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PubMed1999

The emergence of decreased susceptibility to vancomycin in Staphylococcus epidermidis.

BACKGROUND: Coagulase-negative staphylococci (CNS) are the major cause of nosocomial bloodstream infection. Emergence of vancomycin resistance among CNS is a serious public health concern, because CNS usually are multidrug-resistant, and glycopeptide antibiotics, among which only vancomycin is available in the United States, are the only remaining effective therapy. In this report, we describe the first bloodstream infection in the United States associated with a Staphylococcus epidermidis strain with decreased susceptibility to vancomycin. METHODS: We reviewed the hospital's microbiology records for all CNS strains, reviewed the patient's medical and laboratory records, and obtained all available CNS isolates with decreased susceptibility to vancomycin. Blood cultures were processed and CNS isolates identified by using standard methods; antimicrobial susceptibility was determined by using minimum inhibitory concentration (MIC) and disk-diffusion methods. Nares cultures were obtained from exposed healthcare workers (HCWs) to identify possible colonization by CNS with decreased susceptibility to vancomycin. RESULTS: The bloodstream infection by an S. epidermidis strain with decreased susceptibility to vancomycin occurred in a 49-year-old woman with carcinoma. She had two blood cultures positive for CNS; both isolates were S. epidermidis. Although susceptible to vancomycin by the disk-diffusion method (16-17 mm), the isolates were intermediate by MIC (8-6 microg/mL). The patient had received an extended course of vancomycin therapy; she died of her underlying disease. No HCW was colonized by CNS with decreased susceptibility to vancomycin. CONCLUSIONS: This is the first report in the United States of bloodstream infection due to S. epidermidis with decreased susceptibility to vancomycin. Contact precautions likely played a role in preventing nosocomial transmission of this strain, and disk-diffusion methods may be inadequate to detect CNS with decreased susceptibility to vancomycin.

Anti-Bacterial Agents↗
PubMed1992

Staphylococcus epidermidis bacteremia from transfusion of contaminated platelets: application of bacterial DNA analysis.

Septicemia is a rare complication of platelet transfusion. A case is reported of transfusion-associated septicemia in a 66-year-old man who received a 10-unit pool of platelets. During transfusion, he experienced rigors, wheezing, dyspnea, and fever. A total of four blood cultures drawn 10 and 36 hours after discontinuation of the transfusion grew Staphylococcus epidermidis. Culture of the residual platelet pool yielded S. epidermidis with a colony count of 10(5) organisms per mL. Strain identity of all four blood isolates and the platelet pool isolate was confirmed by gel electrophoresis of EcoRI and HindIII restriction digests of whole-cell DNA. There have been 31 prior reported cases of platelet transfusion-associated septicemia, of which 9 have been caused by coagulase-negative staphylococci. Systemic reactions to platelet transfusions should prompt consideration of transfusion-associated bacteremia as the cause.

Aged↗
PubMed2004

In vitro attachment of Staphylococcus epidermidis to surgical sutures with and without Ag-containing bioactive glass coating.

The ability of a silver-doped bioactive glass (AgBG) coating to prevent bacterial colonization on surgical sutures was investigated in vitro. Bioactive glass powders, in the form of 45S5 Bioglass and AgBG, were used to coat Mersilk sutures using an optimized 'in house' slurry-dipping process. In vitro experiments were carried out using Staphylococcus epidermidis under both batch and flow conditions. While the traditional batch culture testing was used to determine the number of viable cells adhered to the surface, the flow-cell was used to visualize attachment and detachment over time. Under batch conditions of up to 180 min, statistically significant differences were observed in the colony forming units (CFU) per suture for both the coated and uncoated Mersilk sutures. The results showed that the AgBG coating had the greatest effect on limiting bacterial attachment (8 x 10(2) CFU) when compared to the 45S5 Bioglass coating (3.2 x 10(3) CFU) and the uncoated Mersilk (1.2 x 10(4) CFU). Also under flow conditions differences were seen between the coated and uncoated sutures. Therefore, this preliminary study has demonstrated the quantification and visualization of bacterial attachment onto sutures in order to compare the antibacterial properties of Ag-containing bioactive glass coatings. The bactericidal properties imparted by Ag-containing glass open new opportunities for use of the composite sutures in wound healing and body wall repair.

Bacterial Adhesion↗
PubMed2004

The control of Staphylococcus epidermidis biofilm formation and in vivo infection rates by covalently bound furanones.

In order to overcome the continuing infection rate associated with biomaterials, the use of covalently bound furanones as an antibiofilm coating for biomaterials has been investigated. Furanones have previously been shown to inhibit growth of Gram-positive and Gram-negative bacteria. The aim of these studies were to covalently bind furanones to polymers and to test their efficacy for inhibiting biofilm formation of Staphylococcus epidermidis and in vivo infection rate. Two methods of covalent attachment of furanones were used. The first, a co-polymerisation with a styrene polymer, and second, a plasma-1-ethyl-3-(dimethylaminopropyl) carbodiimide (EDC) reaction to produce furanone-coated catheters. Biofilm formation by S. epidermidis in vitro was inhibited by 89% for polystryene-furanone disks and by 78% by furanone-coated catheters (p<0.01). In an in vivo sheep model we found furanones were effective at controlling infection for up to 65 days. Furanones have potential to be used as a coating for biomaterials to control infection caused by S. epidermidis.

Animals↗
PubMed2006

Assessment of ica operon carriage and biofilm production in Staphylococcus epidermidis isolates causing bacteraemia in bone marrow transplant recipients.

The clinical significance of coagulase-negative staphylococci isolated from blood culture is typically assessed on the basis of a combination of clinical and microbiological criteria. However, these criteria are difficult to apply to haematology patients who are highly immunosuppressed and from whom blood cultures are obtained most frequently through a central venous catheter. This study analysed 112 episodes of Staphylococcus epidermidis bacteraemia that occurred in 79 bone marrow transplant recipients. In 73 (65%) episodes, only one blood culture set was positive for S. epidermidis, while 39 (35%) episodes grew S. epidermidis from multiple blood cultures. Nine patients had two or more episodes of bacteraemia with the same strain, as determined by pulsed-field gel electrophoresis (PFGE). The PFGE method also showed that 34 (31%) isolates belonged to seven clusters, indicating the persistence of certain clones in the environment. Of the 109 isolates analysed, 59 (54%) produced biofilm and 91 (83.5%) carried the ica operon. Isolates that produced biofilm were observed to colonise central venous catheters faster than non-biofilm-producing isolates (18 vs. 37 days; p 0.03). No clinical features were associated with carriage of the ica operon, but the ica operon was carried more frequently by the isolates that formed clusters.

Adhesins, Bacterial↗
PubMed1991

Characterization of a proteinaceous adhesin of Staphylococcus epidermidis which mediates attachment to polystyrene.

Coagulase-negative staphylococci (CoNS) have evolved into important agents of foreign body-related infections. Adhesion of causative bacteria to biomaterials is considered to be an essential step in these infections. We and others have shown that adhesion of CoNS to biomaterials may be mediated by protease-sensitive surface constituents. In the present study we expanded on these investigations by characterizing a biomaterial adhesin of Staphylococcus epidermidis 354 by using a strain-specific monoclonal antibody (MAb 36.4). MAb 36.4 was strongly and exclusively reactive with strain 354 in an enzyme-linked immunosorbent assay in which whole bacteria were used as antigens. Immunoblotting of cell wall polypeptides of strain 354 revealed strong reactivity with a 200- to 220-kDa band and a weaker reaction in the 100- to 110-kDa range. Preincubation of strain 354 with MAb 36.4 resulted in a 54 to 91% (mean +/- standard deviation, 74% +/- 14%; n = 10) inhibition of adhesion to polystyrene spheres. Fab fragments prepared from MAb 36.4 also inhibited adhesion effectively, indicating specific blocking of an adhesion antigen rather than aspecific inhibition. Immunogold electron microscopy with MAb 36.4 revealed deposition of gold particles on the cell surface and possibly also on fimbrialike surface projections. It is concluded that a surface-located protein antigen of S. epidermidis 354 recognized by MAb 36.4 acts as an adhesin mediating attachment to uncoated foreign material. It is speculated that this type of adhesion to biomaterials may play an important role in the pathogenesis of foreign body-related infections caused by CoNS.

Antibodies, Monoclonal↗
PubMed1982

The occurrence of Staphylococcus epidermidis in a department of thoracic and cardiovascular surgery. A clinical and epidemiological investigation.

Changes in resistance traits of Staphylococcus epidermidis isolated in the preoperative and postoperative phases from patients undergoing open heart surgery were studied in a two-step prospective investigation. Period 1 comprised 32 patients. All received streptomycin for five days and methicillin for seven days, starting the evening before operation. None of the patients was colonized with multiresistant (MR) strains before or immediately after operation. Two days after operation, in the intensive care unit (ICU) 79% of the patients carried MR S. epidermidis in the nose. Air analyses showed that 30% of the bacteria isolated from the ICU were MR, while such strains were seldom found in the operating theatre. Nose swabs from the staff showed that 26% at the ICU and none in the operating theatre carried MR strains. In an attempt to counteract the selection for MR strains, all patients in period 2 received methicillin alone for only 3 days, and disinfection of the ICU was then performed after each patient. Period 2 comprised 105 patients. The frequency of MR S. epidermidis in the patient material declined from 80% to 40% and from 26% to 15% in the staff members. No changes were found concerning the frequency of postoperative complications. The conclusion is that methicillin alone for three days gives as good a protection against postoperative infections as a more broad-spectrum treatment and that reduced use of antibiotics will reduce the risk of early colonization with resistant strains.

Cardiac Surgical Procedures↗
PubMed1988

The role of extracellular slime in opsonophagocytosis of Staphylococcus epidermidis.

Infections caused by coagulase-negative staphylococci (CNS) are a major problem in immunocompromised patients. It has been claimed that extracellular slime production by CNS predicts pathogenicity and inhibits host defences. Luminol-enhanced neutrophil chemiluminescence (CL) and bacterial killing assays were used to assess the effect of slime production on opsonophagocytosis and killing by polymorphonuclear leucocytes in vitro. There was wide variation in CL induction amongst the 43 strains of Staphylococcus epidermidis examined. The presence of slime had no influence either on the requirement or on the efficiency of opsonisation. Slime-producing and non-slime-producing strains showed a stepwise increase in induced CL up to a serum concentration of 10%, and were dependent on complement for efficient phagocytosis. The bacterial killing assays confirmed the CL results. Our data suggest that extracellular staphylococcal slime has no specific anti-opsonic property in vitro. Opsonophagocytosis may still be hampered in vivo by the physical presence of slime.

Bacterial Proteins↗
PubMed1996

Prophylaxis against Staphylococcus epidermidis vascular graft infection with rifampicin-soaked, gelatin-sealed Dacron.

An animal model was used to assess the efficacy of rifampicin-impregnated, gelatin-sealed Dacron in the prevention of vascular graft infections caused by Staphylococcus epidermidis. Under a general anaesthetic an interposition graft was placed into sheep carotid artery. On completion of the operation 1 ml of normal saline containing 10(8) colony forming units (cfu) of a slime-producing S. epidermidis was inoculated directly onto the graft. After 3 weeks the graft was harvested. Swabs were taken of perigraft tissues, and of external and internal aspects of the graft. A 3-5-mm segment of the graft was incubated in broth medium and a second segment was ground for 5 min and incubated in broth medium. The presence of abscess formation and anastomotic disruption was assessed. Ten sheep received a gelatin-sealed Dacron graft (control), while nine received the same graft impregnated with rifampicin at a concentration of 1.2 mg/ml (treated). Eight of 10 control grafts were infected, with 30 of 50 possible cultures positive, compared with four of nine treatment grafts infected (P = 0.13) and 13 of 45 cultures positive (P = 0.004). The control group had four abscesses and two anastomotic disruptions; the treatment group had no abscesses (P = 0.05) or anastomotic disruptions (P = 0.26). Other organisms were isolated from nine of the 12 infected grafts, most commonly Staphylococcus aureus. There was no development of resistance to rifampicin. Rifampicin-impregnated, gelatin-sealed Dacron is successful at reducing the incidence of S. epidermidis vascular graft infection.

Administration, Topical↗
PubMed1995

Staphylococcus epidermidis isolation and antibiotic resistance in a neonatal intensive care unit.

Bacterial ecology was studied in 1114 newborns (355 at term, 759 preterm) admitted to a neonatal intensive care unit (NICU) during a three year period. Bacterial samples were taken in each newborn from external ear canal, pharynx and eyes in all patients, and from endotracheal tube, umbilical catheter and blood in selected patients. The predominant flora was characterized by gram-positive microorganisms (63.53%), Staphylococcus epidermidis representing 34.68% of all isolated strains. S. epidermidis isolation increased significantly with time (p < 0.002) and was highest in summer. The percentage of S. epidermidis resistant strains to oxacillin (63.8%) and to amikacin (17.8%) was high. This is the antimicrobial combination we commonly employ as empirical treatment of suspected bacterial infection in our NICU. Knowledge of characteristics of local microbial flora seems important in order to optimize preventive and therapeutic policies for neonatal infections.

Drug Resistance, Microbial↗
PubMed2001

Factors compromising antibiotic activity against biofilms of Staphylococcus epidermidis.

Several factors associated with bacterial biofilms were studied for their role in phenotypic resistance to antibiotics. These factors included bacterial slime extracted from biofilms, reduced growth rates of biofilm-embedded bacteria and high bacterial inocula. Antibiotic activity against suspended bacteria in the presence of these factors, either alone or combined, was compared with activity against adherent biofilms. All MICs, determined by standard susceptibility tests, were below the sensitivity breakpoints for Staphylococcus epidermidis strain V2. The addition of bacterial slime to suspended bacteria reduced the bactericidal activity of glycopeptides but had less or no effect on the activity of the other antibiotics tested. High bacterial inocula affected the activity of flucloxacillin and quinolones only moderately or not at all, though a more pronounced effect on glycopeptides was observed. In contrast, the bactericidal activity of most antibiotics was severely compromised when adherent bacterial biofilms were used as inocula. In conclusion, the presence of slime, slow growth rates and high bacterial counts may explain the poor activity of glycopeptides against biofilm-embedded organisms, but these factors, either alone or in combination, do not explain the lack of bactericidal activity of other drugs against biofilms. Thus, additional factors need to be identified.

Anti-Bacterial Agents↗
PubMed1978

Rifampin therapy of Staphylococcus epidermidis. Use in infections from indwelling artificial devices.

Rifampin was added to existing antibiotic regimens in two patients with Staphylococcus epidermidis infections; one patient had prosthetic valve endocarditis and the other had an infection of a CSF shunt. The addition of rifampin increased serum or CSF bactericidal titers 16-fold or greater and was correlated with a favorable clinical response. The results of tests for tube-dilution antibiotic susceptibility showed rifampin to be the most active of all antibiotics tested against the patients' organisms. The combinations of gentamicin sulfate, nafcillin sodium, or vancomycin hydrochloride with rifampin prevented the emergence of rifampin resistance in vitro and promoted enhanced killing when compared with either antibiotic alone.

Adolescent↗
PubMed1983

Evidence for transient Staphylococcus epidermidis bacteremia in patients and in healthy humans.

A new blood lysis-filtration culture technique revealed a high incidence of Staphylococcus epidermidis in the blood of patients and of healthy people. Of 2,004 blood cultures from patients, the blood lysis method grew S. epidermidis in 233 (11.6%), whereas a conventional two-bottle culture system grew this organism in 48 (2.4%). To determine the incidence deriving from the skin, 100 mock blood cultures by each technique were performed. The antecubital fossa was prepared as for a phlebotomy. The needle was inserted through the skin but not into the vein. Needles were cultured by conventional and lysis-filtration culture. A total of 1 conventional culture of 100 (1%) and 2 lysis-filtration cultures of 100 (2%) grew S. epidermidis. Of 100 lysis-filtration and conventional control cultures with broth in place of blood, no cultures were positive. Blood samples from 8 of 117 (6.8%) healthy blood donors were positive for S. epidermidis by lysis-filtration, whereas no matching conventional cultures were positive. Phage typing patterns of skin and blood strains from selected individuals were the same. S. epidermidis isolates were often concomitant with isolates of bona fide pathogens. I conclude that intermittent, transient, asymptomatic S. epidermidis bacteremia occurs frequently in patients and in healthy humans.

Cells, Cultured↗
PubMed2003

Interactions of Pseudomonas aeruginosa and Staphylococcus epidermidis in adhesion to a hydrogel.

PURPOSE: Bacterial strains with known capability to bind to hydrogel lenses were examined for their relative capacities to attach irreversibly to a hydrogel contact lens in pure and mixed cultures. METHODS AND RESULTS: Time course studies of adhesion through adenosine triphosphate (ATP) or radiolabel analyses indicated that primary adhesion by Pseudomonas aeruginosa to a 37% water-content hydrogel lens was more dense and rapid than that of Staphylococcus epidermidis. Primary adhesion of P. aeruginosa was similar after 5 min and 2 hr, whereas S. epidermidis showed an incremental increase in adhesion over the first 30 min. Sequential challenge of lenses with P. aeruginosa followed by S. epidermidis gave levels of primary adhesion for each species similar to those obtained with single pure cultures. When lenses were challenged with S. epidermidis first, primary adhesion of P. aeruginosa was significantly diminished. Exposures of multiple sets of lenses (n = 4) to a standard inoculum of P. aeruginosa resulted in levels of primary adhesion per lens after 1 hr equivalent to that found for a single lens in 5 min or in 2 hr. CONCLUSION: These data further support that normal biota may be protective for the eye. The data also suggest that under conditions of the primary adhesion-screening test, a limited number of cells of GSU no. 3 (selected phenotype) are involved in adhesion to the hydrogel.

Adenosine Triphosphate↗
PubMed2003

Lysostaphin disrupts Staphylococcus aureus and Staphylococcus epidermidis biofilms on artificial surfaces.

Staphylococci often form biofilms, sessile communities of microcolonies encased in an extracellular matrix that adhere to biomedical implants or damaged tissue. Infections associated with biofilms are difficult to treat, and it is estimated that sessile bacteria in biofilms are 1,000 to 1,500 times more resistant to antibiotics than their planktonic counterparts. This antibiotic resistance of biofilms often leads to the failure of conventional antibiotic therapy and necessitates the removal of infected devices. Lysostaphin is a glycylglycine endopeptidase which specifically cleaves the pentaglycine cross bridges found in the staphylococcal peptidoglycan. Lysostaphin kills Staphylococcus aureus within minutes (MIC at which 90% of the strains are inhibited [MIC(90)], 0.001 to 0.064 microg/ml) and is also effective against Staphylococcus epidermidis at higher concentrations (MIC(90), 12.5 to 64 microg/ml). The activity of lysostaphin against staphylococci present in biofilms compared to those of other antibiotics was, however, never explored. Surprisingly, lysostaphin not only killed S. aureus in biofilms but also disrupted the extracellular matrix of S. aureus biofilms in vitro on plastic and glass surfaces at concentrations as low as 1 microg/ml. Scanning electron microscopy confirmed that lysostaphin eradicated both the sessile cells and the extracellular matrix of the biofilm. This disruption of S. aureus biofilms was specific for lysostaphin-sensitive S. aureus, as biofilms of lysostaphin-resistant S. aureus were not affected. High concentrations of oxacillin (400 microg/ml), vancomycin (800 microg/ml), and clindamycin (800 microg/ml) had no effect on the established S. aureus biofilms in this system, even after 24 h. Higher concentrations of lysostaphin also disrupted S. epidermidis biofilms.

Anti-Bacterial Agents↗
PubMed1991

[Microbiological characterization of clinical isolates of Staphylococcus epidermidis].

As a result of recent development in medical practice including use of new antimicrobial agents, coagulase-negative Staphylococci (CNS) that were once considered nonpathogenic contaminants have captured attention as causes of disease. The 43 clinical isolates of Staphylococcus epidermidis sensu stricto and 7 isolates of S. epidermidis from the medical staffs were characterized with regard to (1) their biochemical profiles, (2) slime productivity, (3) beta-lactamase productivity and (4) plasmid patterns. Most of the isolates have an identical biochemical profile code. The slime production was observed in the 9 strains isolated from pleural effusions or the tubes used for pleural drainage. These strains had a similar antimicrobial susceptibility profile that are commonly seen in multi-resistant strains of methicillin-resistant Staphylococcus aureus (MRSA). In addition, most of these strains produced beta-lactamase. For the plasmid profiling, we selected 12 isolates that possessed 5 distinct antimicrobial susceptibility profiles. Upon agarose gel electrophoresis, 8 isolates were shown to possess a 1.9 kb plasmid. These 8 isolates had resistance against tobramycin (TOB) and erythromycin (EM). Emergence of S. epidermidis as causes of disease will increasingly necessitate the detailed microbiological characterization of the clinical isolates.

DNA, Bacterial↗
PubMed1998

[The resistance of Propionibacterium acnes and Staphylococcus epidermidis to cyclines. The Research and Study Group on Acne].

BACKGROUND: A rising percentage of tetracycline-resistant Propionibacterium acnes strains has been reported in the English literature. PATIENTS AND METHODS: We studied a population of 16 patients with acne who had been treated with oral tetracyclines during the preceding year. A bacteriological examination of a skin biopsy was obtained in all patients to determine aerobic and anaerobic flora as wells as resistance to tetracycline and minocycline. RESULTS: Staphylococcus epidermidis strains were frequently resistant to tetracycline (87.5%) as well as minocycline (30%). Tetracycline-resistant Propionibacterium acnes were also observed (7%). Inversely, we were unable to evidence any minocycline-resistant Propionibacterium acnes strains. CONCLUSION: These findings emphasize the importance of determining whether therapeutic response is related or not to the presence of resistant strains.

Acne Vulgaris↗