The species distribution, antimicrobial resistance and risk factors for poor outcome of coagulase-negative staphylococci bacteraemia in China

Abstract

Objective Coagulase-negative staphylococci (CoNS) are one of the major opportunistic pathogens and the incidence of CoNS bacteraemia is increasing. However, most of the CoNS-positive blood cultures are contaminants rather than true CoNS bacteraemia. In order to minimize contamination, we defined true CoNS bacteraemia as the patient that has two or more identical CoNS-positive blood cultures drawn within 48 h in this study and the objective of this study was to analyse the species distribution and antibiotic resistance and to identify risk factors for 30-day mortality of the true CoNS-bacteraemia. Method By reviewing the electronic medical database, this study retrospectively analysed patients diagnosed as CoNS bacteraemia by blood cultures in a comprehensive tertiary care hospital in China from January 1, 2014, to December 31, 2017. Result A total of 1241 patients with 1562 episodes of CoNS-positive blood cultures were recorded in the database but only 157 patients were finally diagnosed as true CoNS bacteraemia after contaminants were excluded. All these 157 patients (12.7%, 157/1241) had bacteraemia-related clinical symptoms. Among the 157 patients, the most common species were Staphylococcus hominis (40.8%), Staphylococcus epidermidis (36.3%) and Staphylococcus capitis (11.5%). The antimicrobial susceptibility tests showed that all CoNS had a high rate of resistance to penicillin (94.9%), oxacillin (93.6%) and erythromycin (92.4%). Resistance to gentamicin (22.3%) and rifampicin (10.8%) was low, and none of the bacteria were resistant to vancomycin or linezolid. The 30-day mortality of patients with CoNS bacteraemia was up to 12.7% (20/157), and the multivariate logistics regression analysis showed that chronic renal failure (OR 5.9, 95% CI 1.6–21.5, p = 0.007) and chronic liver failure (OR 4.0, 95% CI 1.2–13.1, p = 0.024) were both the significant independent risk factors for the 30-day mortality of CoNS bacteraemia. Conclusion Staphylococcus hominis and Staphylococcus epidermidis were the most common species in CoNS bacteraemia. All CoNS had high multi-drug resistance, but gentamicin and rifampicin had a relatively lower resistance and could be considered as alternative antibiotics for anti-CoNS bacteraemia in addition to vancomycin and linezolid. Additionally, patients with chronic renal failure or chronic liver failure have a higher 30-day mortality after the onset of CoNS bacteraemia.

Prevalence and Antibiotic Resistance of Bacteria Isolated From Cerebrospinal Fluid Among Children With Bacterial Meningitis in China From 2016 to 2018: A Multicenter Retrospective Study

“…5). These surveillance data were in line with the report from Beijing, China (93.6%) [23] but higher than the values reported in eastern Nepal (57.7%) [30] and Ethiopia (37.0%) [31]. Consistent with most previous studies [29][30][31], there were no LNZ-or VAN-resistant isolates found in our study.…”

“…S. epidermidis was detected more commonly in the surgical department (31.1%) than in the PICU (10.8%) and other departments (13.9%) in this study (P<0.001), and this result was consistent with a previous report [19]. Various reports have demonstrated that CoNS species have emerged as the most common cause of central nervous infections [19] and bloodstream infections [21,22], and resulted in 8.0-12.7% mortality [19,23]. This emerging situation may be related to the progress and development of medical technology, the use of medical devices and long-term hospitalization.…”

Prevalence and antibiotic resistance of bacteria isolated from cerebrospinal fluid among children with bacterial meningitis in China from 2016 to 2018: A multicenter retrospective study

“…The resistance rates of S. epidermidis, S. hominis and S. haemolyticus isolates to PEN and ERY were greater than 71.0% in the present study, which were similar to previous studies conducted in Brazil (100% and 86.2%, respectively) [29] and Beijing, China (94.9% and 92.4%, respectively) [23]. OXA is considered to be an indication of methicillin resistance.…”

Pharmacokinetics of Macrolide Antibiotics and Transport into the Interstitial Fluid: Comparison among Erythromycin, Clarithromycin, and Azithromycin

“…After infection, S. epidermidis is present mainly in the extracellular tissue space, but S. aureus and S. pyogenes can invade nonphagocytic cells [19,20]. A recent clinical study reported that S. epidermidis isolated from patients with coagulase-negative staphylococci bacteremia exhibited a high rate of resistance against EM (87.7%) [21]. Taken together, these results suggest that the subinhibitory EM levels in the ISF, which is the target site for S. epidermidis, may favor the emergence of bacterial resistance.…”