Staphylococcus lugdunensis infective endocarditis: description of 10 cases and analysis of native valve, prosthetic valve, and pacemaker lead endocarditis clinical profiles

Abstract

Objective: To evaluate the incidence and the clinical and echocardiographic features of infective endocarditis (IE) caused by Staphylococcus lugdunensis and to identify the prognostic factors of surgery and mortality in this disease. Design: Prospective cohort study. Setting: Study at two centres (a tertiary care centre and a community hospital). Results: 10 cases of IE caused by S lugdunensis were identified at our institutions, representing 0.8% (four of 467), 1.5% (two of 135), and 7.8% (four of 51) of cases of native valve, prosthetic valve, and pacemaker lead endocarditis in the non-drug misusers. Native valve IE was present in four patients (two aortic, one mitral, and one pulmonary), prosthetic valve aortic IE in two patients, and pacemaker lead IE in the other four patients. All patients with left sided IE had serious complications (heart failure, periannular abscess formation, or shock) requiring surgery in 60% (three of five patients) of cases with an overall mortality rate of 80% (four of five patients). All patients with pacemaker IE underwent combined medical treatment and surgery, and mortality was 25% (one patient). In total 59 cases of IE caused by S lugdunensis were identified in a review of the literature. The combined analysis of these 69 cases showed that native valve IE (53 patients, 77%) is characterised by mitral valve involvement and frequent complications such as heart failure, abscess formation, and embolism. Surgery was needed in 51% of cases and mortality was 42%. Prosthetic valve endocarditis (nine of 60, 13%) predominated in the aortic position and was associated with abscess formation, required surgery, and high mortality (78%). Pacemaker lead IE (seven of 69, 10%) is associated with a better prognosis when antibiotic treatment is combined with surgery. Conclusions: S lugdunensis IE is an uncommon cause of IE, involving mainly native left sided valves, and it is characterised by an aggressive clinical course. Mortality in left sided native valve IE is high but the prognosis has improved in recent years. Surgery has improved survival in left sided IE and, therefore, early surgery should always be considered. Prosthetic valve S lugdunensis IE carries an ominous prognosis.

2015 ESC Guidelines for the management of infective endocarditis

“…Staphylococcus aureus zazwyczaj wywołuje IZW o ostrym przebiegu, ze znaczną destrukcją zastawek, podczas gdy CoNS postać choroby o przedłużającym się przebiegu (poza S. lugdunensis [155] oraz niektórych przypadków S. capitis) [156,157]. W tabeli 17 podsumowano zalecenia dotyczące leczenia IZW wywołanego przez gronkowce złociste metycylinowrażliwe i metycylinooporne oraz CoNS zarówno na własnej zastawce, jak i u osób z protezą zastawkową.…”

Staphylococcus Lugdunensis Native Tricuspid Valve Endocarditis: a Case Report and Review of Literature

“…lugdunensis is a part of the resident flora of the human skin, particularly in the perineum and the breast. 7 It has been associated with a wide variety of infections, including skin and soft tissue infections, 3 Endocarditis is the one of the most devastating complications of an S. lugdunensis infection. In contrast to other CNS having a subacute or indolent presentation, S. lugdunensis has a fulminant course similar to S. aureus endocarditis with frequent complications (60%).…”

“…Anguera et al in their review of 69 patients noted heart failure (45%), periannular abscess (19%), and systemic embolization (30%) to be the common complications. 3 S. lugdunensis predominantly causes native valve endocarditis (77%), as opposed to other CNS that tend to infect prosthetic valves. 3,7 It has a predilection to involve the left-sided valves in the following order: mitral valve (49%), aortic valves (26%) and both mitral and aortic valves (17%).…”

“…3 S. lugdunensis predominantly causes native valve endocarditis (77%), as opposed to other CNS that tend to infect prosthetic valves. 3,7 It has a predilection to involve the left-sided valves in the following order: mitral valve (49%), aortic valves (26%) and both mitral and aortic valves (17%). 7 Ours is an unusual case of tricuspid valve endocarditis.…”

“…S. lugdunensis is has been reported to cause central nervous system infections, abscesses, wound infections, joint infections, and endocarditis. [1][2][3] We report a rare case of native tricuspid valve S. lugdunensis endocarditis in a non-intravenous drug user and include a brief literature review.…”