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Staphylococcus capitis endocarditis due to a transvenous endocardial pacemaker infection: case report and review of Staphylococcus capitis endocarditis.

OBJECTIVES: Newer microbiologic methods to determine the species of coagulase-negative staphylococci (CoNS) have evolved which have shown that most endocarditis due to CoNS is caused by Staphylococcus epidermidis, and far fewer by Staphylococcus warneri and Staphylococcus lugdunensis. METHODS: The recent opportunity to successfully treat a patient with methicillin-resistant Staphylococcus capitis endocarditis secondary to an infected transvenous pacemaker led to a review of the literature relating to S. capitis endocarditis. RESULTS: Thirteen previously recorded patients were identified. Twelve (86%) patients were male. Ten had endocarditis associated with a native valve, two with prosthetic valves and one with a transvenous pacemaker. Mortality was low in all 14 cases (including this case report) with only two deaths; one in a patient with a native valve and the other with a prosthetic valve. Four of the isolates were methicillin resistant but sensitive to vancomycin, which was used in the treatment of eight patients. Those patients with prosthetic cardiac devices appear to do better when the devices are surgically removed. CONCLUSIONS: CoNS as a cause of endocarditis appears to be increasing and the current ability to determine the species of these organisms should elicit the epidemiology, clinical characteristics and biomolecular mechanisms involved in the induction of valvular disease.

Adult↗

Identification of the Staphylococcus sciuri species group with EcoRI fragments containing rRNA sequences and description of Staphylococcus vitulus sp. nov.

Strains of a new species, Staphylococcus vitulus, were isolated from food and a variety of mammals. This species was recognized on the basis of the results of an analysis of genomic EcoRI fragments containing portions of the rRNA operons. The patterns of hybridized fragments obtained from strains belonging to the new taxon were sorted into a distinguishable cluster and were distinct from the Staphylococcus lentus and Staphylococcus sciuri patterns. The results of DNA-DNA hybridization reactions demonstrated that strains in this cluster were more closely related to S. lentus and S. sciuri than to other Staphylococcus species and yet were significantly different. While these strains had some of the phenotypic characteristics of the S. sciuri species group, the newly recognized taxon could be distinguished by its very small colonies on P agar, absence of alkaline phosphatase activity, and lack of acid production from L-arabinose, maltose, N-acetylglucosamine, D-mannose, and raffinose. The type strain of the new species is strain DD 756 (= ATCC 51145).

Animals↗

Complex genomic and phenotypic characterization of the related species Staphylococcus carnosus and Staphylococcus piscifermentans.

On the basis of numerical analysis of 100 phenotypic features, the strains of two species, Staphylococcus carnosus and Staphylococcus piscifermentans, were differentiated into two separate phenons corresponding with the macrorestriction patterns of their genomic DNA, as well as with the results of ribotyping and PCR amplification of enterobacterial repetitive intergenic consensus sequences. One of the S. carnosus strains, the F-2 strain, was shown to be marginal, exhibiting the lowest genomic and phenotypic similarity to the S. carnosus type strain DSM 20501T. Two of the strains studied (strains S. carnosus SK 06 and S. piscifermentans SK 05) were phenotypically convergent, forming a separate phenon. They were phenotypically similar, even though the genomic DNA of one of them was homologous with that of the S. carnosus type strain, whereas that of the other was homologous with the genomic DNA of the S. piscifermentans type strain. In such cases, fingerprinting methods (particularly macrorestriction analysis and ribotyping) served as important correctives, as they allow phenotypically convergent strains to be distinguished on the basis of their genomic profiles. The results of this paper support the proposal for the new species Staphylococcus condimenti as well as the new subspecies Staphylococcus carnosus subsp. utilis.

Bacterial Typing Techniques↗

Reclassification of Staphylococcus pulvereri Zakrzewska-Czerwinska et al. 1995 as a later synonym of Staphylococcus vitulinus Webster et al. 1994.

A polyphasic taxonomic approach was applied to strains of the species Staphylococcus vitulinus and Staphylococcus pulvereri in order to clarify their taxonomic relatedness. Four reference strains, representing both species, and seven strains isolated from human clinical material were characterized by biotyping, ribotyping and SDS-PAGE analysis of whole-cell proteins, and none of the screening approaches allowed the two taxa to be distinguished. DNA-DNA hybridization experiments between four selected representative strains, including the type strains, confirmed that Staphylococcus pulvereri is a later synonym of Staphylococcus vitulinus.

Abscess↗

Staphylococcus epidermidis and Staphylococcus aureus in otitis media with effusion.

Bacteriologic investigation of middle ear effusion (MEE), external ear canal, and the nasopharynx was carried out on 458 patients with otitis media with effusion. Staphylococcus epidermidis was the most common bacteria in MEE, even after excluding the contaminants from the external ear canal, which had the same value of minimal inhibitory concentration as the paired MEE. The bacterial agreement of S epidermidis between MEE and the nasopharynx was extremely rare in contrast with Haemophilus influenzae, Streptococcus pneumoniae, and Branhamella catarrhalis, although the organism was also frequently isolated from the nasopharynx. Staphylococcus aureus, having the same minimal inhibitory concentration as that in the nasopharynx, was more frequently found in MEE than S epidermidis. The results suggest that S epidermidis found in MEE is not a pathogen, but rather a contaminant in many instances. Staphylococcus aureus seems to be a causative agent in otitis media with effusion.

Adolescent↗

Identification of Staphylococcus epidermidis and Staphylococcus hominis from blood cultures by testing susceptibility to desferrioxamine.

Testing susceptibility to desferrioxamine has recently been described as a method for the identification of Staphylococcus epidermidis. This method was compared to a commercial test and the tube coagulase test for the identification of staphylococci from blood cultures and other fluid specimens. A total of 216 isolates was tested over a 13-month period. Sensitivity of the desferrioxamine test in identifying isolates of Staphylococcus epidermidis and Staphylococcus hominis was 97.3%, while specificity was 91.8%. When isolates displaying discrepant desferrioxamine results were characterized using recently described interpretive criteria, sensitivity and specificity of the desferrioxamine test improved to 100%. The desferrioxamine test was reliable, inexpensive and simple to perform, and should prove useful in the diagnostic laboratory.

Bacteremia↗

Conjugational transfer of gentamicin resistance plasmids intra- and interspecifically in Staphylococcus aureus and Staphylococcus epidermidis.

We have previously reported the transfer of gentamicin resistance (Gmr) plasmids in a mixed culture inter- and intraspecifically between strains of Staphylococcus aureus and Staphylococcus epidermidis isolated at Michael Reese Hospital (Jaffe et al., Antimicrob. Agents Chemother. 21:773-779, 1982). We have now shown that representatives of these plasmids were transferred between apparently nonlysogenic strains of S. aureus either in mixed culture in broth or by filter-mating on agar medium. The mechanism of transfer appeared to be conjugation. A transferable Gmr plasmid (pSH8) mobilized or cotransferred a tetracycline R-plasmid and a chloramphenicol R-plasmid that were not independently transferable. The transfer of Gmr plasmids was accompanied by a high incidence of deletion mutations with varied loss of plasmid resistance determinants and, with some mutants, loss of the ability to effect self-transfer. Restriction endonuclease digestion of pSH8 and its deletion mutants made it possible to assign the property of self-transfer to a specific segment of the pSH8 genome and provided the basis for a physical and genetic map of that plasmid. Similar Gmr plasmids from S. aureus strains isolated in locations remote from Michael Reese Hospital had resistance determinants and transfer properties comparable to those of pSH8. Our observations provide evidence for the conjugal transfer of some staphylococcal plasmids, apparently independent of the presence of phage. This mechanism may be of significance in the intra- and interspecific dissemination of resistance to aminoglycosides and other antibiotics in Staphylococcus spp.

Chromosome Mapping↗

Sensitivity of canine Staphylococcus intermedius strains to the phages typing Staphylococcus aureus isolated from man.

98 staphylococci strains isolated from skin lesions of dogs were tested for their morphological, physiological and biochemical characteristics. These examinations have proved that the majority of the strains was Staphylococcus intermedius (n = 97), and only one was Staphylococcus aureus. The strains were also tested for their sensitivity to bacteriophages. Most of Staphylococcus intermedius strains (n = 75) could be typed with the set of human phages, typing staphylococci isolated from man. Two phages, 676 and Phi 131 have turned out to be highly active towards a large number of the isolates.

Animals↗

In vitro antimicrobial activity of imipenem in combination with vancomycin or teicoplanin against Staphylococcus aureus and Staphylococcus epidermidis.

The interaction between imipenem and two glycopeptides against staphylococci was examined for potential synergy. Imipenem in combination with vancomycin or teicoplanin exerted a synergistic or additive effect against a majority of Staphylococcus aureus and Staphylococcus epidermidis isolates tested by the checkerboard method. Synergistic inhibitory effects were frequently accompanied by synergistic bactericidal effects. For a proportion of bacterial isolates of both species, the demonstration of synergy by the checkerboard method was confirmed by time-kill studies using antibiotic combinations at the MICs or at achievable serum antibiotic levels. Only with a single isolate of Staphylococcus epidermidis was antagonism with either antibiotic combination recorded.

Drug Resistance, Microbial↗

Comparison of adherence and urine growth rate properties of Staphylococcus saprophyticus and Staphylococcus epidermidis.

To compare the adherence properties of Staphylococcus saprophyticus and Staphylococcus epidermidis in vitro studies were conducted with clinical isolates and cell culture monolayers (Hela, Vero, MDCK). Staphylococcus saprophyticus exhibited greater cell adherence, but no significant difference in mean urine growth rate. Its cell-adherence properties seem to explain in part its virulence.

Adhesiveness↗

Cloning and expression of Staphylococcus epidermidis urease gene sequences in Staphylococcus carnosus.

The urease gene sequences of Staphylococcus epidermidis CNS23 were cloned and expressed in Staphylococcus carnosus TM300. In vitro translation of the cloned sequences revealed four polypeptides (60, 17, 11 and 7.5 kDa) that were associated with enzyme activity. Southern hybridisation experiments showed high homologies with the urease genes of Staphylococcus saprophyticus.

Blotting, Southern↗

Comparison of identification systems for Staphylococcus epidermidis and other coagulase-negative Staphylococcus species.

Three commercially available systems (API Staph-Trac, API 20GP, and Vitek GPI), used to identify coagulase-negative staphylococci, were evaluated against 277 bloodstream isolates, including 94 isolates of Staphylococcus epidermidis and 183 isolates of other coagulase-negative Staphylococcus species. The conventional method of Kloos and Schleifer served as the reference method. Controls included 14 ATCC type culture strains of coagulase-negative staphylococci. The API Staph-Trac system showed the highest rate of agreement with reference method, correctly identifying 73% of the isolates. The Vitek GPI System had an overall rate of agreement of 67% and the API 20GP system correctly identified 61%. The API Staph-Trac system correctly identified 94% of the isolates of S. epidermidis compared with 64% by both Vitek GPI and API 20GP. The most common error for both Vitek GPI and API 20GP systems was the failure to identify organisms contained within the database of the systems. Because none of the tested commercial identification systems identified "non-epidermidis" coagulase-negative Staphylococcus species with a high degree of accuracy, the systems need to be markedly improved or new systems developed.

Bacteremia↗

Inhibition of virulence factor expression in Staphylococcus aureus by the Staphylococcus epidermidis agr pheromone and derivatives.

The agr quorum-sensing system in Staphylococci controls the production of surface proteins and exoproteins. In the pathogenic species Staphylococcus aureus, these proteins include many virulence factors. The extracellular signal of the quorum-sensing system is a thiolactone-containing peptide pheromone, whose sequence varies among the different staphylococcal strains. We demonstrate that a synthetic Staphylococcus epidermidis pheromone is a competent inhibitor of the Staphylococcus aureus agr system. Derivatives of the pheromone, in which the N-terminus or the cyclic bond structure was changed, were synthesized and their biological activity was determined. The presence of a correct N-terminus and a thiolactone were absolute prerequisites for an agr-activating effect in S. epidermidis, whereas inhibition of the S. aureus agr system was less dependent on the original structure. Our results show that effective quorum-sensing blockers that suppress the expression of virulence factors in S. aureus can be designed based on the S. epidermidis pheromone.

Bacterial Proteins↗

Methicillin-resistant Staphylococcus aureus and methicillin-resistant Staphylococcus epidermidis infections in the cornea.

PURPOSE: To describe the incidence and clinical management of corneal infections with methicillin-resistant Staphylococcus aureus (MRSA) or methicillin-resistant Staphylococcus epidermidis (MRSE). METHODS: The incidence of methicillin-resistant Staphylococcus (MRS) at the Department of Ophthalmology, Kyoto Prefectural University of Medicine, was reviewed during the 5-year period from January 1996 to December 2000. Clinical aspects of MRS colonization or infection in the eye were investigated. RESULTS: Methicillin-resistant S. aureus or MRSE was detected from 30 eyes with ocular diseases; post-keratoplasty (11 eyes), ocular surface disorders without operation (9 eyes), and others (10 eyes). Among the 30 eyes, 12 manifested keratitis. Eight cases (8 eyes) occurred after keratoplasty, including four postoperative cases in patients with Stevens-Johnson syndrome, and two bilateral cases (4 eyes) in patients with acute-phase Stevens-Johnson syndrome. The degree of MRS keratitis was classified into 4 groups: asymptomatic carrier or conjunctivitis, intraepithelial infiltrations, superficial keratitis, and severe keratitis leading to corneal perforation. All cases of keratitis were treated successfully with topical ofloxacin (OFLX), vancomycin (VCM), or arbekacin (ABK). CONCLUSION: Factors associated with ocular MRS colonization were long-term use of antibiotics and/or steroids, and hospitalization. Patients who had undergone keratoplasty or who had Stevens-Johnson syndrome were at increased risk of MRS keratitis. Superficial stromal infiltrations, minimal melting, and minimal stromal scarring are characteristic of MRS keratitis. Therapy for MRS keratitis is summarized. Ofloxacin, VCM, and ABK are effective in the treatment of MRS keratitis. Vancomycin eye ointment is effective as the final choice in serious cases.

Adult↗

The Staphylococcus aureus and Staphylococcus epidermidis transferrin-binding proteins are expressed in vivo during infection.

Staphylococci express a 42 kDa cell-wall-associated protein which functions as a receptor for the mammalian iron-binding glycoprotein transferrin. To determine whether this transferrin-binding protein (TBP) is expressed during infection, Staphylococcus aureus and Staphylococcus epidermidis were grown in vivo in chambers implanted intraperitoneally in rats. SDS-PAGE and Western blotting of cell wall proteins prepared from staphylococci recovered directly from the chambers revealed the presence of both the TBP and bacterial-surface-associated rat transferrin. To obtain evidence for the in vivo expression of the staphylococcal TBPs in humans, sera and human peritoneal dialysate (HPD) from non-infected patients undergoing continuous ambulatory peritoneal dialysis (CAPD) and sera from healthy human volunteers were screened for anti-TBP antibodies. Western immunoblots revealed that three out of ten samples from the latter group, seven out of ten HPD samples and ten of ten CAPD patient serum samples contained antibodies to the TBP of both S. aureus and S. epidermidis. To gain further insights into the appearance of TBP antibodies, HPD samples were collected over time from CAPD patients whose HPD samples taken immediately after catheter insertion lacked anti-TBP antibodies. In two of these patients, each of whom experienced an episode of peritonitis due to S. epidermidis or Staphylococcus hominis, antibodies to the TBP appeared in the HPD collected immediately post-infection. To determine whether such TBP antibodies were capable of blocking interactions between transferrin and its staphylococcal receptor, HPD immunoglobulin fractions were purified using protein A-Sepharose beads. In competition assays, these immunoglobulins blocked the binding of 125I-labelled transferrin both to whole bacteria and to the isolated 42 kDa TBPs of S. aureus and S. epidermidis. These provide evidence to show that staphylococcal TBPs are expressed in vivo during infection.

Animals↗

The adherence of Staphylococcus aureus, Staphylococcus epidermidis and Escherichia coli on cotton, polyester and their blends.

The adherent behaviour of the Gram-positive Staphylococcus aureus and Staphylococcus epidermidis and the Gram-negative Escherichia coli on cotton, polyester and their blends through contact in aqueous suspensions was studied. Staphylococcus epidermidis was found to adhere to fabrics much more so than Staph. aureus. The adherence of both Staph. epidermidis and Staph. aureus to fabrics increased as the content of polyester fibres in the fabrics increased. The attachment of E. coli to all fabrics was very low and was not affected by the fibre contents. Total numbers of adherent bacteria on cotton and polyester fabrics were related directly to the concentrations of the bacterial suspensions. The extents of adherence, expressed by the percentage of adherent bacteria from the suspension, however, were independent of the concentration. The length of contact with bacteria was also found to affect the adherence of bacteria on fabrics studied.

Absorption↗

Cloning and expression of methicillin resistance from Staphylococcus epidermidis in Staphylococcus carnosus.

A 6.2-kilobase chromosomal DNA fragment from a methicillin-resistant Staphylococcus epidermidis strain was cloned into Staphylococcus carnosus by using staphylococcal plasmid pCA44 as the vector. The recombinant plasmid obtained, pBBB21, conferred methicillin resistance on its host and was responsible for the synthesis of a low-affinity penicillin-binding protein (PBP), PBP 2'. PBP 2' determined by the S. epidermidis DNA and expressed as a membrane-bound PBP in S. carnosus reacted with monoclonal antibodies directed against PBP 2' of Staphylococcus aureus origin, and the cloned S. epidermidis DNA hybridized to the methicillin (mec)-specific DNA from S. aureus. These findings point to a common origin of the methicillin resistance determinant in staphylococci.

Bacterial Proteins↗

Ciprofloxacin resistance in coagulase-positive and -negative staphylococci: role of mutations at serine 84 in the DNA gyrase A protein of Staphylococcus aureus and Staphylococcus epidermidis.

gyrA mutations in quinolone-resistant pathogenic isolates of Staphylococcus spp. have been detected by the direct HinfI digestion of polymerase chain reaction products. Homology among gyrA genes allowed rapid examination of both coagulase-positive and -negative isolates. DNA sequence analysis revealed that ciprofloxacin resistance in Staphylococcus epidermidis is associated with a novel Ser-84----Phe mutation in the DNA gyrase A protein, analogous to Ser-84----Leu changes observed in Staphylococcus aureus.

Anti-Infective Agents↗