Advertisement

Supportive Care in Cancer

, Volume 25, Issue 4, pp 1063–1069 | Cite as

Staphylococcus lugdunensis infections, filling in the gaps: a 3-year retrospective review from a comprehensive cancer center

  • Lior NesherEmail author
  • Jeffery Tarrand
  • Roy F Chemaly
  • Kenneth VI. Rolston
Original Article

Abstract

Objective

Staphylococcus lugdunensis is considered to be more aggressive than other coagulase-negative staphylococci (CoNS). There are gaps in knowledge regarding the importance of isolating S. lugdunensis from different sources and in different patient subsets. Our objective was to describe the spectrum, clinical manifestations, and outcomes of infections caused by S. lugdunensis in patients with cancer.

Methods

A retrospective review of all cancer patients from whom S. lugdunensis was isolated in a pure culture from clinically significant sites.

Results

Between 2011 and 2014, 2263 CoNS were isolated, of them 45 S. lugdunensis were isolated in a pure culture and were included in this analysis. Only three patients were neutropenic. Skin and skin structure infections (SSSIs) occurred most often (36 cases) followed by five blood stream infections, one of which had destructive endocarditis and four infections at other sites. Of the 36 SSSIs, 29 were related to surgical or invasive procedures, and six of these involved an implanted medical device. All isolates were susceptible to vancomycin, 98% to levofloxacin and 89% to oxacillin. All patients responded to the therapy.

Conclusions

Cancer patients including those with neutropenia do not appear to have an increased frequency of infections caused by S. lugdunensis. SSSIs are predominant and are often associated with surgical procedures and/or implanted medical devices. Blood stream infections caused by S. lugdunensis are uncommon but may have an increased rate of serious complications such as endocarditis. Nevertheless, these organisms are generally susceptible to multiple classes of antimicrobial agents, and the overall response to therapy is high.

Keywords

Staphylococcus lugdunensis Cancer patients Skin/skin structure infection 

Notes

Compliance with ethical standards

Conflict of interest

This study was supported in part by the NIH/NCI under award number P30CA016672 and used the Cancer Center Support Grant resources. The authors had a full control of the data, analysis, and writing of the manuscript, and no others had any input.

References

  1. 1.
    Nesher L, Rolston KV (2014) The current spectrum of infection in cancer patients with chemotherapy related neutropenia. Infection 42(1):5–13CrossRefGoogle Scholar
  2. 2.
    Freney J, Brun Y, Bes M, Meugnier H, Grimont F, Grimont P (1988) Staphylococcus lugdunensis sp. nov. and staphylococcus schleiferi sp. nov., two species from human clinical specimens. Int J Syst Bacteriol 38:168–172CrossRefGoogle Scholar
  3. 3.
    Frank KL, Del Pozo JL, Patel R (2008) From clinical microbiology to infection pathogenesis: how daring to be different works for Staphylococcus lugdunensis. Clin Microbiol Rev 21(1):111–133CrossRefGoogle Scholar
  4. 4.
    Liang M, Mansell C, Wade C, Fisher R, Devlin G (2012) Unusually virulent coagulase-negative Staphylococcus lugdunensis is frequently associated with infective endocarditis: a Waikato series of patients. N Z Med J 125(1354):51–59PubMedGoogle Scholar
  5. 5.
    Shah NB, Osmon DR, Fadel H, Patel R, Kohner PC, Steckelberg JM et al (2010) Laboratory and clinical characteristics of staphylococcus lugdunensis prosthetic joint infections. J Clin Microbiol 48(5):1600–1603CrossRefGoogle Scholar
  6. 6.
    Klotchko A, Wallace MR, Licitra C, Sieger B (2011) Staphylococcus lugdunensis: an emerging pathogen. South Med J 104(7):509–514CrossRefGoogle Scholar
  7. 7.
    Liesenborghs L, Peetermans M, Claes J, Veloso TR, Vandenbriele C, Criel M et al (2016) Shear-resistant binding to von willebrand factor allows staphylococcus lugdunensis to adhere to the cardiac valves and initiate endocarditis. J Infect Dis 213(7):1148–1156CrossRefGoogle Scholar
  8. 8.
    Fadel HJ, Patel R, Vetter EA, Baddour LM (2011) Clinical significance of a single Staphylococcus lugdunensis-positive blood culture. J Clin Microbiol 49(4):1697–1699CrossRefGoogle Scholar
  9. 9.
    German GJ, Wang B, Bernard K, Stewart N, Chan F, Pacheco AL et al (2013) Staphylococcus lugdunensis: low prevalence and clinical significance in a pediatric microbiology laboratory. Pediatr Infect Dis J 32(1):87–89CrossRefGoogle Scholar
  10. 10.
    Bieber L, Kahlmeter G (2010) Staphylococcus lugdunensis in several niches of the normal skin flora. Clin Microbiol Infect 16(4):385–388CrossRefGoogle Scholar
  11. 11.
    Bellamy R, Barkham T (2002) Staphylococcus lugdunensis infection sites: predominance of abscesses in the pelvic girdle region. Clin Infect Dis 35(3):E32–E34CrossRefGoogle Scholar
  12. 12.
    Lina B, Vandenesch F, Reverdy ME, Greenland T, Fleurette J, Etienne J (1994) Non-puerperal breast infections due to Staphylococcus lugdunensis. Eur J Clin Microbiol Infect Dis 13(8):686–687CrossRefGoogle Scholar
  13. 13.
    Hellbacher C, Törnqvist E, Söderquist B (2006) Staphylococcus lugdunensis: clinical spectrum, antibiotic susceptibility, and phenotypic and genotypic patterns of 39 isolates. Clin Microbiol Infect 12(1):43–49CrossRefGoogle Scholar
  14. 14.
    Kleiner E, Monk AB, Archer GL, Forbes BA (2010) Clinical significance of staphylococcus lugdunensis isolated from routine cultures. Clin Infect Dis 51(7):801–803CrossRefGoogle Scholar
  15. 15.
    Beekmann SE, Diekema DJ, Doern GV (2005) Determining the clinical significance of coagulase-negative staphylococci isolated from blood cultures. Infect Control Hosp Epidemiol 26(6):559–566CrossRefGoogle Scholar
  16. 16.
    Sabe MA, Shrestha NK, Gordon S and Menon V 2014 Staphylococcus lugdunensis: a rare but destructive cause of coagulase-negative staphylococcus infective endocarditis. Eur Heart J Acute Cardiovasc CareGoogle Scholar
  17. 17.
    Streit JM, Jones RN, Sader HS, Fritsche TR (2004) Assessment of pathogen occurrences and resistance profiles among infected patients in the intensive care unit: report from the sentry antimicrobial surveillance program (north america, 2001). Int J Antimicrob Agents 24(2):111–118CrossRefGoogle Scholar
  18. 18.
    Sahm DF, Deane J, Bien PA, Locke JB, Zuill DE, Shaw KJ et al (2015) Results of the surveillance of tedizolid activity and resistance program: in vitro susceptibility of gram-positive pathogens collected in 2011 and 2012 from the United States and Europe. Diagn Microbiol Infect Dis 81(2):112–118CrossRefGoogle Scholar
  19. 19.
    Biedenbach DJ, Arhin FF, Moeck G, Lynch TF, Sahm DF (2015) In vitro activity of oritavancin and comparator agents against staphylococci, streptococci and enterococci from clinical infections in Europe and North America, 2011–2014. Int J Antimicrob Agents 46(6):674–681CrossRefGoogle Scholar
  20. 20.
    Tan TY, Ng SY, He J (2008) Microbiological characteristics, presumptive identification, and antibiotic susceptibilities of Staphylococcus lugdunensis. J Clin Microbiol 46(7):2393–2395CrossRefGoogle Scholar
  21. 21.
    Giormezis N, Kolonitsiou F, Makri A, Vogiatzi A, Christofidou M, Anastassiou ED et al (2015) Virulence factors among staphylococcus lugdunensis are associated with infection sites and clonal spread. Eur J Clin Microbiol Infect Dis 34(4):773–778CrossRefGoogle Scholar
  22. 22.
    Yen TY, Sung YJ, Lin HC, Peng CT, Tien N, Hwang KP et al. 2014 Emergence of oxacillin-resistant staphylococcus lugdunensis carrying staphylococcal cassette chromosome mec type v in central taiwan. J Microbiol Immunol InfectGoogle Scholar
  23. 23.
    Liu C, Shen D, Guo J, Wang K, Wang H, Yan Z et al (2012) Clinical and microbiological characterization of staphylococcus lugdunensis isolates obtained from clinical specimens in a hospital in China. BMC Microbiol 12:168CrossRefGoogle Scholar
  24. 24.
    Tseng SP, Lin YT, Tsai JC, Hung WC, Chen HJ, Chen PF et al. 2013 Genotypes and phenotypes of staphylococcus lugdunensis isolates recovered from bacteremia. J Microbiol Immunol InfectGoogle Scholar
  25. 25.
    Pereira EM, Schuenck RP, Nouér SA, Santos KR (2011) Methicillin-resistant Staphylococcus lugdunensis carrying SCCmec type V misidentified as MRSA. Braz J Infect Dis 15(3):293–295PubMedGoogle Scholar
  26. 26.
    Ebright JR, Penugonda N, Brown W (2004) Clinical experience with Staphylococcus lugdunensis bacteremia: a retrospective analysis. Diagn Microbiol Infect Dis 48(1):17–21CrossRefGoogle Scholar
  27. 27.
    Sato M, Kubota N, Horiuchi A, Kasai M, Minami K, Matsui H (2016) Frequency, clinical manifestations, and outcomes of Staphylococcus lugdunensis Bacteremia in children. J Infect Chemother 22(5):298–302CrossRefGoogle Scholar
  28. 28.
    Zinkernagel AS, Zinkernagel MS, Elzi MV, Genoni M, Gubler J, Zbinden R et al. Significance of Staphylococcus lugdunensis bacteremia: report of 28 cases and Infection. 2008;36(4):314–321.Google Scholar
  29. 29.
    Choi SH, Chung JW, Lee EJ, Kim TH, Lee MS, Kang JM et al (2010) Incidence, characteristics, and outcomes of Staphylococcus lugdunensis bacteremia. J Clin Microbiol 48(9):3346–3349CrossRefGoogle Scholar
  30. 30.
    Lin JF, Cheng CW, Kuo AJ, Liu TP, Yang CC, Huang CT et al (2015) Clinical experience and microbiologic characteristics of invasive Staphylococcus lugdunensis infection in a tertiary center in northern Taiwan. J Microbiol Immunol Infect 48(4):406–412CrossRefGoogle Scholar
  31. 31.
    Wu AB, Wang MC, Tseng CC, Lin WH, Teng CH, Huang AH et al (2011) Clinical and microbiological characteristics of community-acquired Staphylococcus lugdunensis infections in Southern Taiwan. J Clin Microbiol 49(8):3015–3018CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  1. 1.Department of Infectious Diseases, Infection Control and Employee HealthThe University of Texas MD Anderson Cancer CenterHoustonUSA
  2. 2.Infectious Disease Institute, Faculty of health sciencesBen-Gurion University, Soroka Medical CenterBeer-ShebaIsrael
  3. 3.Department of Laboratory MedicineThe University of Texas MD Anderson Cancer CenterHoustonUSA

Personalised recommendations