Smarter Decisions,
Better Care

UpToDate synthesizes the most recent medical information into evidence-based practical recommendations clinicians trust to make the right point-of-care decisions.

  • Rigorous editorial process: Evidence-based treatment recommendations
  • World-Renowned physician authors: over 5,100 physician authors and editors around the globe
  • Innovative technology: integrates into the workflow; access from EMRs

Choose from the list below to learn more about subscriptions for a:


Subscribers log in here


Staphylococcus lugdunensis

INTRODUCTION

Staphylococcus lugdunensis is a coagulase-negative staphylococcus (CoNS). Like other CoNS, S. lugdunensis in humans ranges from a harmless skin commensal to a life-threatening pathogen (as with infective endocarditis). Unlike other CoNS, however, S. lugdunensis can cause severe disease reminiscent of the virulent infections frequently attributable to Staphylococcus aureus [1]. In addition, most S. lugdunensis isolates remain susceptible to a large number of antimicrobial agents.

S. lugdunensis was first described in 1988 and was distinguished from other coagulase-negative staphylococcal species via DNA relatedness studies based on 11 clinical strains. The new species was named after Lyon, the French city where the organism was first isolated (Lugdunum, the Latin name of Lyon) [2]. S. lugdunensis is unique among CoNS because of its propensity for causing aggressive native valve infective endocarditis (IE) and its susceptibility to a vast array of antimicrobial agents.

The microbiology, clinical features, and treatment of S. lugdunensis infections will be reviewed here. Other issues related to coagulase-negative staphylococci are discussed in detail separately.

EPIDEMIOLOGY

S. lugdunensis infections in humans range from harmless skin colonization to invasive infection. The majority of infections are related to skin and soft tissue, the bloodstream, and prosthetic devices.

The frequency of S. lugdunensis infection is probably underappreciated, since many clinical laboratories do not routinely speciate coagulase-negative staphylococci [3,4]. Among 494 coagulase-negative staphylococcal isolates from a clinical setting, S. lugdunensis accounted for 3 percent of isolates [3]. Unlike Staphylococcus epidermidis, in general, S. lugdunensis should be presumed to be a true pathogen. Among 229 S. lugdunensis clinical isolates in one series, only 15 percent were considered contaminants or colonizing organisms [5].

                

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2014. | This topic last updated: Sep 5, 2014.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2014 UpToDate, Inc.
References
Top
  1. Frank KL, Del Pozo JL, Patel R. From clinical microbiology to infection pathogenesis: how daring to be different works for Staphylococcus lugdunensis. Clin Microbiol Rev 2008; 21:111.
  2. Freney J, Brun Y, Bes M, et al. Staphylococcus lugdunensis sp nov and Staphylococcus schleiferi sp nov, two species from human clinical specimens. Int J Syst Bacteriol 1988; 38:168.
  3. Gatermann SG, Koschinski T, Friedrich S. Distribution and expression of macrolide resistance genes in coagulase-negative staphylococci. Clin Microbiol Infect 2007; 13:777.
  4. Kleiner E, Monk AB, Archer GL, Forbes BA. Clinical significance of Staphylococcus lugdunensis isolated from routine cultures. Clin Infect Dis 2010; 51:801.
  5. Herchline TE, Ayers LW. Occurrence of Staphylococcus lugdunensis in consecutive clinical cultures and relationship of isolation to infection. J Clin Microbiol 1991; 29:419.
  6. Fleurette J, Bès M, Brun Y, et al. Clinical isolates of Staphylococcus lugdunensis and S. schleiferi: bacteriological characteristics and susceptibility to antimicrobial agents. Res Microbiol 1989; 140:107.
  7. Tan TY, Ng SY, He J. Microbiological characteristics, presumptive identification, and antibiotic susceptibilities of Staphylococcus lugdunensis. J Clin Microbiol 2008; 46:2393.
  8. Mateo M, Maestre JR, Aguilar L, et al. Genotypic versus phenotypic characterization, with respect to susceptibility and identification, of 17 clinical isolates of Staphylococcus lugdunensis. J Antimicrob Chemother 2005; 56:287.
  9. Frank KL, Reichert EJ, Piper KE, Patel R. In vitro effects of antimicrobial agents on planktonic and biofilm forms of Staphylococcus lugdunensis clinical isolates. Antimicrob Agents Chemother 2007; 51:888.
  10. Carroll K, Weinstein M. 2007. Manual and automated systems for detection and identification of microorganisms. In: Manual of clinical microbiology, 9th ed, Murray PR, Baron EJ, Jorgensen JH, et al (Eds), ASM Press, Washington, DC 2009. Vol 1, p.192.
  11. Loonen AJ, Jansz AR, Bergland JN, et al. Comparative study using phenotypic, genotypic, and proteomics methods for identification of coagulase-negative staphylococci. J Clin Microbiol 2012; 50:1437.
  12. Petti CA, Simmon KE, Miro JM, et al. Genotypic diversity of coagulase-negative staphylococci causing endocarditis: a global perspective. J Clin Microbiol 2008; 46:1780.
  13. Martineau F, Picard FJ, Ke D, et al. Development of a PCR assay for identification of staphylococci at genus and species levels. J Clin Microbiol 2001; 39:2541.
  14. Poyart C, Quesne G, Boumaila C, Trieu-Cuot P. Rapid and accurate species-level identification of coagulase-negative staphylococci by using the sodA gene as a target. J Clin Microbiol 2001; 39:4296.
  15. Goh SH, Potter S, Wood JO, et al. HSP60 gene sequences as universal targets for microbial species identification: studies with coagulase-negative staphylococci. J Clin Microbiol 1996; 34:818.
  16. Vandenesch F, Etienne J, Reverdy ME, Eykyn SJ. Endocarditis due to Staphylococcus lugdunensis: report of 11 cases and review. Clin Infect Dis 1993; 17:871.
  17. Higaki S, Kitagawa T, Morohashi M, Yamagishi T. Distribution and antimicrobial susceptibility of coagulase-negative staphylococci from skin lesions. J Int Med Res 1999; 27:191.
  18. Paterson DL, Nuttall N. Serious infections due to Staphylococcus lugdunensis. Aust N Z J Med 1997; 27:591.
  19. Hellbacher C, Törnqvist E, Söderquist B. Staphylococcus lugdunensis: clinical spectrum, antibiotic susceptibility, and phenotypic and genotypic patterns of 39 isolates. Clin Microbiol Infect 2006; 12:43.
  20. Herchline TE, Barnishan J, Ayers LW, Fass RJ. Penicillinase production and in vitro susceptibilities of Staphylococcus lugdunensis. Antimicrob Agents Chemother 1990; 34:2434.
  21. Becker K, Pagnier I, Schuhen B, et al. Does nasal cocolonization by methicillin-resistant coagulase-negative staphylococci and methicillin-susceptible Staphylococcus aureus strains occur frequently enough to represent a risk of false-positive methicillin-resistant S. aureus determinations by molecular methods? J Clin Microbiol 2006; 44:229.
  22. Tee WS, Soh SY, Lin R, Loo LH. Staphylococcus lugdunensis carrying the mecA gene causes catheter-associated bloodstream infection in premature neonate. J Clin Microbiol 2003; 41:519.
  23. CLSI. 2005. Performance standards for antimicrobial susceptibility testing: Fifteenth informational supplement. CLSI/NCCLS document M100-S15. Clinical and Laboratory Standards Institute, Wayne, PA. 2005.
  24. NCCLS. 1999. Performance standards for antimicrobial susceptibility testing. Ninth informational supplement M100-S9. NCCLS, Wayne, PA. 1999.
  25. Bourgeois I, Pestel-Caron M, Lemeland JF, et al. Tolerance to the glycopeptides vancomycin and teicoplanin in coagulase-negative staphylococci. Antimicrob Agents Chemother 2007; 51:740.
  26. Götz F. Staphylococcus and biofilms. Mol Microbiol 2002; 43:1367.
  27. O'Gara JP. ica and beyond: biofilm mechanisms and regulation in Staphylococcus epidermidis and Staphylococcus aureus. FEMS Microbiol Lett 2007; 270:179.
  28. Pareja J, Gupta K, Koziel H. The toxic shock syndrome and Staphylococcus lugdunensis bacteremia. Ann Intern Med 1998; 128:603.
  29. Costerton JW, Stewart PS, Greenberg EP. Bacterial biofilms: a common cause of persistent infections. Science 1999; 284:1318.
  30. Frank KL, Patel R. Poly-N-acetylglucosamine is not a major component of the extracellular matrix in biofilms formed by icaADBC-positive Staphylococcus lugdunensis isolates. Infect Immun 2007; 75:4728.
  31. Tan TY, Ng SY, Ng WX. Clinical significance of coagulase-negative staphylococci recovered from nonsterile sites. J Clin Microbiol 2006; 44:3413.
  32. Bellamy R, Barkham T. Staphylococcus lugdunensis infection sites: predominance of abscesses in the pelvic girdle region. Clin Infect Dis 2002; 35:E32.
  33. Fervenza FC, Contreras GE, Garratt KN, Steckelberg JM. Staphylococcus lugdunensis endocarditis: a complication of vasectomy? Mayo Clin Proc 1999; 74:1227.
  34. Lessing MP, Crook DW, Bowler IC, Gribbin B. Native-valve endocarditis caused by Staphylococcus lugdunensis. QJM 1996; 89:855.
  35. Patel R, Piper KE, Rouse MS, et al. Frequency of isolation of Staphylococcus lugdunensis among staphylococcal isolates causing endocarditis: a 20-year experience. J Clin Microbiol 2000; 38:4262.
  36. Polenakovik H, Herchline T, Bacheller C, Bernstein J. Staphylococcus lugdunensis endocarditis after angiography. Mayo Clin Proc 2000; 75:656.
  37. van der Mee-Marquet N, Achard A, Mereghetti L, et al. Staphylococcus lugdunensis infections: high frequency of inguinal area carriage. J Clin Microbiol 2003; 41:1404.
  38. Lina B, Vandenesch F, Reverdy ME, et al. Non-puerperal breast infections due to Staphylococcus lugdunensis. Eur J Clin Microbiol Infect Dis 1994; 13:686.
  39. Seenivasan MH, Yu VL. Staphylococcus lugdunensis endocarditis--the hidden peril of coagulase-negative staphylococcus in blood cultures. Eur J Clin Microbiol Infect Dis 2003; 22:489.
  40. Anguera I, Del Río A, Miró JM, et al. Staphylococcus lugdunensis infective endocarditis: description of 10 cases and analysis of native valve, prosthetic valve, and pacemaker lead endocarditis clinical profiles. Heart 2005; 91:e10.
  41. Chu VH, Woods CW, Miro JM, et al. Emergence of coagulase-negative staphylococci as a cause of native valve endocarditis. Clin Infect Dis 2008; 46:232.
  42. Fowler VG Jr, Miro JM, Hoen B, et al. Staphylococcus aureus endocarditis: a consequence of medical progress. JAMA 2005; 293:3012.
  43. Røder BL, Wandall DA, Frimodt-Møller N, et al. Clinical features of Staphylococcus aureus endocarditis: a 10-year experience in Denmark. Arch Intern Med 1999; 159:462.
  44. Watanakunakorn C. Staphylococcus aureus endocarditis at a community teaching hospital, 1980 to 1991. An analysis of 106 cases. Arch Intern Med 1994; 154:2330.
  45. Seifert H, Oltmanns D, Becker K, et al. Staphylococcus lugdunensis pacemaker-related infection. Emerg Infect Dis 2005; 11:1283.
  46. Ebright JR, Penugonda N, Brown W. Clinical experience with Staphylococcus lugdunensis bacteremia: a retrospective analysis. Diagn Microbiol Infect Dis 2004; 48:17.
  47. Zinkernagel AS, Zinkernagel MS, Elzi MV, et al. Significance of Staphylococcus lugdunensis bacteremia: report of 28 cases and review of the literature. Infection 2008; 36:314.
  48. Friedman ND, Kaye KS, Stout JE, et al. Health care--associated bloodstream infections in adults: a reason to change the accepted definition of community-acquired infections. Ann Intern Med 2002; 137:791.
  49. Sanzéni L, Ringberg H. Fistulating periprosthetic Staphylococcus lugdunensis hip infection cured by intra-articular teicoplanin injections--a case report. Acta Orthop Scand 2003; 74:624.
  50. Sampathkumar P, Osmon DR, Cockerill FR 3rd. Prosthetic joint infection due to Staphylococcus lugdunensis. Mayo Clin Proc 2000; 75:511.
  51. Weightman NC, Allerton KE, France J. Bone and prosthetic joint infection with Staphylococcus lugdunensis. J Infect 2000; 40:98.
  52. Elliott SP, Yogev R, Shulman ST. Staphylococcus lugdunensis: an emerging cause of ventriculoperitoneal shunt infections. Pediatr Neurosurg 2001; 35:128.
  53. Spanu T, Rigante D, Tamburrini G, et al. Ventriculitis due to Staphylococcus lugdunensis: two case reports. J Med Case Rep 2008; 2:267.
  54. Mei-Dan O, Mann G, Steinbacher G, et al. Septic arthritis with Staphylococcus lugdunensis following arthroscopic ACL revision with BPTB allograft. Knee Surg Sports Traumatol Arthrosc 2008; 16:15.
  55. Murdoch DR, Everts RJ, Chambers ST, Cowan IA. Vertebral osteomyelitis due to Staphylococcus lugdunensis. J Clin Microbiol 1996; 34:993.
  56. Camacho M, Guis S, Mattei JP, et al. Three-year outcome in a patient with Staphylococcus lugdunensis discitis. Joint Bone Spine 2002; 69:85.
  57. Greig JM, Wood MJ. Staphylococcus lugdunensis vertebral osteomyelitis. Clin Microbiol Infect 2003; 9:1139.
  58. Thomas S, Hoy C, Capper R. Osteomyelitis of the ear canal caused by Staphylococcus lugdunensis. J Infect 2006; 53:e227.
  59. Chiquet C, Pechinot A, Creuzot-Garcher C, et al. Acute postoperative endophthalmitis caused by Staphylococcus lugdunensis. J Clin Microbiol 2007; 45:1673.
  60. Bello C, Eskandar M, El GR, et al. Staphylococcus lugdunensis endometritis: a case report. West Afr J Med 2007; 26:243.
  61. Kim JH, Lee JY, Kim HR, et al. Acute lymphadenitis with cellulitis caused by Staphylococcus lugdunensis. Korean J Lab Med 2008; 28:196.
  62. Hammami BK, Ghorbel H, Abid F, et al. [Psoas abscess of the adult: study of 38 cases]. Tunis Med 2007; 85:631.
  63. Casanova-Roman M, Sanchez-Porto A, Casanova-Bellido M. Urinary tract infection due to Staphylococcus lugdunensis in a healthy child. Scand J Infect Dis 2004; 36:149.
  64. Haile DT, Hughes J, Vetter E, et al. Frequency of isolation of Staphylococcus lugdunensis in consecutive urine cultures and relationship to urinary tract infection. J Clin Microbiol 2002; 40:654.
  65. Schnitzler N, Meilicke R, Conrads G, et al. Staphylococcus lugdunensis: report of a case of peritonitis and an easy-to-perform screening strategy. J Clin Microbiol 1998; 36:812.
  66. Mermel LA, Allon M, Bouza E, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. Clin Infect Dis 2009; 49:1.