, which may contribute to the sub-acute and persistent nature often associated with these infections. The adaptive immune response to S. epidermidis remains poorly described, and represents an area which may provide significant new discoveries in the coming years.

Tailoring Antimicrobial Susceptibility Testing to Individual Species of Coagulase-Negative Staphylococci: Next Up, Staphylococcus epidermidis

“…It is the CoNS species most commonly recovered from clinical specimens (2) and is an important cause of nosocomial and foreign-body-related infections, especially among immunocompromised individuals (4). Because of the ability of this species to form biofilms, treatment can be complicated (5) and may require protracted courses of antimicrobials. Furthermore, S. epidermidis isolates often display resistance to many classes of antimicrobials, including the beta-lactams (6).…”

Relationship between quinolone use and resistance of Staphylococcus epidermidis in patients with acne vulgaris

“…S. epidermidis normally functions to balance the skin microbiome and is rarely pathogenic to healthy individuals. However, the species can cause surgical site infection (SSI), skin infection and opportunistic infection in aged or immunocompromised individuals . Furthermore, biofilms on the surface of clinical devices are correlated with antimicrobial resistance and delay healing.…”

Staphylococcus epidermidis: how to turn from commensal to be a pathogen lifestyle

“…In this study, the initial adhesion to different materials (acrylic and glass For example, S. epidermidis may be involved in prosthetic joint, vascular graft, surgical site, central nervous system shunt and cardiac device infections. 5,[9][10][11] In contrast to S. aureus, S. epidermidis does not produce many aggressive virulence factors, and consequently the infections caused are, at least in immunocompetent patients, often low-grade and chronic. For severely immunocompromised patients, S. epidermidis may develop into a life-threatening pathogen triggering septicaemia, meningitis, and other serious conditions 1,12 Staphylococcus epidermidis infections mostly are considered as being extremely recalcitrant to therapy.…”

“…S. epidermidis, generally regarded as an opportunist pathogen, is now recognised as a real "new" pathogen, since it is the major etiologic agent of BAI. 10,11,15 Biomaterialassociated infections is generally related to microbial biofilm formation, defined as a microbial community encased in a matrix of self-produced extracellular polymeric substances (slime). Slime affects antimicrobial resistance as well as the effectiveness of the host immune system 14,16 .…”