Abstract
BackgroundStaphylococcus epidermidis is a pathogen that is frequently encountered in the hospital environment. Healthcare workers (HCWs) can serve as a reservoir for the transmission of S. epidermidis to patients.MethodsThe aim of this study was to compare and identify differences between S. epidermidis isolated from 20 patients with catheter-related bloodstream infections (CRBSIs) and from the hands of 42 HCWs in the same hospital in terms of antimicrobial resistance, biofilm production, presence of the intercellular adhesion (ica) operon and genetic diversity (pulsed field gel electrophoresis (PFGE), multilocus sequence typing (MLST) and staphylococcal cassette chromosome (SCC) mec typing).ResultsS. epidermidis isolates that caused CRBSI were resistant to significantly more non-betalactam drugs than were isolates collected from HCWs. Among the 43 mecA positive isolates (26 from HCWs), the most frequent SCCmec type was type IV (44%). The ica operon was significantly more prevalent in CRBSI isolates than in HCWs (P < 0.05). Weak in vitro biofilm production seemed to correlate with the absence of the ica operon regardless of the commensal or pathogenic origin of the isolate. The 62 isolates showed high diversity in their PFGE patterns divided into 37 different types: 19 harbored only by the CRBSI isolates and 6 shared by the clinical and HCW isolates. MLST revealed a total of ten different sequence types (ST). ST2 was limited to CRBSI-specific PFGE types while the “mixed” PFGE types were ST5, ST16, ST88 and ST153.ConclusionOne third of CRBSI episodes were due to isolates belonging to PFGE types that were also found on the hands of HCWs, suggesting that HCW serve as a reservoir for oxacillin resistance and transmission to patients. However, S. epidermidis ST2, mecA-positive and icaA-positive isolates, which caused the majority of clinically severe CRBSI, were not recovered from the HCW’s hands.
Highlights
Catheter-related bloodstream infection (CRBSI) is one of the most common healthcare-associated infections [1], and coagulase-negative staphylococci, predominantly Staphylococcus epidermidis, are the most common pathogens involved
S. epidermidis isolates from patients with CRBSI were significantly more resistant to all non-betalactam drugs, except for erythromycin and fusidic acid, than the S. epidermidis isolates collected from Healthcare worker (HCW)
Almost onequarter of CRBSI episodes were due to isolates from pulsed field gel electrophoresis (PFGE) types that were found to colonize the healthy students, all severe CRBSI episodes were caused by isolates belonging to “specific” PFGE types that were not found in the community
Summary
Catheter-related bloodstream infection (CRBSI) is one of the most common healthcare-associated infections [1], and coagulase-negative staphylococci, predominantly Staphylococcus epidermidis, are the most common pathogens involved. Muldrew et al demonstrated the presence of a predominant and persistent clone among central line isolates from a specific ward. They showed that this clone was not found among S. epidermidis isolates collected from a control group living in the community [4]. Controversy remains over the source of these bacteria isolated from central venous catheters Crosstransmission of these pathogens might occur directly between patients in contact with one another, indirectly through contamination from the environment or through the contaminated hands of healthcare workers (HCWs). Healthcare workers (HCWs) can serve as a reservoir for the transmission of S. epidermidis to patients
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