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Molecular Epidemiology of Coagulase-Negative Staphylococci Isolated From Immunocompromised Patients

Published online by Cambridge University Press:  21 June 2016

Loreen A. Herwaldt ,
Richard J. Hollis ,
Linda D. Boyken  and
Michael A. Pfaller
Loreen A. Herwaldt*
Affiliation:
Department of Internal Medicine, Iowa City, Iowa
Richard J. Hollis
Affiliation:
Department of Pathology, Iowa City, Iowa
Linda D. Boyken
Affiliation:
Department of Internal Medicine, Iowa City, Iowa
Michael A. Pfaller
Affiliation:
Department of Pathology, Iowa City, Iowa University of Iowa College of Medicine, and Veterans Affairs Medical Center, Iowa City, Iowa Department of Pathology, Oregon Health Science University, Portland, Oregon
*
Department of Internal Medicine, The University of Iowa Hospitals and Clinics, C41 GH, Iowa City, IA 52242-1009
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Abstract

objective:

To define the source of invasive coagulase-negative staphylococci (CNS) and the epidemiology of strain variation in immunocompromised patients.

Design:

Weekly microbial surveillance cultures were obtained from the nares, throat, skin, rectum, and urine. Plasmid pattern analysis was performed on all coagulase-negative staphylococci isolated from blood cultures and on selected strains from the surveillance sites.

Setitng:

A 902-bed, university-owned, tertiary-care referral hospital.

Participants:

Forty-four patients on the bone marrow transplant or hematologic malignancy services.

Results:

Plasmid pattern analysis was performed on 340 surveillance isolates (median = 7 per patient) and 201 bloodstream isolates (median = 3 per patient). Patients were colonized with numerous unique strains (median= 5 per patient) of coagulase-negative staphylococci. The 44 patients had 108 episodes of positive blood cultures, 20 of which were preceded by colonization with the same strain. Isolation of the matching strain from surveillance cultures preceded the positive blood culture by 1 to 8 days in 9 episodes and 18 to 389 days in 11 episodes. The matching strain was isolated from the skin in only 6 (30%) of those episodes and from mucosal sites in 70%. Of the 108 episodes of positive blood cultures, 21 were identified as nosocomial bloodstream infections. Four of the 21 nosocomial bloodstream infections were preceded by colonization with the same strain. In all 4 episodes, the infecting strain was cultured from the nares before the blood cultures were obtained.

Conclusions:

Our results suggest that mucous membranes might be sources for strains of CNS causing bacteremia.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 13 , Issue 2 , February 1992 , pp. 86 - 92
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1992

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