- Email: [email protected]
KMP023 Recurrent pacemaker-related infection due to small colony variants (SCVs) of Staphylococcus aureus
Wissenschaftliches Programm 55. DGHM-Tagung 29. September-1. Oktober 2003 in Dresden Abstracts - Poster
©
0
~ ~ M~o~
Recurrent Pacemaker-Related Infection due to Small Colony Variants (SCVs) of S t a p h y l o c o c c u s aureus
yon Eiff, C.1; Wisplinghoff, H.2; Schnabel, p.3; Seifert, H. 2 1University of MOnster Hospital and Clinics; Institute of Medical Microbiology 2University of Cologne; Institute for Medical Microbiology, Immunology and Hygiene 3University of Cologne; Department I I I of Internal Medicine Infections due to Staphylococcus aureus range from mild skin infections to acute life-threatening diseases. However, S. aureus may also cause a chronic type of disease with persistent or recurrent infections. Skin and soft tissue infections, chronic osteomyelitis, and persistent infections in patients with cystic fibrosis have been associated with small colony variants (SCVs), a naturally occurring subpopulation of S. aureus. Here, we describe the first known case of a device-related bloodstream infection due to S. aureus SCVs. A 63-year old patient presented with fever and chills and a pacemaker pocket infection due to S. aureus. Following removal of the device he was treated initially with vancomycin and rifampin for 4 weeks. Only the tip of the PM lead remained fixed in the myocardium. After discontinuation of antimicrobial therapy he returned again with high fever. Within a period of seven months, with repeated antimicrobial treatment courses, several sets of blood cultures yielded SCVs, initially misidentified as coagulase-negative staphylococci. Finally, S. aureus SCVs were confirmed by PCR amplification of the nuc and coa genes as well as by determination of auxotrophy for heroin. Continuously positive blood cultures with the same strain as demonstrated by molecular typing and the presumable persistence of these organisms on the PM-lead tip may partly be explained by the poor effectiveness of cellwall active antibiotics such as vancomycin against these slow-growing organisms and their ability to persist intracellularly. The infection was finally cured by open heart surgery and removal of the tip of the PM-lead. This case adds to the spectrum of persistent and relapsing infections attributed to S. aureus SCVs. The laboratory should be particularly alert for S. aureus SCVs when samples are submitted from patients who have received long-term antimicrobial therapy especially if the infection is unusually persistent and/or recurrent.
http://www.dghm.org
377
©
0
~ ~ M~o~
Recurrent Pacemaker-Related Infection due to Small Colony Variants (SCVs) of S t a p h y l o c o c c u s aureus
yon Eiff, C.1; Wisplinghoff, H.2; Schnabel, p.3; Seifert, H. 2 1University of MOnster Hospital and Clinics; Institute of Medical Microbiology 2University of Cologne; Institute for Medical Microbiology, Immunology and Hygiene 3University of Cologne; Department I I I of Internal Medicine Infections due to Staphylococcus aureus range from mild skin infections to acute life-threatening diseases. However, S. aureus may also cause a chronic type of disease with persistent or recurrent infections. Skin and soft tissue infections, chronic osteomyelitis, and persistent infections in patients with cystic fibrosis have been associated with small colony variants (SCVs), a naturally occurring subpopulation of S. aureus. Here, we describe the first known case of a device-related bloodstream infection due to S. aureus SCVs. A 63-year old patient presented with fever and chills and a pacemaker pocket infection due to S. aureus. Following removal of the device he was treated initially with vancomycin and rifampin for 4 weeks. Only the tip of the PM lead remained fixed in the myocardium. After discontinuation of antimicrobial therapy he returned again with high fever. Within a period of seven months, with repeated antimicrobial treatment courses, several sets of blood cultures yielded SCVs, initially misidentified as coagulase-negative staphylococci. Finally, S. aureus SCVs were confirmed by PCR amplification of the nuc and coa genes as well as by determination of auxotrophy for heroin. Continuously positive blood cultures with the same strain as demonstrated by molecular typing and the presumable persistence of these organisms on the PM-lead tip may partly be explained by the poor effectiveness of cellwall active antibiotics such as vancomycin against these slow-growing organisms and their ability to persist intracellularly. The infection was finally cured by open heart surgery and removal of the tip of the PM-lead. This case adds to the spectrum of persistent and relapsing infections attributed to S. aureus SCVs. The laboratory should be particularly alert for S. aureus SCVs when samples are submitted from patients who have received long-term antimicrobial therapy especially if the infection is unusually persistent and/or recurrent.
http://www.dghm.org
377