Staphylococcus lugdunensis: Review of Epidemiology, Complications, and Treatment

Abstract

Staphylococcus lugdunensis is a species of coagulase-negative staphylococci (CNS) that induces a variety of infectious diseases, including skin and soft tissue infection (SSTI), infective endocarditis (IE), and bone and PJI. This review article underscores the important points in the literature about S. lugdunensis infections, including its epidemiology, diagnosis, and treatment, as well as specific types of infections it can cause. Anatomical and age-related distributions of S. lugdunensis SSTIs have been noted, though they most commonly occur as abscesses. S. lugdunensis can also manifest as an aggressive form of IE presenting with valve destruction and abscess formation, frequently requiring surgery and with a high mortality rate. Bone and joint infections caused by S. lugdunensis are also more invasive than infections by other species of CNS. The clinical presentation of S. lugdunensis infection in SSTI, IE, and bone/joint infection is frequently more similar to that of S. aureus infection than that of other CNS infections, necessitating species-level differentiation of CNS for proper diagnosis. Though historically, this depended upon biochemical tests that were neither routine nor reliable, the implementation of matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF MS) in clinical laboratories has made identification of CNS species such as S. lugdunensis more practical. Imaging modalities, especially the fluorodeoxyglucose (FDG) with positron emission tomography (PET), are another important emerging trend in the diagnosis of infectious diseases such as S. lugdunensis infection. S. lugdunensis remains highly susceptible to a wide gamut of antibacterial therapies, which is uncharacteristic of other CNS. Infections can usually be treated by antibiotics traditionally used for CNS such as oxacillin. The breakpoints for S. lugdunensis are higher than those of other CNS and similar to S. aureus breakpoints. In the case of aggressive IE or bone/joint infection by S. lugdunensis, it is recommended to treat with a βlactam agent. Further study is needed to understand the diversity, virulence, and population structure of this species, as well as its role in other infections, such as urinary tract infections (UTIs), respiratory infections, peritonitis, and bacteremia.

Native tricuspid valve infective endocarditis with Staphylococcus lugdunesis: An unusual complication post spinal epidural injection – Case report and literature review

“…CoNS is frequently considered as a contamination, however, S. lugdunensis should be considered as a pathogen, it has similar virulence to S. aureus, both have similar fibrinogen-binding proteins that play an important role in their virulence [ 4 ]. The spectrum of diseases caused by S. lugdunensis ranges mainly from skin and soft tissue infections to more serious conditions like bacteremia with subsequent seeding with arthritis, osteomyelitis, and infective endocarditis [ 5 , 6 ].…”

Lymphocele Containing Staphylococcus lugdunensis

“…However, serious infections could occur from S. lugdunensis affecting prosthetic joints and heart valves. Patients infected by S. lugdunensis have shown to have concurrent comorbidities such as chronic immunosuppression, diabetes, or recent trauma [4][5][6]. Skin infections and abscess formations are the most common sources of S. lugdunensis infections [3].…”

“…The use of matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF MS) in laboratories has resulted in more accurate S. lugdunensis identification [9]. S. lugdunensis has been noted to be highly susceptible to penicillins, such as oxacillin, erythromycin, linezolid, and a wide variety of other antibiotics [3][4]. Bocher et al state they noted no difference in antimicrobial susceptibility between isolates from hospitalized patients and isolates from general practice.…”

“…S. lugdunensis is a coagulase-negative staphylococci normally known to be a skin colonizer [ 3 ]. Over the years, it has shown to cause a wide variety of infections especially involving prosthetic joints and heart valves [ 4 - 5 ]. Bocher et al noted that majority of the cases were found in skin abscesses, wound infections, and paronychias [ 3 ].…”

“…S. lugdunensis has been noted to be highly susceptible to penicillins, such as oxacillin, erythromycin, linezolid, and a wide variety of other antibiotics [ 3 - 4 ]. Bocher et al state they noted no difference in antimicrobial susceptibility between isolates from hospitalized patients and isolates from general practice.…”