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Staphylococcus Epidermidis Infection

Staphylococcus epidermidis infection is mainly a nosocomial infection caused by the Gram-positive bacillus, Staphylococcus epidermidis. It is now the commonest cause of infection associated with indwelling medical catheters, prosthetic devices, and implants. Clinical manifestations are variable depending upon the location of the infection.


Presentation

Staphylococcus epidermidis (S.epidermidis) is a bacteria residing on human skin which today has become recognized as an opportunistic virulent pathogen [1]. S.epidermidis infections are associated with indwelling medical catheters, devices, and implants like central or peripheral intravenous lines, urinary catheters, prosthetic heart valves, prosthetic joints, and cerebrospinal fluid shunts [2] [3]. These catheters and devices probably become contaminated by the bacteria when being inserted by medical personnel [4]. The infection can be transmitted by healthcare providers due to improper hand hygiene. It can also be transmitted directly through a patient to patient contact and/or through environmental contamination [5].

S.epidermidis infection affects mainly hospitalized patients. Clinical manifestations depend on the location of the infection e.g. a patient with a skin infection will have impetigo while a patient with urinary tract infection may present with dysuria or pyuria. Fever is an omnipresent manifestation along with malaise, asthenia, and fatigue. Low birth weight neonates and immunosuppressed individuals have a higher incidence of septicemia, osteomyelitis, septic arthritis, bursitis, endocarditis, intracardiac abscesses, and myositis. Patients with endocarditis may present with night sweats, unexplained weight loss, cough, dyspnea, pallor, petechiae, and splinter hemorrhages under the nail bed. However, the incidence of serious complications like prosthetic valve endocarditis is relatively low in Staphylococcus epidermidis infection, which is typically either chronic or subacute in nature [6].

Generalized Lymphadenopathy
  • We conclude that catheter-related S. epidermidis infection may result in generalized lymphadenopathy due to dissemination of the infective focus.[ncbi.nlm.nih.gov]
Splinter Hemorrhage
  • Patients with endocarditis may present with night sweats, unexplained weight loss, cough, dyspnea, pallor, petechiae, and splinter hemorrhages under the nail bed.[symptoma.com]
Uremia
  • View Article : Google Scholar : PubMed/NCBI 19 Zhou Yan and Zhu Shuqing: Acute arrest of hematopoiesis due to oral methotrexate in a patient with uremia.[spandidos-publications.com]
Neglect
  • The current state of the art in antimicrobial activation of biomaterials through surface modification and the incorporation of antimicrobial agents is then discussed as is a somewhat neglected area related to BAI, the immune response to an implanted biomaterial[books.google.com]

Workup

S. epidermidis infection should be suspected in individuals with prosthetic devices even if they present up to a year after the surgery with low-grade fever and malaise. It should also be suspected in hospitalized and intensive care unit patients with indwelling catheters and fever. Physical examination may be nonspecific or will reveal purulent discharging wounds, hypotension, cardiac murmur in cases of endocarditis, and abnormal sounds on auscultation in pneumonia. The diagnosis is confirmed if at least two blood cultures obtained on two different days/times are positive for S.epidermidis [5]. Specimen samples for microbiological testing can be acquired from the site of infection e.g. wounds or urine. Gram stain of sputum samples and cultures may be useful to detect the organism in patients with pneumonia. As S. epidermidis is a common contaminant, urine culture must be obtained properly via catheterization or suprapubic aspiration in patients with urinary tract infection [7].

Transthoracic echocardiography (TTE) is recommended in all patients with suspected endocarditis [8]. Transesophageal echocardiography (TEE) can be performed, in absence of contraindications, if TTE does not detect vegetations in clinically suspicious cases of endocarditis [9].

Imaging studies like ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI) may be indicated to detect S.epidermidis infection in osteomyelitis or uncertain sites.

Gram-Positive Bacteria
  • Category Infectious disease Brite Infectious diseases [BR: br08401 ] Bacterial infections Infections caused by Gram-positive bacteria H01401 Methicillin-resistant Staphylococcus epidermidis (MRSE) infection Human diseases in ICD-11 classification [BR:[genome.jp]
  • Long believed to be predominantly due to Gram-negative bacteria, during the second half of the 20th century, Gram-positive bacteria, in particular Staphylococcus aureus , have become leading causes of sepsis and sepsis-related deaths [2].[id-hub.com]
  • Staphylococcus epidermidis, also referred to as Staph epidermidis is a species from the genus of Staphylococcus which consists of some 40 Gram-positive bacteria.[prod.hopkins-abxguide.org]
  • Strains of Staphylococcus resistant to our most powerful antibiotics have increased pressure on researchers to find alternative, more effective ways of fighting Staphylococcus.Staphylococci are spherical Gram-positive bacteria, which are immobile and[bacmap.wishartlab.com]
  • Since its injection formulation was first approved for the indication of infectious disease due to Gram-positive bacteria in 1958 in the USA, vancomycin has become an approved antibiotic throughout the world and is highly valued particularly for the treatment[bmjopen.bmj.com]
Gram-Positive Coccus
  • Pathophysiology S aureus is a gram-positive coccus that is both catalase- and coagulase-positive. Colonies are golden and strongly hemolytic on blood agar.[emedicine.medscape.com]
Human Parvovirus B19
  • PubMed/NCBI 15 Al-Abdwani RM, Khamis FA, Balkhair A, Sacharia M and Wali YA: A child with human parvovirus B19 infection induced aplastic anemia and acute hepatitis: Effectiveness of immunosuppressive therapy.[spandidos-publications.com]

Treatment

  • treatment completion or discontinuation.[bmjopen.bmj.com]
  • They explore the molecular mechanisms of bacterial adherence, biofilm formation, regulation of biofilm maintenance, and cell-to-cell communication and present the latest information on various treatment protocols that should aid physicians in the treatment[books.google.com]
  • However, the symptoms persisted after 1 week of treatment and the WBC count had reduced to 0.1 10 9 cells/l.[spandidos-publications.com]
  • The treatments of staphylococcal infections are complicated by the development of antibiotic resistance, and the remaining effective treatment against most strains of multidrug-resistant staphylococci, including MRSA and MRSE, is the glycopeptide antibiotic[genome.jp]
  • Biofilm formation contributes to the ability of the organism to withstand the host's innate and acquired immune defense mechanisms and to resist antimicrobial therapy, so that device removal is a regular feature for the treatment of S. epidermidis biomaterial-associated[opus.bath.ac.uk]

Prognosis

  • Staph Infection Prognosis When mild and promptly treated with antibiotics, the prognosis for recovery from a Staph infection is excellent. However, a MRSA infection can have an entirely different outlook.[onhealth.com]
  • What Is the Prognosis of a Staph Infection? If a staph infection is treated early with appropriate antibiotics and, if necessary, surgical drainage, the patient's prognosis is excellent. However, the U.S.[emedicinehealth.com]

Etiology

  • A previous study reported that infection may trigger the process of AAH, and exposure to certain drugs may be the possible etiology ( 8 ). The patient presented with a high fever, pallor and tiredness.[spandidos-publications.com]
  • Traditionally, S. aureus has been considered as the main etiological agent of mastitis.[bmcmicrobiol.biomedcentral.com]

Epidemiology

  • Molecular epidemiology of Staphylococcus epidermidis in a neonatal intensive care unit over a three-year period. J Clin Microbiol. 2000; 38 (5): 1740-6[ PubMed ] 20. Koksal F, Yasar H, Samasti M.[archcid.com]
  • Epidemiology of Methicillin-Resistant Staphylococcus aureus Isolated From Health Care Providers in Mofid Children Hospital. Arch Pediatr Infect Dis. 2015; 3 (2) 22. Mertens A, Ghebremedhin B.[pedinfect.com]
  • “Molecular Epidemiology of Staphylococcus epidermidis in a Neonatal Intensive Care Unit over a Three-Year Period.” Journal of Clinical Microbiology. Vol. 38, No. 5 (May 2000); p. 1740-1746 6. Picture: Web Page By: Mohammad Bukhari September 27, 2004[web.uconn.edu]
  • Research in our group focusses on understanding the epidemiology, clinical impact and optimal therapeutic strategies for treating drug-resistant staphylococcal infections, as well as using bacterial genomics and infection models to understand how staphylococci[biomedicalsciences.unimelb.edu.au]
  • Epidemiologische und molekulare Untersuchungen zur Biofilmbildung in Staphylococcus epidermidis und Staphylococcus aureus Epidemiological and molecular investigations of the biofilm formation in Staphylococcus epidermidis and Staphylococcus aureus Staphylococcus[opus.bibliothek.uni-wuerzburg.de]
Sex distribution
Age distribution

Pathophysiology

  • The current accepted pathophysiological mechanism of S. epidermidis orthopedic device infection is the direct inoculation of skin colonizing strains at the time of surgery [2] – [4] .[journals.plos.org]
  • Pathophysiology S aureus is a gram-positive coccus that is both catalase- and coagulase-positive. Colonies are golden and strongly hemolytic on blood agar.[emedicine.medscape.com]

Prevention

  • This novel model can now be used to characterize immune ontogeny, evaluate infection biomarkers, and assess preventative and therapeutic modalities.[ncbi.nlm.nih.gov]
  • Clearly, a better understanding of the pathogenesis of these infections and improved means for prevention and treatment are urgently needed![books.google.com]
  • NIAID supports basic and applied research to prevent, diagnose and treat infectious diseases such as HIV/AIDS and other sexually transmitted infections, influenza, tuberculosis, malaria and illness from potential agents of bioterrorism.[hospitalacquiredinfections.blogspot.com]
  • Ice-cold medium was added, and the cells were infected with bacteria (10 5 CFU/well) and allowed to adhere for 1 hour at 4 C to prevent invasion.[journals.plos.org]
  • Can Staph Infections Be Prevented? There is no vaccine currently available to prevent Staphylococcus aureus . Preventing Staph remains the best defense against contracting an infection.[onhealth.com]

References

Article

  1. CDC. National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control. 2004;32:470–485.
  2. Rogers KL, Fey PD, Rupp ME. Coagulase-negative staphylococcal infections. Infect Dis Clin North Am. 2009;23:73–98.
  3. Todd JK. Coagulase-negative staphylococci. In: Kliegman RM, Stanton BF, St Geme JWIII, Schor NF, Behrman RE, editors. Nelson Textbook of Pediatrics. 19. Philadelphia: Saunders; 2011; 909–910.
  4. Uckay I, Pittet D, Vaudaux P, et al. Foreign body infections due to Staphylococcus epidermidis. Ann Med. 2009;41:109–119.
  5. Cherifi S, Byl B, Deplano A, et al. Genetic characteristics and antimicrobial resistance of Staphylococcus epidermis isolates from patients with catheter related bloodstream infections and from colonized healthcare workers in a Belgian hospital. Ann Clin Microbiol and Antimicrob. 2014; 13:20.
  6. Otto M. Staphylococcus epidermidis - the accidental pathogen. Nat Rev Microbiol. 2009;7(8):555-567
  7. Kanai H, Sato H, Takei Y. Community-acquired methicillin-resistant Staphylococcus epidermidis pyelonephritis in a child: a case report. J Med Case Rep. 2014; 8:415.
  8. Holland TL, Arnold C, Fowler VG Jr. Clinical management of Staphylococcus aureus bacteremia: a review. JAMA. 2014;312 (13):1330-41.
  9. Kaasch AJ, Fowler VG Jr, Rieg S, et al. Use of a simple criteria set for guiding echocardiography in nosocomial Staphylococcus aureus bacteremia. Clin Infect Dis. 2011;53 (1):1-9.

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Last updated: 2018-06-21 17:30