Zinkernagel A S, Zinkernagel M S, Elzi M V, Genoni M, Gubler J, Zbinden R, Mueller N J
Division of Infectious Diseases and Hospital Epidemiology, Dept. of Internal Medicine, University Hospital Zurich, Rämistrasse 100/RAE U 74, CH-8091, Zürich, Switzerland.
Infection. 2008 Aug;36(4):314-21. doi: 10.1007/s15010-008-7287-9. Epub 2008 Jul 21.
Staphylococcus lugdunensis endocarditis has been associated with an aggressive course. The aim of this study was to determine factors associated with the development of endocarditis in patients with S. lugdunensis bacteremia.
A retrospective analysis of all patients with S. lugdunensis bacteremia in three tertiary care centers in Switzerland was performed. Data regarding medical history, symptoms, and susceptibility of S. lugdunensis isolates were collected. Our results were reviewed in the context of the current literature.
A total of 28 patients with S. lugdunensis bacteremia were identified. Of the 13 patients with endocarditis, all were community acquired. Cardiac surgery was performed in 85% of these patients; mortality was 23%, reflecting the aggressive course of this disease. In contrast, in the 15 patients without endocarditis, no complications associated with S. lugdunensis bacteremia were observed. In 73%, a probable source was identified in the form of a venous catheter or other foreign device. Only three of these episodes were community acquired. No difference was observed in susceptibility of the S. lugdunensis isolates to penicillin, which was 77% in endocarditis isolates, and 87% in isolates of bacteremia without endocarditis, respectively.
S. lugdunensis bacteremia is associated with endocarditis in up to 50% of patients. Every patient with community-acquired S. lugdunensis bacteremia should be carefully examined for signs of endocarditis. Once S. lugdunensis endocarditis is diagnosed, close monitoring is essential and surgical treatment should be considered early. In the nosocomial setting, endocarditis is far less frequent, and S. lugdunensis bacteremia is usually associated with a catheter or other foreign materials.
路邓葡萄球菌心内膜炎病程凶险。本研究旨在确定路邓葡萄球菌菌血症患者发生心内膜炎的相关因素。
对瑞士三家三级医疗中心所有路邓葡萄球菌菌血症患者进行回顾性分析。收集患者病史、症状及路邓葡萄球菌分离株药敏数据。结合当前文献对研究结果进行综述。
共确诊28例路邓葡萄球菌菌血症患者。13例心内膜炎患者均为社区获得性感染。其中85%的患者接受了心脏手术；死亡率为23%，反映出该病的凶险病程。相比之下，15例无心内膜炎的患者未观察到与路邓葡萄球菌菌血症相关的并发症。73%的患者可确定可能的感染源为静脉导管或其他外来装置。这些感染中仅3例为社区获得性感染。路邓葡萄球菌分离株对青霉素的药敏情况无差异，心内膜炎分离株的药敏率为77%，无心内膜炎菌血症分离株的药敏率为87%。
高达50%的路邓葡萄球菌菌血症患者会并发心内膜炎。每例社区获得性路邓葡萄球菌菌血症患者均应仔细检查心内膜炎体征。一旦确诊路邓葡萄球菌心内膜炎，密切监测至关重要，应尽早考虑手术治疗。在医院环境中，心内膜炎的发生率要低得多，路邓葡萄球菌菌血症通常与导管或其他异物有关。
