University of Maryland Medical Center, Baltimore MD, USA.
University of Maryland Medical Center, Baltimore MD, USA.
Diagn Microbiol Infect Dis. 2021 Mar;99(3):115261. doi: 10.1016/j.diagmicrobio.2020.115261. Epub 2020 Nov 6.
Staphylococcus lugdunensis is a coagulase negative Staphylococcus species and frequent human skin commensal with the potential for aggressive infection. Guidance surrounding S. lugdunensis bacteremia (SLB) from a single set of blood cultures is lacking.
A multicenter, retrospective cohort of patients with SLB from at least one blood culture set within the University of Maryland Medical System from 2015 to 2019 is presented. Objectives are to describe baseline characteristics, compare the clinical status and treatment course, and to evaluate the clinical outcomes among patients with SLB in single versus multiple sets.
Thirty-six patients were included, 24 with one set of blood cultures positive for S lugdunensis and 12 with multiple sets. Baseline characteristics were similar between the groups, though patients with SLB in multiple sets were more commonly on hemodialysis (P = 0.029). Central lines were the most common source (17%). Most (97%) fulfilled systemic inflammatory response syndrome or Souvenir criteria, had an infectious focus on imaging, or had a second positive culture site. Most (78%) were treated as clinically significant. Patients with multiple positive sets were more commonly treated with antibiotics for >2 weeks (P = 0.02).
SLB was rare and occurred more frequently as a single set of positive cultures. Patient characteristics and clinical courses were similar between single and multiple set groups. Given the potential severity of S. lugdunensis bacteremia it seems prudent to treat S. lugdunensis in a single blood culture as true bacteremia, pending larger studies and guidelines.
路邓葡萄球菌是凝固酶阴性葡萄球菌，是一种常见的人类皮肤共生菌，具有侵袭性感染的潜力。目前缺乏针对一份血培养物中发现的路邓葡萄球菌菌血症（SLB）的指导意见。
本研究纳入了 2015 年至 2019 年期间，马里兰大学医学系统中至少有一份血培养物呈 SLB 的多中心回顾性队列患者。目的是描述患者的基线特征，比较单一与多份血培养物阳性的 SLB 患者的临床状况和治疗过程，并评估其临床结局。
共纳入 36 例患者，其中 24 例患者有一份血培养物呈路邓葡萄球菌阳性，12 例患者有两份血培养物阳性。两组患者的基线特征相似，但多份血培养物阳性的患者更常接受血液透析治疗（P=0.029）。中心静脉置管是最常见的感染源（17%）。大多数（97%）患者符合全身炎症反应综合征或 Souvenir 标准，影像学检查有感染灶，或有第二个阳性培养部位。大多数（78%）患者被认为具有临床意义。多份血培养物阳性的患者更常接受>2 周的抗生素治疗（P=0.02）。
SLB 较为罕见，多表现为一份血培养物阳性。单份与多份血培养物阳性患者的特征和临床病程相似。鉴于路邓葡萄球菌菌血症的潜在严重性，在等待更大规模的研究和指南出台之前，对单份血培养物中的路邓葡萄球菌似乎应视为真性菌血症进行治疗，这似乎是合理的。
