Emergence of a Teicoplanin-Resistant Small Colony Variant of Staphylococcus epidermidis During Vancomycin Therapy

Abstract

Small colony variants of Staphylococcus aureus can cause persistent and recurrent infections. There are only a few reports of small colony variants of coagulase-negative staphylococci. Herein a case of infection with a teicoplanin-resistant small colony variant of Staphylococcus epidermidis is presented. The small colony variant was isolated from blood cultures of a patient with acute leukaemia and therapy-induced neutropenia who was treated with vancomycin for catheter-associated bloodstream infection. Despite removal of the catheter and adequate antibiotic therapy, the infection did not clear and the patient died 20 days after continuous antibiotic therapy.

Partial atlE Sequencing of Staphylococcus epidermidis Strains from Prosthetic Joint Infections

“…Our findings are also consistent with previous studies reporting that many PJI strains are ica positive, IS256 positive, and oxacillin resistant (7,17,26,36). The high prevalence of mecA among our S. epidermidis strains (more than 85%) is significant: it leads to glycopeptides being increasingly frequently used for treatment, and as multiresistant clones are already circulating, there is a risk of selection of strains with decreased susceptibility to glycopeptides, as has been described for other types of infection (1).…”

Clinical Significance and Pathogenesis of Staphylococcal Small Colony Variants in Persistent Infections

“…Unusually for the staphylococcal SCV phenotype, this stable SCV was strongly adherent to solid agar media, similar to sticky colonies formed by Rothia mucilaginosa (Stomatococcus mucilaginosus). Some SCV observations have been described for coagulase-negative staphylococcal (CoNS) species, particularly for S. epidermidis, S. capitis, and S. warneri, mostly in association with foreign bodyrelated infections (3,(19)(20)(21)(22)(23)(24). Also, for S. lugdunensis, a coagulasenegative species with a unique status almost resembling S. aureus in some aspects (25), SCVs have been reported for pacemakerrelated and prosthetic joint infections (PJIs) (20,26).…”

Prosthetic Joint Infections Due to Coagulase-Negative Staphylococci

“…The clinical consequences of this altered phenotype are the improved persistence in mammalian cells and a reduced susceptibility to antibiotics, which make them nearly ideal candidates for recurrences. Furthermore, foreign material itself inhibits neutrophil antibacterial activity (5). Because of those given above facts, these infections are difficult to treat.…”

“…However, with the presence of a foreign body such as an implant, CoNS must be considered as a potential causative pathogen (2,4). Staphylococcal implant infections are difficult to treat because of their ability to both grow biofilms and to form small-colony variants (4,5). Prosthetic joint infections (PJI) are the most concerned group in terms of the allocation of research funds.…”