Staphylococcus lugdunensis: Review of Epidemiology, Complications, and Treatment.

Shridhar Parthasarathy,Anvitha Rangan,Satya Durugu,Avinaash Raja Sager,Shrey Shah

doi:10.7759/cureus.8801

Abstract

Staphylococcus lugdunensis is a species of coagulase-negative staphylococci (CNS) that induces a variety of infectious diseases, including skin and soft tissue infection (SSTI), infective endocarditis (IE), and bone and PJI. This review article underscores the important points in the literature about S. lugdunensis infections, including its epidemiology, diagnosis, and treatment, as well as specific types of infections it can cause. Anatomical and age-related distributions of S. lugdunensis SSTIs have been noted, though they most commonly occur as abscesses. S. lugdunensis can also manifest as an aggressive form of IE presenting with valve destruction and abscess formation, frequently requiring surgery and with a high mortality rate. Bone and joint infections caused by S. lugdunensis are also more invasive than infections by other species of CNS. The clinical presentation of S. lugdunensis infection in SSTI, IE, and bone/joint infection is frequently more similar to that of S. aureus infection than that of other CNS infections, necessitating species-level differentiation of CNS for proper diagnosis. Though historically, this depended upon biochemical tests that were neither routine nor reliable, the implementation of matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF MS) in clinical laboratories has made identification of CNS species such as S. lugdunensis more practical. Imaging modalities, especially the fluorodeoxyglucose (FDG) with positron emission tomography (PET), are another important emerging trend in the diagnosis of infectious diseases such as S. lugdunensis infection. S. lugdunensis remains highly susceptible to a wide gamut of antibacterial therapies, which is uncharacteristic of other CNS. Infections can usually be treated by antibiotics traditionally used for CNS such as oxacillin. The breakpoints for S. lugdunensis are higher than those of other CNS and similar to S. aureus breakpoints. In the case of aggressive IE or bone/joint infection by S. lugdunensis, it is recommended to treat with a β-lactam agent. Further study is needed to understand the diversity, virulence, and population structure of this species, as well as its role in other infections, such as urinary tract infections (UTIs), respiratory infections, peritonitis, and bacteremia.

Highlights

BackgroundStaphylococcus lugdunensis is a species of coagulase-negative staphylococci (CNS), known to be a normal skin commensal that preferentially colonizes the perineal region [1,2,3]
In a study of the largest cohort of its kind, Shah et al found that prosthetic joint infections (PJIs) due to S. lugdunensis tend to be more invasive than other CNS species and are more similar to those due to S. aureus: infections presented with an acute clinical picture of copious purulent discharge and rapid tissue destruction [6]
Previous literature highlights some of the important aspects of this organism - its predilection for soft tissue infection (SSTI), aggressive clinical course, a possible relationship with immunosuppression/comorbidity, and a wide spectrum of antibiotic susceptibilities

Summary

Introduction

Staphylococcus lugdunensis is a species of coagulase-negative staphylococci (CNS), known to be a normal skin commensal that preferentially colonizes the perineal region [1,2,3]. In a literature review ranging from 1988 to 2008 with a total of 67 documented cases, Liu et al found that S. lugdunensis IE predominantly affected the left side of the heart and formed vegetations demonstrable on echocardiography [9] These infections were more prevalent in males, and the majority of infected patients were middle-aged with a history of comorbidity [9]. In a study of the largest cohort of its kind, Shah et al found that PJIs due to S. lugdunensis tend to be more invasive than other CNS species and are more similar to those due to S. aureus: infections presented with an acute clinical picture of copious purulent discharge and rapid tissue destruction [6]. Treatment with a β-lactam and debridement of foreign material should be pursued [48,49,50]

Conclusions

Findings

Disclosures