Laboratory and Clinical Characteristics of Staphylococcus lugdunensis Prosthetic Joint Infections

Abstract

Staphylococcus lugdunensis is a coagulase-negative staphylococcus that has several similarities to Staphylococcus aureus. S. lugdunensis is increasingly being recognized as a cause of prosthetic joint infection (PJI). The goal of the present retrospective cohort study was to determine the laboratory and clinical characteristics of S. lugdunensis PJIs seen at the Mayo Clinic in Rochester, MN, between 1 January 1998 and 31 December 2007. Kaplan-Meier survival methods and Wilcoxon sum-rank analysis were used to determine the cumulative incidence of treatment success and assess subset comparisons. There were 28 episodes of S. lugdunensis PJIs in 22 patients; half of those patients were females. Twenty-five episodes (89%) involved the prosthetic knee, while 3 (11%) involved the hip. Nine patients (32%) had an underlying urogenital abnormality. Among the 28 isolates in this study tested by agar dilution, 24 of 28 (86%) were oxacillin susceptible. Twenty of the 21 tested isolates (95%) lacked mecA, and 6 (27%) of the 22 isolates tested produced ␤-lactamase. The median durations of parenteral ␤-lactam therapy and vancomycin therapy were 38 days (range, 23 to 42 days) and 39 days (range, 12 to 60 days), respectively. The cumulative incidences of freedom from treatment failure (standard deviations) at 2 years were 92% (؎7%) and 76% (؎12%) for episodes treated with a parenteral ␤-lactam and vancomycin, respectively (P ‫؍‬ 0.015). S. lugdunensis is increasingly being recognized as a cause of PJIs. The majority of the isolates lacked mecA. Episodes treated with a parenteral ␤-lactam antibiotic appear to have a more favorable outcome than those treated with parenteral vancomycin.Staphylococcus lugdunensis, a coagulase-negative staphylococcus, was first described by Freney et al. in 1988 (6) on the basis of the analysis of 11 strains collected in Lyon, France. It is increasingly being identified as a cause of serious infections (10,12,13,(15)(16)(17). This organism may produce a bound coagulase via a clumping factor, a property which, if it is present, it shares with Staphylococcus aureus; but unlike S. aureus, it does not produce a free coagulase. In the laboratory, it can give a positive slide (short) coagulase test result but gives a negative tube (long) coagulase test result; hence, if appropriate tests are not performed, it is sometimes misidentified as S. aureus. Of the many coagulase-negative staphylococci that react to pyrrolidonylarylamidase (PYR), only S. lugdunensis, along with a small number of Staphylococcus epidermidis strains, is able to decarboxylate ornithine, distinguishing it from other staphylococcal species (13, 15).Although it is classified as a coagulase-negative staphylococcus, S. lugdunensis can be virulent and can cause serious infections, including prosthetic joint infections (PJIs), endocarditis, osteomyelitis, and septicemia. This organism is considered part of the normal flora of human skin, and it has been reported to be present in the perineum and inguinal area as well (10,16,17,21). In additio...

Acute Necrotizing Sinusitis Caused by Staphylococcus lugdunensis

“…lugdunensis has been reported as an agent of endovascular infection, particularly in patients with inguinal skin breaks (vasectomy or cardiac catheterization via the femoral route [6,8]) and as a cause of pelvic girdle abscesses (2), highlighting that the predominant ecological niche of the organism is likely to be the groin. S. lugdunensis has also been reported as a cause of skin and soft tissue infections, particularly involving the breast, abdomen, and lower limbs (1,2,4), and has been identified as an agent of prosthetic joint infection (10). In keeping with these reports, studies that have screened healthy persons for carriage have confirmed identification from skin of the abdomen, groin, and lower extremities (3,12).…”

“…However, based on the production of bound coagulase (5), S. lugdunensis can also easily be misidentified in the laboratory as S. aureus (8), as was initially the case in this instance. Because it shares certain virulence characteristics with S. aureus, S. lugdunensis is now well recognized as a potential cause of invasive and destructive infections that can mimic S. aureus disease (1,4,7,10,14).…”

Implementation of Matrix-Assisted Laser Desorption Ionization–Time of Flight Mass Spectrometry in Routine Clinical Laboratories Improves Identification of Coagulase-Negative Staphylococci and Reveals the Pathogenic Role of Staphylococcus lugdunensis

“…Such associations of S. lugdunensis with severe infections were previously reported in various patient cases and series, including specimens from various origins, i.e. endocarditis, skin and soft tissue infections, arthritis, prosthetic joint infections, sepsis without identified gateway, pseudo-toxic shock syndrome, necrotizing sinusitis, and brain abscesses (30)(31)(32)(33)(34)(35). S. lugdunensis is the second cause of endocarditis due to CoNS, with a poor prognosis in 40% of cases (36).…”

Catalase-Negative Staphylococcus lugdunensis Strain with a Novel Point Mutation in the Catalase Gene Isolated from a Patient with Chronic Suppurative Otitis Media

“…In addition, the isolate showed negative results for the slide and tube coagulase tests (performed with EDTAhuman plasma) with the primary and subculturing cultures. In the tube coagulase test, the isolate tested negative at every time point (1,2,3,4,6,8,10,12, and 24 h). Staphylococcus aureus (ATCC 25923) was used as the positive control.…”