The Role of the Coagulase-negative Staphylococci (CoNS) in Infective Endocarditis; A Narrative Review from 2000 to 2020

Abstract

: Coagulase-negative staphylococci (CoNS) are part of the microbiota of human skin and rarely linked with soft tissue infections. In recent years, CoNS species considered as one of the major nosocomial pathogens and can cause several infections such as catheter-acquired sepsis, skin infection, urinary tract infection, endophthalmitis, central nervous system shunt infection, surgical site infections, and foreign body infection. These microorganisms have a significant impact on human life and health and, as typical opportunists, cause peritonitis in individuals undergoing peritoneal dialysis. Moreover, it is revealed that these potential pathogens are mainly related to the use of indwelling or implanted in a foreign body and cause infective endocarditis (both native valve endocarditis and prosthetic valve endocarditis) in patients. In general, approximately eight percent of all cases of native valve endocarditis is associated with CoNS species, and these organisms cause death in 25% of all native valve endocarditis cases. Moreover, it is revealed that methicillin-resistant CoNS species cause 60 % of all prosthetic valve endocarditis cases. In this review, we describe the role of the CoNS species in infective endocarditis, and we explicated the reported cases of CoNS infective endocarditis in the literature from 2000 to 2020 to determine the role of CoNS in the process of infective endocarditis.

Coagulase-negative staphylococci (CoNS) meningitis: a narrative review of the literature from 2000 to 2020

“…S. capitis has two subspecies and acts as normal flora of human ears, neck, face and scalp. This bacterium comprises 5% of all CoNS bacteria and has the ability to induce numerous severe infections such as otitis externa, infective endocarditis (prosthetic and native valve endocarditis), cellulitis, primary chronic osteomyelitis, urinary tract infection, late- and early-onset sepsis, orthopaedic periprosthetic infections, pneumonia and catheter-associated bloodstream infections [ 60 , 61 ]. Patients with a suppressed immune system or underlying cardiac disease are considered to be highly susceptible to these infections, so they are therefore categorized into the high-risk groups [ 62 ].…”

“…in 1988 [ 76 ]. S. lugdunensis colonizes 30% to 50% of patients, and similar to other CoNS isolates, it constitutes the microbiota of the skin of healthy individuals [ 60 ]. Cutaneous infections, dental abscesses, cardiac pacemakers and infected vascular devices are breeding grounds for S. lugdunensis infections in the community [ 64 ].…”

“…According to reports, S. lugdunensis can cause meningitis after dental infection, embolic native valve endocarditis and ventriculostomy [ 22 , 66 ]. Biofilm formation in S. lugdunensis is an important means to adhere to native tissues and prosthetic materials [ 60 ]. On the basis of published studies from 2000 to 2020, the underlying conditions and clinical manifestations in patients with S. lugdunensis meningitis include native valve endocarditis, polymyositis, dyslipidaemia, asthma surgery for Rathke cleft cyst, intense headache, vomiting, lethargy, psychomotor inhibition and left homonymous haemianopsia [ 20 , 23 , 24 ].…”

“…Staphylococcus epidermidis is a member of the human microbiota often considered to be a culture contaminant in clinical laboratory and hospital environments [ 60 ]. Unlike other CoNS isolates, genes encoding enterotoxins and toxic shock syndrome toxin 1 (TSST-1) have not been found among S. epidermidis strains [ 67 ].…”

“…Similar to other CoNS isolates, Staphylococcus hominis is a common member of the healthy human skin microbiome. In addition, in contrast to S. epidermidis , this organism produces acid from trehalose, and it is rarely resistant to novobiocin [ 60 ]. Among Staphylococcus species, two species, S. hominis and Staphylococcus warneri , constitute 14% of all CoNS isolates in body fluids such as urine, prostatic secretions and semen [ 73 ].…”