Skin and soft tissue infections caused by Staphylococcus lugdunensis: Report of 20 cases

Arias, Marta; Tena, Daniel; Apellániz, María; Asensio, María Pilar; Caballero, Pilar Calvo; Hernández, Carmen; Tejedor, Francisco Javier Tejedor; Bisquert, Julia

doi:10.3109/00365548.2010.509332

Cited by 38 publications

(36 citation statements)

References 28 publications

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“…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).…”

Section: Discussionmentioning

confidence: 59%

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

et al. 2015

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The use of matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) for staphylococcal identification is now considered routine in laboratories compared with the conventional phenotypical methods previously used. We verified its microbiological relevance for identifying the main species of coagulase-negative staphylococci (CoNS) by randomly selecting 50 isolates. From 1 January 2007 to 31 August 2008, 12,479 staphylococci were isolated with phenotypic methods, of which 4,594 were identified as Staphylococcus aureus and 7,885 were coagulase negative staphylococci. Using MALDI-TOF MS from 1 January 2011 to 31 August 2012, 14,913 staphylococci were identified, with 5,066 as S. aureus and 9,847 as CoNS. MALDI-TOF MS allowed the identification of approximately 85% of the CoNS strains, whereas only 14% of the CoNS strains were identified to the species level with phenotypic methods because they were often considered contaminants. Furthermore, the use of MALDI-TOF MS revealed the occurrence of recently characterized Staphylococcus species, such as S. pettenkoferi, S. condimenti, and S. piscifermentans. Microbiological relevance analysis further revealed that some species displayed a high rate of microbiological significance, i.e., 40% of the S. lugdunensis strains included in the analysis were associated with infection risk. This retrospective microbiological study confirms the role of MALDI-TOF MS in clinical settings for the identification of staphylococci with clinical consequences. The species distribution reveals the occurrence of the recently identified species S. pettenkoferi and putative virulent species, including S. lugdunensis. C oagulase-negative staphylococci (CoNS) are normal inhabitants of the human skin that lately have revealed themselves as significant etiological agents causing nosocomial infections, particularly in medical devices (1-4). Until recently, the phenotypic identification of Ͼ40 currently recognized CoNS species remained a challenge, because the technique was labor-intensive and uncommon CoNS were usually not identified (5, 6). Until recently, CoNS identification at the species level was performed only for clinical isolates that were considered clinically significant according to clinical or microbiological criteria. Meanwhile, matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) has emerged as a reliable, fast, and cost-effective alternative for bacterial species identification and is now widely used in microbiology laboratories (7,8). This method allows the identification of all staphylococci isolated in the clinical setting, thus rendering the use of well-known tests, such as free or bound coagulase tests, unnecessary. Previous reports have shown that MALDI-TOF MS is a reliable method to identify Staphylococcus at the species level; however, questions regarding the impact of such methods in clinical settings remain uncertain (9). Staphylococcus epidermidis is probably the major CoNS species causing nosocomial inf...

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Section: Discussionmentioning

confidence: 59%

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

et al. 2015

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“…The duration of antibiotic treatment ranged from 5 to 21 days, with all isolates susceptible to most of the antibiotics tested. 6 Although this study demonstrated that S. lugdunensis is penicillin sensitive, a 3-year retrospective study demonstrated that 80% of isolates (> 50% from skin) were penicillin resistant (80%). 8 This potential variability in the antibiotic resistance profile of S. lugdunensis is far greater than historical estimates and demonstrates the need for testing antibiotic sensitivities when coagulase-negative staphylococci are encountered.…”

Section: Discussionmentioning

confidence: 72%

“…6 The frequency of skin infections due to S. lugdunensis was calculated to be 0.42%, with infection found to be secondary to trauma, surgery or skin disease in 15 of the 20 patients (75%). Of the 20 cases, abscesses (seven cases), surgical wound infections (six cases) and cellulitis (three cases) were the most common clinical presentations.…”

Section: Discussionmentioning

confidence: 99%

Staphylococcus lugdunensis: case report and discussion

Donoghue

Vekic

Wehrhahn

et al. 2014

Australasian Journal of Dermatology

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“…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).…”

Section: S Lugdunensis Is a Coagulase-negativementioning

confidence: 83%

“…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).…”

Section: S Lugdunensis Is a Coagulase-negativementioning

confidence: 99%

Acute Necrotizing Sinusitis Caused by Staphylococcus lugdunensis

et al. 2011

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Staphylococcus lugdunensis is most commonly associated with infections arising from the inguinal region, but here we report this organism as a cause of bacterial sinusitis, highlighting its potential niche as a commensal of the upper airways. The severity of necrosis demonstrates the potential for destructive pathology mimicking Staphylococcus aureus disease. CASE REPORTA 73-year-old Caucasian man with metastatic prostate adenocarcinoma was hospitalized 23 days following the administration of his 7th cycle of mitoxantrone chemotherapy. He reported a 9-day history of progressive right-sided facial and periorbital swelling, right-sided nasal blockage, serous nasal discharge, and visual blurring. He also described progressive discomfort and swelling in the roof of his mouth and had developed a widespread itchy, vesicular rash in the week preceding admission. Despite 1 week of treatment with oral coamoxiclav (625 mg three times daily), his symptoms had worsened.The diagnosis of adenocarcinoma of the prostate (Gleason score of 9, reflecting poorly differentiated disease) had been made 3 years previously, and he had undergone transurethral resection of the prostate and received hormonal treatment with an antiandrogen (bicalutamide), luteinizing hormone-releasing hormone blockade (goserelin), and diethylstilboestrol. Subsequently, he had undergone palliative radiotherapy for bony lesions in the right femur. At the time of admission, he was receiving outpatient chemotherapy with prednisolone (5 mg twice daily) and mitoxantrone, which he had been tolerating well.On clinical examination, he looked unwell with marked swelling and erythema of the right eyelids and cheek. The right conjunctivae were injected and edematous, and there was mild right-sided proptosis, but no gaze palsy. He had a vesicular rash over the trunk and limbs, suggestive of disseminated varicella-zoster virus infection. There were areas of deep, painful ulceration of the hard palate with surrounding mucosal erythema and edema (Fig. 1A and B). He was afebrile and hemodynamically stable (blood pressure, 135/70 mm Hg; heart rate, 70 beats/min).Baseline blood tests showed a normocytic anemia (hemoglobin, 9.3 g/dl; mean corpuscular volume, 96.9 fl) and thrombocytopenia (94 ϫ 10 9 /liter), but the white cell count was within the normal reference range (5.8 ϫ 10 9 /liter). C-reactive protein was raised at 74 mg/liter. Blood cultures were sterile. Magnetic resonance imaging with gadolinium enhancement demonstrated marked right-sided proptosis, with only subtle signs within the orbit to explain this; periorbital cellulitis was confirmed, with the inflammatory change extending into the nasolachrymal sac, nares, and philtrum. There was swelling and enhancement of the right lachrymal gland and marked mucosal thickening in the nasal cavity and throughout the ethmoidal sinuses on the right (Fig. 1C). The cavernous sinus and adjacent brain tissue looked normal.Based on clinical and radiological findings, the diagnosis made was right-sided necrotizing maxillary and eth...

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Skin and soft tissue infections caused by Staphylococcus lugdunensis: Report of 20 cases

Cited by 38 publications

References 28 publications

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

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

Staphylococcus lugdunensis: case report and discussion

Acute Necrotizing Sinusitis Caused by Staphylococcus lugdunensis

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