Small colony variant of methicillin-resistant Staphylococcus aureus isolated from an osteomyelitis case

Abstract

Server Yağcı, Şükriye Kürkçüoğlu, Barış Doğan Öztürk, Fatma Şebnem Erdinç, Necla Eren Tulek Methicillin-resistant Staphylococcus aureus small colony variants may cause soft tissue infections. However, any case presenting with soft tissue abscess after a fracture surgery is not been reported yet. In this report; a case of methicillin-resistant S.aureus small colony variant that was isolated from a 68-years-old man who has a fracture surgery history and recurrent abscess developing in his left thigh was reported. This variant was recovered from aspiration material of the open wound. Daptomycin was used successfully in the treatment of the bacterial infection which is resistant to rifampin.

Keywords

• Small colony variant, methicillin-resistant Staphylococcus aureus, recurrent abscess

Small colony variant of methicillin-resistant Staphylococcus aureus isolated from an osteomyelitis case

Öz

Metisiline dirençli Staphylococcus aureus’un küçük koloni varyantları yumuşak doku enfeksiyonlarına sebep olabilmektedir. Ancak kırık ameliyatı sonrası yumuşak doku apsesi ile seyreden bir olgu henüz rapor edilmemiştir. Bu yazıda; kırık öyküsü olan 68 yaşındaki erkek hastanın sol bacağında gelişen ve tekrarlayan apseden izole edilen metisiline dirençli S. aureus küçük koloni varyantı olgusu sunulmuştur. Bu varyant açık yaradan alınan aspirasyon materyalinden elde edildi. Rifampine dirençli olan bakteri enfeksiyonunun tedavisinde daptomisin başarıyla kullanıldı

Anahtar Kelimeler

• Anahtar klimeler: Küçük koloni varyantı, metisiline dirençli Staphylococcus aureus, tekrarlayan abse

Kaynakça

1. Proctor RA, Balwit JM, Vesga O. Variant subpopulations of Staphylococcus aureus as cause of persistent and recurrent infections. Infect Agents Dis 1994;3:302-312.
2. von Eiff C, Bettin D, Proctor RA, et al. Recovery of small colony variants of Staphylococcus aureus following gen- tamicin bead placement for osteomyelitis. Clin Infect Dis 1997;25:1250-1251.
3. Kahl B, Herrmann M, Everding AS, et al. Persistent infection with small colony variant strains of Staphylococcus aureus in patients with cystic fibrosis. J Infect Dis 1998;177:1023- 1029.
4. Yagci S, Hascelik G, Dogru D, Ozcelik U, Sener B. Preva- lence and genetic diversity of Staphylococcus aureus small- colony variants in cystic fibrosis patients. Clin Microbiol Infect 2013;19:77-84.
5. Proctor RA, von Eiff C, Kahl BC, et al. Small colony variants: a pathogenic form of bacteria that facilitates persistent and recurrent infections. Nat Rev Microbiol 2006;4:295-305.
6. Spanu T, Romano L, D’Inzeo T, et al. Recurrent ventriculo- peritoneal shunt infection caused by small-colony variants of Staphylococcus aureus. Clin Infect Dis 2005;41:e48-52.
7. Proctor RA, van Langevelde P, Kristjansson M, Maslow JN, Ar- beit RD. Persistent and relapsing infections associated with small-colony variants of Staphylococcus aureus. Clin Infect Dis 1995;20:95-102.
8. Clinical and Laboratory Standards Institute: Performance standards for antimicrobial susceptibility testing; 20th infor- mational supplement. CLSI M100-S20. 2010; 30 (1): Clinical and Laboratory Standards Institute, Wayne, PA.

9. Seifert H, von Eiff C, Fatkenheuer G. Fatal case due to meth- icillin-resistant Staphylococcus aureus small colony variants in an AIDS patient. Emerg Infect Dis 1999; 5:450-453.
10. Kipp F, Ziebuhr W, Becker K, et al. Detection of Staphylococ- cus aureus by 16S rRNA directed in situ hybridisation in a patient with a brain abscess caused by small colony variants. J Neurol Neurosurg Psychiatry 2003;74:1000-1002.
11. Vaudaux P, Kelley WL, Lew DP. Staphylococcus aureus small colony variants: difficult to diagnose and difficult to treat. Clin Infect Dis 2006;43:968-970
12. Proctor RA, Peters G. Small colony variants in staphylococ- cal infections: diagnostic and therapeutic implications. Clin Infect Dis 1998;27:419-22.
13. Sendi P, Rohrbach M, Graber P, Frei R, Ochsner PE, Zim- merli W. Staphylococcus aureus small colony variants in prosthetic joint infection. Clin Infect Dis 2006;43:961-967.
14. Schmitz FJ, von Eiff C, Gondolf M, et al. Staphylococcus au- reus small colony variants: rate of selection and MIC values compared to wild-type strains, using ciprofloxacin, ofloxacin, levofloxacin, sparfloxacin and moxifloxacin. Clin Microbiol Infect 1999;5:376-378.
15. von Eiff C, Friedrich AW, Becker K, Peters G. Comparative in vitro activity of ceftobiprole against staphylococci display- ing normal and small-colony variant phenotypes. Antimicrob Agents Chemother 2005;49:4372-4374.
16. Begic D, von Eiff C, Tsuji BT. Daptomycin pharmacodynam- ics against Staphylococcus aureus hemB mutants displaying the small colony variant phenotype. J Antimicrob Chemother 2009;63:977-981.
17. Baltch AL, Ritz WJ, Bopp LH, Michelsen P, Smith RP. Ac- tivities of daptomycin and comparative antimicrobials, singly and in combination, against extracellular and intracellular Staphylococcus aureus and its stable small-colony variant in human monocyte-derived macrophages and in broth. Antimi- crob Agents Chemother 2008;52:1829-1833.
18. Garcia LG, Lemaire S, Kahl BC, et al. Pharmacodynamic evaluation of the activity of antibiotics against hemin- and menadione-dependent small-colony variants of Staphylococ- cus aureus in models of extracellular (broth) and intracellular (THP-1 monocytes) infections. Antimicrob Agents Chemoth- er 2012;56:3700-3711.
19. Nguyen HA, Denis O, Vergison A, et al. Intracellular activ- ity of antibiotics in a model of human THP-1 macrophages infected by a Staphylococcus aureus small-colony variant strain isolated from a cystic fibrosis patient: pharmacody- namic evaluation and comparison with isogenic normal-phe- notype and revertant strains. Antimicrob Agents Chemother 2009;53:1434-1442.
20. Piffaut C, Lustig S, Laurent F, Chidiac C, Ferry T, Lyon BJISG. Small colony variant-producing S aureus prosthesis joint in- fection highlighted by sonication and treated with prolonged high doses of daptomycin. BMJ Case Rep 2013;2013.