Infection

, Volume 45, Issue 2, pp 179–186 | Cite as

Clinical significance of coagulase-negative staphylococci other than S. epidermidis blood stream isolates at a tertiary care hospital

  • Florian Hitzenbichler
  • Michaela Simon
  • Bernd Salzberger
  • Frank Hanses
Original Paper

Abstract

Purpose

We retrospectively evaluated blood culture (BC) isolates of coagulase-negative staphylococci other than Staphylococcus epidermidis (NonSe-CoNS) for clinical relevance at a tertiary care hospital in Germany from January 2011 to September 2015.

Methods

Clinical data were correlated to microbiological results based on medical records. Infection was considered likely if (1) no other infection and (2) two or more isolates of the same species were present and (3) symptoms ameliorated after therapy. Infection was considered possible if a foreign body was present and (1) and (3) were fulfilled. All the other cases were considered contaminations.

Results

313 patients with blood cultures positive for NonSe-CoNS were identified. 61 patients were excluded, either because of missing data or multiple pathogens in the same blood culture. Of the remaining 252 patients, 58 (23 %) were classified as possible (n = 32) or likely (n = 26) infections. S. haemolyticus was the most frequent isolate (infection: n = 28), followed by S. hominis (n = 13), S. capitis (n = 12), and S. lugdunensis (n = 3). One patient died from NonSe-CoNS infection. The source of infection in the majority of patients was foreign bodies (n = 43), and endocarditis was present in six cases. Staphylococci always considered contaminations were: S. auricularis, S. caprae, S. schleiferi, S. pettenkoferi, S. saccharolyticus, and S. simulans. The growth of NonSe-CoNS in the anaerobic BC bottle only and a time to positivity >36 h were associated with contaminations.

Conclusions

One out of four NonSe-CoNS isolates was clinically relevant in our cohort, where S. haemolyticus, S. capitis, S. hominis, and S. lugdunensis contributed to 96.6 % of all relevant infections.

Keywords

Coagulase-negative Staphylococci Bacteremia S. haemolyticus S. lugdunensis Blood culture Contamination 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Becker K, Heilmann C, Peters G. Coagulase-negative staphylococci. Clin Microbiol Rev. 2014;27:870–926. doi: 10.1128/CMR.00109-13.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    von Eiff C, Peters G, Heilmann C. Pathogenesis of infections due to coagulase-negative staphylococci. Lancet Infect Dis. 2002;2:677–85.CrossRefGoogle Scholar
  3. 3.
    Diekema DJ, Pfaller MA, Schmitz FJ, Smayevsky J, Bell J, Jones RN, Beach M. Survey of infections due to Staphylococcus species: frequency of occurrence and antimicrobial susceptibility of isolates collected in the United States, Canada, Latin America, Europe, and the Western Pacific region for the SENTRY Antimicrobial Surveillance Program, 1997–1999. Clin Infect Dis. 2001;32(Suppl 2):S114–32. doi: 10.1086/320184.CrossRefPubMedGoogle Scholar
  4. 4.
    Piette A, Verschraegen G. Role of coagulase-negative staphylococci in human disease. Vet Microbiol. 2009;134:45–54. doi: 10.1016/j.vetmic.2008.09.009.CrossRefPubMedGoogle Scholar
  5. 5.
    Gatermann SG, Koschinski T, Friedrich S. Distribution and expression of macrolide resistance genes in coagulase-negative staphylococci. Clin Microbiol Infect. 2007;13:777–81. doi: 10.1111/j.1469-0691.2007.01749.x.CrossRefPubMedGoogle Scholar
  6. 6.
    Farrag N, Lee P, Gunney R, Viagappan GM. Staphylococcus lugdunensis endocarditis. Postgrad Med J. 2001;77:259–60.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Vandenesch F, Etienne J, Reverdy ME, Eykyn SJ. Endocarditis due to Staphylococcus lugdunensis: report of 11 cases and review. Clin Infect Dis. 1993;17:871–6.CrossRefPubMedGoogle Scholar
  8. 8.
    Jones RM, Jackson MA, Ong C, Lofland GK. Endocarditis caused by Staphylococcus lugdunensis. Pediatr Infect Dis J. 2002;21:265–8.CrossRefPubMedGoogle Scholar
  9. 9.
    Ebright JR, Penugonda N, Brown W. Clinical experience with Staphylococcus lugdunensis bacteremia: a retrospective analysis. Diagn Microbiol Infect Dis. 2004;48:17–21. doi: 10.1016/j.diagmicrobio.2003.08.008.CrossRefPubMedGoogle Scholar
  10. 10.
    Ziegler MJ, Pellegrini DC, Safdar N. Attributable mortality of central line associated bloodstream infection: systematic review and meta-analysis. Infection. 2015;43:29–36. doi: 10.1007/s15010-014-0689-y.CrossRefPubMedGoogle Scholar
  11. 11.
    Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, O’Grady NP, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 update by the infectious diseases society of America. Clin Infect Dis. 2009;49:1–45. doi: 10.1086/599376.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Fadel HJ, Patel R, Vetter EA, Baddour LM. Clinical significance of a single Staphylococcus lugdunensis-positive blood culture. J Clin Microbiol. 2011;49:1697–9. doi: 10.1128/JCM.02058-10.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Ruhe J, Menon A, Mushatt D, Dejace P, Hasbun R. Non- epidermidis coagulase-negative staphylococcal bacteremia: clinical predictors of true bacteremia. Eur J Clin Microbiol Infect Dis. 2004;23:495–8. doi: 10.1007/s10096-004-1134-4.CrossRefPubMedGoogle Scholar
  14. 14.
    Haimi-Cohen Y, Shafinoori S, Tucci V, Rubin LG. Use of incubation time to detection in BACTEC 9240 to distinguish coagulase-negative staphylococcal contamination from infection in pediatric blood cultures. Pediatr Infect Dis J. 2003;22:968–74. doi: 10.1097/01.inf.0000095195.60494.ba.CrossRefPubMedGoogle Scholar
  15. 15.
    Garcia-Vazquez E, Fernandez-Rufete A, Hernandez-Torres A, Canteras M, Ruiz J, Gomez J. When is coagulase-negative Staphylococcus bacteraemia clinically significant? Scand J Infect Dis. 2013;45:664–71. doi: 10.3109/00365548.2013.797599.CrossRefPubMedGoogle Scholar
  16. 16.
    Kirchhoff LV, Sheagren JN. Epidemiology and clinical significance of blood cultures positive for coagulase-negative Staphylococcus. Infect Control. 1985;6:479–86.CrossRefPubMedGoogle Scholar
  17. 17.
    Kim SD, McDonald LC, Jarvis WR, McAllister SK, Jerris R, Carson LA, Miller JM. Determining the significance of coagulase-negative staphylococci isolated from blood cultures at a community 14 hospital: a role for species and strain identification. Infect Control Hosp Epidemiol. 2000;21:213–7. doi: 10.1086/501747.CrossRefPubMedGoogle Scholar
  18. 18.
    Herwaldt LA, Geiss M, Kao C, Pfaller MA. The positive predictive value of isolating coagulase-negative staphylococci from blood cultures. Clin Infect Dis. 1996;22:14–20.CrossRefPubMedGoogle Scholar
  19. 19.
    Durack DT, Lukes AS, Bright DK. New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings-Duke endocarditis service. Am J Med. 1994;96:200–9.CrossRefPubMedGoogle Scholar
  20. 20.
    Chu VH, Cabell CH, Abrutyn E, Corey GR, Hoen B, Miro JM, et al. Native valve endocarditis due to coagulase-negative staphylococci: report of 99 episodes from the international collaboration on endocarditis merged database. Clin Infect Dis. 2004;39:1527–30. doi: 10.1086/424878.CrossRefPubMedGoogle Scholar
  21. 21.
    Falcone M, Campanile F, Giannella M, Borbone S, Stefani S, Venditti M. Staphylococcus haemolyticus endocarditis: clinical and microbiologic analysis of 4 cases. Diagn Microbiol Infect Dis. 2007;57:325–31. doi: 10.1016/j.diagmicrobio.2006.08.019.CrossRefPubMedGoogle Scholar
  22. 22.
    Czekaj T, Ciszewski M, Szewczyk EM. Staphylococcus haemolyticus—an emerging threat in the twilight of antibiotics age. Microbiology. 2015;. doi: 10.1099/mic.0.000178.PubMedGoogle Scholar
  23. 23.
    Bhatt P, Tandel K, Singh A, Mugunthan M, Grover N, Sahni AK. Species distribution and antimicrobial resistance pattern of coagulase-negative staphylococci at a tertiary care centre. Med J Armed Forces India. 2016;72:71–4. doi: 10.1016/j.mjafi.2014.12.007.CrossRefPubMedGoogle Scholar
  24. 24.
    Zinkernagel AS, Zinkernagel MS, Elzi MV, Genoni M, Gubler J, Zbinden R, Mueller NJ. Significance of Staphylococcus lugdunensis bacteremia: report of 28 cases and review of the literature. Infection. 2008;36:314–21. doi: 10.1007/s15010-008-7287-9.CrossRefPubMedGoogle Scholar
  25. 25.
    Sabe MA, Shrestha NK, Gordon S, Menon V. Staphylococcus lugdunensis: a rare but destructive cause of coagulase-negative Staphylococcus infective endocarditis. Eur Heart J Acute Cardiovasc Care. 2014;3:275–80. doi: 10.1177/2048872614523350.CrossRefPubMedGoogle Scholar
  26. 26.
    Sato M, Kubota N, Horiuchi A, Kasai M, Minami K, Matsui H. Frequency, clinical manifestations, and outcomes of Staphylococcus lugdunensis bacteremia in children. J Infect Chemother. 2016;. doi: 10.1016/j.jiac.2016.01.012.Google Scholar
  27. 27.
    Zhang Q, Li D, Bai C, Zhang W, Zheng S, Zhang P, Zhang S. Clinical prognostic factors for time to positivity in cancer patients with bloodstream infections. Infection. 2016;. doi: 10.1007/s15010-016-0890-2.PubMedGoogle Scholar
  28. 28.
    Lim SJ, Choi JY, Lee SJ, Cho YJ, Jeong YY, Kim HC, et al. Intensive care unit-acquired blood stream infections: a 5-year retrospective analysis of a single tertiary care hospital in Korea. Infection. 2014;42:875–81. doi: 10.1007/s15010-014-0651-z.CrossRefPubMedGoogle Scholar
  29. 29.
    Aimoto M, Koh H, Katayama T, Okamura H, Yoshimura T, Koh S, et al. Diagnostic performance of serum high-sensitivity procalcitonin and serum C-reactive protein tests for detecting bacterial infection in febrile neutropenia. Infection. 2014;42:971–9. doi: 10.1007/s15010-014-0657-6.CrossRefPubMedGoogle Scholar
  30. 30.
    Kamath U, Singer C, Isenberg HD. Clinical significance of Staphylococcus warneri bacteremia. J Clin Microbiol. 1992;30:261–4.PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  1. 1.Stabsstelle InfektiologieUniversitätsklinikum RegensburgRegensburgGermany
  2. 2.Institut für Klinische Mikrobiologie und HygieneUniversitätsklinikum RegensburgRegensburgGermany
  3. 3.Interdisziplinäre NotaufnahmeUniversitätsklinikum RegensburgRegensburgGermany

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