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Journal of Clinical Microbiology, September 1998, p. 2696-2702, Vol. 36, No. 9
0095-1137/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.

Clonal Expansion of Staphylococcus epidermidis Strains Causing Hickman Catheter-Related Infections in a Hemato-Oncologic Department

Jan L. Nouwen,1,* Alex van Belkum,1 Siem de Marie,1 Jacqueline Sluijs,1 Jenne J. Wielenga,2 Jan A. J. W. Kluytmans,1,dagger and Henri A. Verbrugh1

Department of Medical Microbiology & Infectious Diseases1 and Department of Hematology,2 Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands

Received 6 February 1998/Returned for modification 15 April 1998/Accepted 26 June 1998

The detailed analysis of 411 strains of coagulase-negative staphylococci (CoNS) obtained from 40 neutropenic hemato-oncologic patients (61 Hickman catheter episodes) on intensive chemotherapy is described. By random amplification of polymorphic DNA (RAPD) analysis, a total of 88 different genotypes were detected: 51 in air samples and 30 in skin cultures prior to insertion, 12 in blood cultures after insertion, and only 5 involved in catheter-related infections (CRI). Two RAPD genotypes of Staphylococcus epidermidis predominated, and their prevalence increased during patient hospitalization. At insertion, these clones constituted 11 of 86 (13%) CoNS isolated from air samples and 33 of 75 (44%) CoNS isolated from skin cultures. After insertion, their combined prevalence increased to 33 of 62 (53%) in catheters not associated with CRI and 139 of 188 (74%) in catheters associated with CRI (P = 0.0041). These two predominant S. epidermidis clones gave rise to a very high incidence of CRI (6.0 per 1,000 catheter days) and a very high catheter removal rate for CRI, 70%, despite prompt treatment with vancomycin. A likely source of S. epidermidis strains involved in CRI appeared to be the skin flora in 75% of cases. The validity of these observations was confirmed by pulsed-field gel electrophoresis (PFGE) of SmaI DNA macrorestriction fragments of blood culture CoNS isolates. Again, two predominant CoNS genotypes were found (combined prevalence, 60%). RAPD and PFGE yielded concordant results in 75% of cases. Retrospectively, the same two predominant CoNS clones were also found among blood culture CoNS isolates from the same hematology department in the period 1991 to 1993 (combined prevalence, 42%) but not in the period 1978 to 1982. These observations underscore the pathogenic potential of clonal CoNS types that have successfully and persistently colonized patients in this hemato-oncology department.

* Corresponding author. Mailing address: Erasmus University Medical Center Rotterdam, Department of Medical Microbiology & Infectious Diseases, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands. Phone: 31 10 463 3510 or 463 3511. Fax: 31 10 463 3875. E-mail: nouwen{at}bacl.azr.nl.

dagger Present address: Department of Clinical Microbiology, St. Ignatius Hospital, 4800 RK Breda, The Netherlands.

Journal of Clinical Microbiology, September 1998, p. 2696-2702, Vol. 36, No. 9
0095-1137/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.


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