Does Staphylococcus lugdunensis pose any infection risk after a cataract surgery ?

Year 2020, Volume: 2 Issue: 2, 37 - 42, 30.08.2020

Mahmut Oğuz Ulusoy , Merih Kıvanç

Abstract

Purpose: The purpose of this study is to present the current risk and to examine the biofilm formation ability and the antibiotic sensitivity of S. lugdunensis that were isolated from the cataract surgeries and to minimize the risks that are likely to occur due to S. lugdunensis following cataract surgeries.

Material and Methods: The bacteria that had been isolated from previous cataract surgeries and stored at the Microbiology Laboratory of Eskisehir Technical University, Faculty of Science, Department of Biology were used for the study. The isolates grown on blood agars were tested with gram stain, catalase, coagulase and oxidase tests. The strains were identified with ID 32 Staph and VITEK II system (BioMerieux). The RiboPrinter® Microbial Characterization System (Dupont Qualicon) and the standard EcoRI DNA preparation kit were used for Automated EcoRIRibotyping. The isolates were assessed for biofilm production according to a modified microtiter plate method and cultivation on Congo Red Agar (CRA) plates. The antibiotic sensitivity of the isolates was tested by the disc diffusion method. Vancomycin and methicillin were assessed by microdilution method.

Results: We identified 12 S. lugdunensis isolates from ocular surface of patients who underwent cataract surgery. They all produced beta hemolytic rough white colonies in the blood agar. Regarding antibiotic sensitivity results, all of the tested isolates were found to be sensitive to vancomycin and levofloxacin. Cefuroxime resistance was found in two third of the strains. While 1 isolate produced strong biofilm, 4 isolates produced a moderate biofilm, with CRA method. Six isolates did not produce any biofilm. As for microtitration method, 3 isolates produced strong biofilm, while 5 isolates did not produce any biofilm.

Conclusion: Vancomycin provided a consistent coverage for S. lugdunensis and should be selected as the first line of treatment for acute endophthalmitis caused by coagulase-negative staphylococcus. In our study, two thirds of the S. lugdunensis isolates were multi drug resistant, and these isolates were resistant to cefuroxime which is used as intracameral antibiotic. This should be kept in mind in endophthalmitis in vulnerable patients.

Keywords

cataract, surgery, staphyloccocus, lugdunensis, endophthalmitis

References

• 1.Babu E, Oropello J. Staphylococcus lugdunensis: the coagulase-negative staphylococcus you don’t want to ignore. Expert Rev Anti Infect Ther 2011;9(10):901-7.
• 2.Böcher S, Tønning B, Skov RL, Prag J. Staphylococcus lugdunensis, a common cause of skin and soft tissue infections in the community. J Clin Microbiol 2009;47(4):946-50.
• 3.Nesher L, Tarrand J, Chemaly RF, Rolston KV. Staphylococcus lugdunensis infections, filling in the gaps: a 3-year retrospective review from a comprehensive cancer center Support Care Canc 2016, 10.1007/s00520-016-3493-7
• 4.Endophthalmitis Vitrectomy Study Group. Results of the Endophthalmitis Vitrectomy study. A randomized trial of immediate vitrectomy and of intravenous antibiotics for the treatment of postoperative bacterial endophthalmitis. Arch Ophthalmol. 1995;113(12):1479–96.
• 5.Yannuzzi NA, Si N, Relhan N, et al. Endophthalmitis after clear corneal cataract surgery:outcomes over two decades. Am J Ophthalmol. 2017;174:155–9.
• 6.Fisch A, Salvanet A, Prazuck T, et al. Epidemiology of infective endophthalmitis in France. Lancet 1991 338:1373–6.
• 7.Kattan HM, Flynn HW. Jr., Pflugfelder SC, Robertson C, and Forster RK . Nosocomial endophthalmitis survey. Current incidence of infection after intraocular surgery. Ophthalmology 1991 98:227–38.
• 8.Miller JJ, Scott IU, Flynn HW. Jr, Smiddy WE, Newton J, Miller D. Acute-onset endophthalmitis after cataract surgery (2000–2004): incidence, clinical settings, and visual acuity outcomes after treatment. Am. J. Ophthalmol. 2005 139:983–7.
• 9.Ng JQ, Morlet N, Pearman JW, et al. Management and outcomes of postoperative endophthalmitis since the endophthalmitis vitrectomy study: the Endophthalmitis Population Study of Western Australia (EPSWA)’s fifth report. Ophthalmology 2005 112:1199–206.
• 10.Chiquet C, Pechinot A, Creuzot-Garcher C, et al. Acute Postoperative Endophthalmitis Caused by Staphylococcus lugdunensis. J. Clinical Microbiol.2007, 45 (6):1673–8.
• 11.Cornut PL, Thuret G, Creuzot-Garcher C, et al. Relationship between baseline clinical data and microbiologic spectrum in 100 patients with acute postcataract endophthalmitis. Retina. 2012 32(3):549–57.
• 12.Murad-Kejbou S, Kashani AH, Capone Jr A, Ruby A. Staphylococcus lugdunensis endophthalmitis after intravitreal injection: a case series. Retin Cases Brief Rep. 2014;8(1):41–4.
• 13.Pandita A, Murphy C. Microbial keratitis in Waikato,New Zealand. Clin Experiment Ophthalmol. 2011;39:393–7.
• 14.Inada N, Harada N, Nakashima M, Shoji J. Severe Staphylococcus lugdunenesis keratitis. Infection 2014:DOI 10.1007/s15010-014-0669-2.
• 15.von Eiff C, Peters G, and Heilmann C. Pathogenesis of infections due to coagulase-negative staphylococci. Lancet Infect. Dis. 2002 2:677–85.
• 16.Bannerman TL.Staphylococcus, Micrococcus, and other catalase-positive cocci that grow aerobically, p. 384-404. In P. R. Murray, E. J. Baron, J. H. Jorgenson, M. A. Pfaller, and R. H. Yolken (eds.), Manual of clinical microbiology, 8th ed., vol. 1. American Society for Microbiology, Washington, DC. 2003.
• 17.Christensen GD, Simpson WA, Younger JJ, et al. Adherence of coagulase-negative staphylococci to plastic tissue culture plates: a quantitative model for the adherence of staphylococci to medical devices. J ClinMicrobiol. 1985; 22: 996–1006.
• 18.Freeman DJ, Falkiner ER, Keane CT. New method for detecting slime production by coagulase negative Staphylococci. J.Clin. Pathol. 1989; 42:872-4.
• 19.Clinical Laboratory Standards Institute. 2005. Performance standards for antimicrobial susceptibility testing; 15th informational supplement. NCCLS/CLSI M100-S15. Clinical Laboratory Standards Institute, Wayne, PA. . 20.Disc susceptibility tests; approved standard. M2-A9. Clinical Laboratory Standards Institute, Wayne, PA.
• 21.Yazgı HM, Uyanık H. Atypical Colony Morphology of nStaphylococcus lugdunensis Isolated from a Wound Specimen. Staphylococcus lugdunensis, Atipik Koloni Görünümü Eurasian J. Medicine. 2010; 42:36-37.
• 22.van der Mee-Marquet N., Achard A, Mereghetti L, Danton A, Minier M, Quentin R. Staphylococcus lugdunensis infections: high frequency of inguinal area carriage. J. Clin. Microbiol. 2003;41:1404-9.
• 23.Hellbacher C, Tornqvist E, and Soderquist B. Staphylococcus lugdunensis: clinical spectrum, antibiotic susceptibility, and phenotypic and genotypic patterns of 39 isolates. Clin. Microbiol. Infect. 2006 12:43-9.
• 24.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 56:287-91.
• 25.Tan TY, Ng S,He J. Microbiological Characteristics, Presumptive Identification, and Antibiotic Susceptibilities of Staphylococcus lugdunensis Journal of clinical microbiology, 2008, 46 (7): 2393–5.
• 26.Garoon RB, Miller D, Flynn HW. Acute-onset endophthalmitis caused by Staphylococcus lugdunensis. American Journal of Ophthalmology Case Reports, 2018;9: 28-30.
• 27.Donvito B, Etienne J, Denoroy L, Greenland T, Benito Y, Vandenesch F. Synergistic haemolytic activity of Staphylococcus lugdunensis is mediated by three peptides encoded by a non-agr genetic locus. Infect Immun 1997; 65: 95-100
• 28.Frank KL, Reichert EJ, Piper KE, Patel R. In Vitro Effects of Antimicrobial Agents on Planktonic and Biofilm Forms of Staphylococcus lugdunensis Clinical Isolates. Antımıcrobıal Agents And Chemotherapy, 2007, 51 (3): 888–95. 29.Donlan RM, Costerton JW. Biofilms: survival mechanisms of clinically relevant microorganisms. Clin Microbiol Rev 2002;15: 167–93.
• 30.Relhan N, Albini TA, Pathenagy A, et al.Endophthalmitis cause by gram-positive organisms with reduced vancomycin susceptibility: literature review and options for treatment Br J Ophthalmol, 2006;100: 446-52.