Clonal expansion of Staphylococcus epidermidis strains causing Hickman catheter-related infections in a hemato-oncologic department
The detailed analysis of 411 strains of coagulase-negative staphylococci (CoNS) obtained from 40 neutropenic hemato-oncologic patients (61 Hickman catheter episodes) on intensive chemotherapy is described. By random amplification of polymorphic DNA (RAPD) analysis, a total of 88 different genotypes were detected: 51 in air samples and 30 in skin cultures prior to insertion, 12 in blood cultures after insertion, and only 5 involved in catheter-related infections (CRI). Two RAPD genotypes of Staphylococcus epidermidis predominated, and their prevalence increased during patient hospitalization. At insertion, these clones constituted 11 of 86 (13%) CoNS isolated from air samples and 33 of 75 (44%) CoNS isolated from skin cultures. After insertion, their combined prevalence increased to 33 of 62 (53%) in catheters not associated with CRI and 139 of 188 (74%) in catheters associated with CRI (P = 0.0041). These two predominant S. epidermidis clones gave rise to a very high incidence of CRI (6.0 per 1,000 catheter days) and a very high catheter removal rate for CRI, 70%, despite prompt treatment with vancomycin. A likely source of S. epidermidis strains involved in CRI appeared to be the skin flora in 75% of cases. The validity of these observations was confirmed by pulsed-field gel electrophoresis (PFGE) of SmaI DNA macrorestriction fragments of blood culture CoNS isolates. Again, two predominant CoNS genotypes were found (combined prevalence, 60%). RAPD and PFGE yielded concordant results in 75% of cases. Retrospectively, the same two predominant CoNS clones were also found among blood culture CoNS isolates from the same hematology department in the period 1991 to 1993 (combined prevalence, 42%) but not in the period 1978 to 1982. These observations underscore the pathogenic potential of clonal CoNS types that have successfully and persistently colonized patients in this hemato-oncology department.
|Keywords||*Random Amplified Polymorphic DNA Technique, Air Microbiology, Antibiotic Prophylaxis, Bacteriological Techniques, Catheters, Indwelling/*adverse effects, Ciprofloxacin/therapeutic use, Fluconazole/therapeutic use, Genotype, Hematologic Neoplasms/complications/drug therapy purification, Humans, Mycoses/prevention & control, Neutropenia, Research Support, Non-U.S. Gov't, Restriction Mapping, Skin/*microbiology, Staphylococcal Infections/*etiology/microbiology/prevention & control, Staphylococcus epidermidis/genetics/*growth & development/isolation &|
Nouwen, J.L., van Belkum, A.F., de Marie, S., Sluijs, J., Wielenga, J.J., Kluytmans, J.A.J.W., & Verbrugh, H.A.. (1998). Clonal expansion of Staphylococcus epidermidis strains causing Hickman catheter-related infections in a hemato-oncologic department. Journal of Clinical Microbiology. Retrieved from http://hdl.handle.net/1765/8880