Clinical manifestations of infection due to coagulase-negative staphylococci
- JoAnn M Tufariello, MD, PhD
JoAnn M Tufariello, MD, PhD
- Albert Einstein College of Medicine
- Franklin D Lowy, MD
Franklin D Lowy, MD
- Professor of Medicine and Pathology & Cell Biology (in Epidemiology)
- Columbia University, College of Physicians and Surgeons
Coagulase-negative staphylococci (CoNS) are a major constituent of human skin commensal flora [1,2]. Once considered relatively avirulent and a likely contaminant when isolated from a clinical specimen, these organisms have increasingly been recognized as a cause of clinically significant nosocomial bloodstream infections. Patients at particular risk include those with prosthetic valves, pacemakers, defibrillators, ventricular assist devices, intravascular catheters, or other foreign bodies, as well as neonates and immunocompromised hosts. These infections are inherently difficult to treat given the propensity of these organisms to colonize foreign material to form a biofilm and to display resistance to multiple antibiotics .
The following discussion will emphasize the issues specific to both native valve endocarditis (NVE) and prosthetic valve endocarditis (PVE) caused by CoNS. Discussion of CoNS infections at other sites is also included. General discussions related to the diagnosis and treatment of infective endocarditis and to the epidemiology, microbiology, pathogenesis, and antibiotic resistance patterns of CoNS are presented separately. (See "Clinical manifestations and evaluation of adults with suspected native valve endocarditis" and "Antimicrobial therapy of native valve endocarditis" and "Epidemiology, clinical manifestations, and diagnosis of prosthetic valve endocarditis" and "Antimicrobial therapy of prosthetic valve endocarditis" and "Epidemiology, microbiology, and pathogenesis of coagulase-negative staphylococci" and "Treatment of infections due to coagulase-negative staphylococci".)
Intravascular catheter infection — Most coagulase-negative staphylococci (CoNS) bloodstream infections are catheter related . For short-term catheters, infection most commonly results from CoNS originating on the patient's skin, migrating via the cutaneous surface of the catheter to gain access to the bloodstream. For longer-term catheters, hub colonization and migration of organisms via the luminal surface is also important.
In general, clinical manifestations may include local erythema and/or drainage, fever, hypotension, and leukocytosis. Diagnosis and management of intravascular catheter infection is discussed further separately. (See "Diagnosis of intravascular catheter-related infections" and "Treatment of intravascular catheter-related infections".)
Distinguishing true infection from skin contamination is important; this is discussed separately. (See "Epidemiology, microbiology, and pathogenesis of coagulase-negative staphylococci", section on 'Infection versus contamination'.)
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- CLINICAL MANIFESTATIONS
- Intravascular catheter infection
- - Native valve
- - Prosthetic valve
- Cardiac devices
- Vascular graft infection
- Prosthetic joint infection
- Central nervous system shunt infection
- Breast implant infections
- Surgical site infection
- Urinary tract infection
- Animal bite wound
- INFECTION IN NEONATES