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]

• Sputum

  Gram stain of sputum samples and cultures may be useful to detect the organism in patients with pneumonia. [symptoma.com]

• Lacrimation

  Eye discharge, eye pain, foreign body sensation, photophobia and lacrimation as symptoms and redness (hyperaemia) and oedema (swelling), swelling of the eyelid, lacrimal-sac fluid reflux and keratitis as objective findings were classified into four levels [bmjopen.bmj.com]

• Eye Pain

  Eye discharge, eye pain, foreign body sensation, photophobia and lacrimation as symptoms and redness (hyperaemia) and oedema (swelling), swelling of the eyelid, lacrimal-sac fluid reflux and keratitis as objective findings were classified into four levels [bmjopen.bmj.com]

• 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]

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]

• 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]

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.