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Bacteriology

Clinical Features, Outcomes, and Molecular Characteristics of Community- and Health Care-Associated Staphylococcus lugdunensis Infections

Chun-Fu Yeh, Shih-Cheng Chang, Chun-Wen Cheng, Jung-Fu Lin, Tsui-Ping Liu, Jang-Jih Lu
R. Patel, Editor
Chun-Fu Yeh
aDivision of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
bGraduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Shih-Cheng Chang
cDepartment of Laboratory Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
dDepartment of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Chun-Wen Cheng
aDivision of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
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Jung-Fu Lin
aDivision of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
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Tsui-Ping Liu
cDepartment of Laboratory Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
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Jang-Jih Lu
cDepartment of Laboratory Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
dDepartment of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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R. Patel
Mayo Clinic
Roles: Editor
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DOI: 10.1128/JCM.00847-16
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    FIG 1

    eBURST diagram showing the relatedness among the major cluster (clonal complex 1) of S. lugdunensis isolates in this study and compared with the reference sequence types (STs) in the database of the Institut Pasteur (http://bigsdb.web.pasteur.fr/). Each circle represents an ST. The size of the circle represents the proportion of the number of isolates in the study.

Tables

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  • TABLE 1

    General data of isolates collected from study period I (May 2003 to May 2013) and study period II (July to October 2014)

    CharacteristicNo. (%) for
    Total (n = 129)Study period I (n = 67)Study period II (n = 62)
    Sample types
    Blood58 (45.0)56 (83.6)2 (3.2)
        Pus39 (30.2)039 (62.9)
        Wound18 (14.0)018 (29.0)
        Ascites4 (3.1)4 (6.0)0
        Body fluid3 (2.3)2 (3.0)1 (1.6)
        Synovial fluid2 (1.6)2 (3.0)0
        Cerebrospinal fluid1 (0.8)1 (1.5)0
        Cervix1 (0.8)01 (1.6)
        Pleural effusion1 (0.8)1 (1.5)0
        Tissue1 (0.8)01 (1.6)
        Amniotic fluid1 (0.8)1 (1.5)0
    Type of infection
        Community associated48 (37.2)7 (10.4)41 (66.1)
        Health care associated81 (62.8)60 (89.6)21 (33.9)
  • TABLE 2

    Distribution of gender, age, comorbidity, source of infection, and outcome between health care- and community-associated infectionsa

    CharacteristicTotal (n = 129)Health care associated (n = 81)Community associated (n = 48)P value
    Gender
        Male73 (56.6)44 (54.3)29 (60.4)0.496
    Age (yr)
        Mean ± SD49.99 ± 24.9051.35 ± 28.1347.70 ± 18.260.423
        0–1715 (11.6)13 (16.0)2 (4.2)0.041b
            <110 (7.8)10 (12.3)00.011b
        18–6476 (58.9)37 (45.7)39 (81.3)<0.001c
        ≥6538 (29.5)31 (38.3)7 (14.6)0.004d
    Comorbidity
        Diabetes mellitus38 (29.5)32 (39.5)6 (12.5)0.001d
        End-stage renal disease32 (24.8)32 (37.5)0<0.001c
        Liver cirrhosis6 (4.7)6 (7.4)00.054
        Solid-organ malignancy19 (14.7)18 (22.2)1 (2.1)0.002d
        Hematologic malignancy2 (1.6)2 (2.5)00.271
        Cerebrovascular accident18 (14.0)14 (17.3)4 (8.3)0.156
    Source of infection
        Skin and soft tissue57 (44.2)16 (19.8)41 (85.4)<0.001c
        Unknown source of bacteremia30 (23.3)28 (34.6)2 (4.2)<0.001c
        Catheter-related bloodstream infection10 (7.8)10 (12.3)00.011b
        Bone and joints8 (6.2)7 (8.6)1 (2.1)0.136
        Arteriovenous fistula/graft6 (4.7)6 (7.4)00.053
        Infective endocarditis5 (3.9)3 (3.7)2 (4.2)0.986
        Intra-abdomen4 (3.1)4 (4.9)00.119
        Genital system3 (2.3)2 (2.5)1 (2.1)0.889
        Peritoneal dialysis-related peritonitis2 (1.6)2 (2.5)00.271
        Lung1 (0.8)1 (1.2)00.441
        Central nervous system1 (0.8)1 (1.2)00.441
        Deep neck1 (0.8)1 (1.2)00.441
        Sinusitis1 (0.8)1 (1.2)00.441
    14-day all-cause mortality9 (7.0)9 (11.1)00.017b
    • ↵a All data are presented as the no. (%), unless otherwise stated.

    • ↵b P < 0.05.

    • ↵c P < 0.001.

    • ↵d P < 0.01.

  • TABLE 3

    Antibiotic resistance, distribution of SCCmec typing, agr group, and δ-hemolysin, clonal complex, and multilocus sequence typing among Staphylococcus lugdunensis isolates that cause health care- and community-associated infection

    CharacteristicaNo. (%) forP value
    Total (n = 129)Health care associated (n = 81)Community associated (n = 48)
    Antibiotic resistance
        Penicillin87 (67.4)62 (76.5)25 (52.1)0.004b
        Oxacillin27 (20.9)26 (32.1)1 (2.1)<0.001c
        Clindamycin28 (21.7)19 (23.5)9 (18.8)0.529
        Erythromycin32 (24.8)22 (27.2)10 (20.8)0.424
        TMP-SMX3 (2.3)1 (1.2)2 (4.2)0.285
    SCCmec type
        II5 (3.9)5 (6.2)00.078
        IV1 (0.8)1 (1.2)00.441
        V17 (13.2)17 (21.0)0<0.001c
        Vt2 (1.6)2 (2.5)00.271
        NT2 (1.6)1 (1.2)1 (2.1)0.703
    agr type
        I57 (44.2)31 (38.3)26 (54.2)0.078
        II72 (55.8)50 (61.7)22 (45.8)0.078
    δ-Hemolysin
        Negative10 (7.8)7 (8.6)3 (6.3)0.624
    Clonal complex and MLST typing
        CC156 (43.4)
            ST62 (1.6)2 (2.5)00.271
            ST2511 (8.5)5 (6.2)6 (12.5)0.215
            ST4138 (29.5)24 (29.6)14 (29.2)0.841
            ST443 (2.3)03 (6.3)0.002b
            ST452 (1.6)02 (4.2)0.064
        CC22 (1.6)
            ST292 (1.6)1 (1.2)1 (1.2)0.703
        CC333 (25.6)
            ST3833 (25.6)27 (33.3)6 (12.5)0.009b
        CC412 (9.3)
            ST3312 (9.3)6 (7.4)6 (12.5)0.337
        CC71 (0.8)
            ST271 (0.8)01 (2.1)0.194
        CC822 (17.1)
            ST3615 (11.6)12 (14.8)3 (6.3)0.141
            ST397 (5.4)2 (2.5)5 (10.4)0.054
        Singletons
            ST433 (2.3)2 (2.5)1 (2.1)0.889
    • ↵a TMP-SMX, trimethoprim-sulfamethoxazole; NT, nontypeable; MLST, multilocus typing sequence typing.

    • ↵b P < 0.01.

    • ↵c P < 0.001.

  • TABLE 4

    MLST and year of isolation of oxacillin-resistant Staphylococcus lugdunensis (n = 27)

    MLST typing (n)Clonal complexSCCmec typing (no. of isolates)No. of isolates by yr of isolation
    200920102011201220132014
    ST6 (2)CC1II (2)11
    ST38 (21)CC3IV (1)1
    V (17)254123
    Vt (2)11
    NT (1)1a
    ST41 (4)CC1II (3)21
    NT (1)1
    • ↵a The isolates belonged to community-associated infections. Other isolates belonged to health care-associated infections.

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Clinical Features, Outcomes, and Molecular Characteristics of Community- and Health Care-Associated Staphylococcus lugdunensis Infections
Chun-Fu Yeh, Shih-Cheng Chang, Chun-Wen Cheng, Jung-Fu Lin, Tsui-Ping Liu, Jang-Jih Lu
Journal of Clinical Microbiology Jul 2016, 54 (8) 2051-2057; DOI: 10.1128/JCM.00847-16

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Clinical Features, Outcomes, and Molecular Characteristics of Community- and Health Care-Associated Staphylococcus lugdunensis Infections
Chun-Fu Yeh, Shih-Cheng Chang, Chun-Wen Cheng, Jung-Fu Lin, Tsui-Ping Liu, Jang-Jih Lu
Journal of Clinical Microbiology Jul 2016, 54 (8) 2051-2057; DOI: 10.1128/JCM.00847-16
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