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Fascinoma Rounds Coagulase negative staphylococcus in the urine. October 26th, 2005 Sharmistha Mishra, Vanessa Allen, And with great thanks to Subash Mohan. Case 2: Coagulase negative staphylococcus in the urine. What is the clinical significance of finding CN staph in urine?. Pathogens.

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fascinoma rounds coagulase negative staphylococcus in the urine

Fascinoma RoundsCoagulase negative staphylococcus in the urine

October 26th, 2005

Sharmistha Mishra,

Vanessa Allen,

And with great thanks to Subash Mohan

case 2 coagulase negative staphylococcus in the urine
Case 2: Coagulase negative staphylococcus in the urine
  • What is the clinical significance of finding CN staph in urine?
pathogens
Pathogens
  • Coagulase negative staphylococcus
  • 35 spp. ~ 15 potential human pathogens
    • Staphylococcus saprophyticus
      • Common cause of UTI in young women
      • Treated as outpatients
    • Staphylococcus epidermidis
      • Rare growth in urine
      • Generally hospital acquired
    • Distiguished by novobiocin in the lab
urinary tract infections caused by coagulase negative staphylococci characteristics of infections
Urinary Tract Infections Caused by Coagulase-Negative Staphylococci: Characteristics of Infections
septicemia associated with staph epidermidis uti case 1
Septicemia Associated with Staph epidermidis UTI - Case #1
  • 77M with DM and HTN
  • Right hip sub-trochanteric fracture and ORIF
  • Subsequent urinary incontinence -> indwelling Foley catheter
  • Two weeks later he had high grade fever, confusion, and lethargy (foley had already been removed), temperature was 39.4° C , blood pressure 70/0 mm Hg, HR 126/min
  • IV NS, ampicillin, and aztreonam and dopamine
  • Two blood cultures = S epidermidis.
  • Urine specimen = S epidermidis (> 106 colony-forming units/mL)
  • Same susceptibility pattern (vancomycin, tetracycline, and trimethoprim-sulfamethoxazole).

Cadorna, EA. et al, SMJ, 0038-4348, Aug 1, 1995, vol. 88, issue 8

septicemia associated with staph epidermidis uti case 2
Septicemia Associated with Staph epidermidis UTI - Case #2
  • 64M in MVA , traumatic rupture of left hemidiaphragm
  • Exploratory laparotomy with repair of diaphragm, left chest tube thoracostomy, and feeding jejunostomy placement
  • 3 weeks later, pulmonary embolism -> placement of an IVC filter
  • @ 8 weeks, the jejunostomy tube, Foley catheter, intravenous lines, and tracheostomy tube were removed.
  • Three weeks later, his temperature rose to 39.4°C; blood pressure was 64/46 mm Hg, and the heart rate was 124/min.
  • Two blood cultures = S epidermidis.
  • Urine culture S epidermidis (>106 CFU/mL) with the same antimicrobial susceptibility pattern (vancomycin, tetracycline, trimethoprim-sulfamethoxazole).
possible explanations
Possible Explanations
  • Hematogenous spread of staphylococcus epidermidis
  • Staphylococcus lugdunensis
    • vs other CN staph species
s lugdunensis
S. lugdunensis
  • CN staph
  • Transient skin flora, inguinal area
  • Identified by PYR hydrolysis and ornithine decarboxylate activity
  • More virulent than other CN staph
    • lipase, esterase, glycocalyx and fibrinogen affinity factor
  • Focus of infection (229)
    • skin and soft tissue infections (7, 65)
    • respiratory infections (13)
    • endocarditis
    • Bacteremia (15)
    • brain abscess
    • vascular prosthesis infection (11)
    • osteomyelitis.
    • Abscesses 14
staphylococcus lugdunensis utis
Staphylococcus lugdunensis UTIs
  • Generally reported as mixed flora in urine
  • Rarely a contaminant
  • Case #1
    • 6F admitted with a 16 h history of fever to 39.7°C, flank pain, nausea and vomiting.
    • WBC 18.14
    • A catheter specimen urinalysis showed proteinuria (1+), traces of blood and absence of nitrites
    • microscopic analysis showed 10–20 leukocytes with a small number of bacteria.
    • Urine culture showed growth of >100,000 colonies/ml of S. lugdunensis in a pure culture.

Casanova-Roman M. et al. Scandinavian Journal of Infectious Diseases. 36(2):149-50, 2004.

clinical correlate of staph lugdunensis in urine culture
Clinical correlate of staph lugdunensis in urine culture
  • Mayo Clinic
  • 500 isolates of coagulase-negative staphylococci from 4,652 consecutive urine specimens
  • 31/500 (6%) staph lugdunensis
  • 29/31 of mixed flora
  • 70% not treated

Haile Dt et al. Journal of Clinical Microbiology. 40(2):654-6, 2002 Feb.