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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].

Weight Loss
  • Patients with endocarditis may present with night sweats, unexplained weight loss, cough, dyspnea, pallor, petechiae, and splinter hemorrhages under the nail bed.[symptoma.com]
  • Besides fever and fatigue, symptoms of endocarditis may also include night sweats, unintended weight loss, chronic cough, shortness of breath, pale skin, blood in urine and red spots on the skin.[prod.hopkins-abxguide.org]
Chronic Infection
  • It is known that capsular contraction after silicone breast implantation may be caused by chronic infection and the review supports the IRG's concern that low grade infection with an organism such as Staph Epidermidis could cause chronic ill health in[hospitalacquiredinfections.blogspot.com]
  • Brady RA, Leid JG, Calhoun JH, Costerton JW, Shirtliff ME (2008) Osteomyelitis and the role of biofilms in chronic infection. FEMS Immunol Med Microbiol 52: 13–22. View Article Google Scholar 11.[journals.plos.org]
Severe Pain
  • When the patient has few clinical signs except severe pain it suggests that the bacteria may be pseudomonas. This bacteria seems to irritate nerve endings more than other germs. Another rare infection is caused by mycobacterium fortuitum.[hospitalacquiredinfections.blogspot.com]
Weakness
  • Staph Sepsis Sepsis (blood infection) with high fever, rapid heart beat and breathing, weakness, dizziness and affected consciousness often arise from skin vascular catheters, infected intestine in heavily ill patients or those receiving long term antibiotic[healthhype.com]
Pallor
  • Patients with endocarditis may present with night sweats, unexplained weight loss, cough, dyspnea, pallor, petechiae, and splinter hemorrhages under the nail bed.[symptoma.com]
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]
Aspiration
  • As S. epidermidis is a common contaminant, urine culture must be obtained properly via catheterization or suprapubic aspiration in patients with urinary tract infection.[symptoma.com]
  • Direct aspiration of the cerebral spinal fluid shunt is obtained, and CSF analysis demonstrates a leukocytosis, elevated protein, and decreased glucose. CSF Gram stain demonstrates gram-positive cocci in clusters. CSF cultures are pending.[medbullets.com]
Sputum
  • Gram stain of sputum samples and cultures may be useful to detect the organism in patients with pneumonia.[symptoma.com]
Night Sweats
  • Patients with endocarditis may present with night sweats, unexplained weight loss, cough, dyspnea, pallor, petechiae, and splinter hemorrhages under the nail bed.[symptoma.com]
  • Besides fever and fatigue, symptoms of endocarditis may also include night sweats, unintended weight loss, chronic cough, shortness of breath, pale skin, blood in urine and red spots on the skin.[prod.hopkins-abxguide.org]
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]
Petechiae
  • Patients with endocarditis may present with night sweats, unexplained weight loss, cough, dyspnea, pallor, petechiae, and splinter hemorrhages under the nail bed.[symptoma.com]
Dysuria
  • 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.[symptoma.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.

Pyuria
  • 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.[symptoma.com]
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]
  • 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]
  • 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]
  • positive bacteria resistant to antimicrobial drugs H01401 メチシリン耐性表皮ブドウ球菌感染症 病原体 Staphylococcus epidermidis [GN: ser ] 治療薬 バンコマイシン塩酸塩 [DR: D00926 ] リンク ICD-11: MG51.Y ICD-10: B95 文献 PMID: 15774886 著者 Gill SR, Fouts DE, Archer GL, Mongodin EF, Deboy RT[genome.jp]
Mycobacterium Fortuitum

Treatment

  • 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]
  • Background: Peritonitis is responsible for the majority of peritoneal dialysis treatment failures and significant morbidity and mortality.[anzsnasm.com]
  • Identification and treatment of carriers may be necessary in this situation. In school settings, the child should be excluded from school until specific treatment begins. Lesions must be covered with a watertight dressing.[www2.health.vic.gov.au]
  • Because of the ability of PGA to promote resistance to innate immune defenses, learning more about the protein could lead to new treatments for S.[hospitalacquiredinfections.blogspot.com]

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]

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]
  • “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]
  • 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]
  • 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]
  • Molecular Epidemiology of Methicillin-Resistant Staphylococcus aureus. Medscape Today from Emerg Infect Dis 7(2), 2001 [On-line article]. Available online at . Estrada, B. (2004 March 2). MRSA in Patients With Cystic Fibrosis.[labtestsonline.it]
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]

Prevention

  • 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]
  • 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]
  • Centers for Disease Control and Prevention. Overview of Healthcare-associated MRSA. (Online information). Available online at . Accessed December 2007. Centers for Disease Control and Prevention. Overview of Community-associated MRSA.[labtestsonline.it]
  • How can you prevent staph food poisoning? The following steps can help prevent staph food poisoning (adapted from the U.S. Centers for Disease Control and Prevention). Shop safely. Bag raw meat, poultry, or fish separately from other food items.[northshore.org]
  • Staph, on the other hand, could prevent CR2 from functioning properly. This clue pointed the finger at one particular Staph molecule: Extracellular Fibrinogen-Binding Protein.[popsci.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: 2019-06-28 09:25