Ventriculitis due to Staphylococcus lugdunensis: two case reports

Teresa Spanu,Domenico Policicchio,Brunella Posteraro,Donato Rigante,Tiziana D'Inzeo,Giovanni Fadda,Maurizio Sanguinetti,Barbara Fiori,Gianpiero Tamburrini

doi:10.1186/1752-1947-2-267

Abstract

IntroductionStaphylococcus lugdunensis is an unusually virulent coagulase-negative staphylococcus that has rarely been implicated in central nervous system infections.Case presentationTwo children hospitalized in the Neurosurgery Unit developed ventriculitis caused by methicillin-resistant Staphylococcus lugdunensis following placement of external ventriculostomy drains. The causative organisms were identified by molecular studies. The patients recovered without significant sequelae after high doses of intrathecal vancomycin.ConclusionDistinguishing Staphylococcus lugdunensis from other coagulase-negative staphylococcus species is crucial because it carries a substantial risk for severe central nervous system infections displayed by patients with implanted cerebrospinal fluid devices. Clinicians should not underestimate the importance of the isolation of this species from cerebrospinal fluid specimens.

Highlights

Staphylococcus lugdunensis is an unusually virulent coagulase-negative staphylococcus that has rarely been implicated in central nervous system infections.Case presentation: Two children hospitalized in the Neurosurgery Unit developed ventriculitis caused by methicillin-resistant Staphylococcus lugdunensis following placement of external ventriculostomy drains
This report analyzes the management of these patients in light of the few previously reported cases of S. lugdunensis central nervous system (CNS) infections and summarizes the molecular characteristics of the isolates recovered from cerebrospinal fluid (CSF) and ventricular drain cultures
There have been no reports of S. lugdunensis ventriculitis associated with External ventriculostomy drain (EVD), which are widely used in neurosurgery for continuous intracranial pressure monitoring, injection of therapeutic agents, and temporary external drainage of CSF [9]

Summary

Conclusion

Unlike other CoNS which usually display low virulence, S. lugdunensis can cause severe CNS infections in patients with implanted CSF drainage devices. Accurate species-level identification of isolates causing staphylococcal CSF shunt infections is clearly essential for their successful treatment, but it is fundamental for epidemiological surveillance and for improving our understanding of the pathophysiological factors affecting the clinical outcome of these infections. With the increasing use of invasive medical devices for management of neurosurgical patients, CSF shunt infections are likely to become more common. Failure to identify their causative agents can be disastrous when the infection is due to S. lugdunensis. FM177467 and FM177468, respectively, for the rpoB http://www.jmedicalcasereports.com/content/2/1/267 gene and under accession nos. FM177469 and FM177470, respectively, for the 16 rRNA gene. CNS: Central nervous system; CoNS: Coagulase-negative staphylococcus; CSF: Cerebrospinal fluid; EVD: External ventriculostomy drain; IT: Intrathecal; VPS: ventriculoperitoneal shunt; MRI: Magnetic resonance imaging; PFGE: Pulsed-field gel electrophoresis

Introduction

Discussion

11. Clinical Laboratory Standards Institute

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