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Objective Coagulase-negative Staphylococcus (CoNS) is the most frequent pathogen causing late-onset sepsis (LOS) in neonatal intensive care units (NICUs). Technical difficulties hinder blood culture (BC) collection and obtaining only one culture before initiating antibiotic therapy is a common practice. We sought to assess specific clinical information and CoNS cultures for the diagnosis of true bacteremia in the NICU. Study Design This historical cohort study was conducted in NICUs at the Hadassah-Hebrew University Medical Center of Jerusalem in Israel. Clinical and laboratory data in every CoNS bacteremia were collected and compared between bacteremia groups as follows: true positive, two positive BCs; contaminant, one positive BC out of two; undefined, one BC obtained and found positive. Results For 3.5 years, CoNS was isolated in 139 episodes. True positive was identified in 44 of 139 (31.7%), contaminant in 42 of 139 (30.2%), and the event was undefined in 53 of 139 (38.1%). Vancomycin treatment was more frequent in the true positive and undefined groups than the contaminant group (100, 90.6, and 73.8% respectively, p = 0.001); treatment was also prolonged in these two groups (p < 0.001). No clinical variables were associated with true bacteremia on multivariable analysis. Conclusion Diagnosis should definitely be based on at least two positive BCs, despite objective difficulties in obtaining BCs in neonates. Key Points CoNS is a frequent pathogen causing LOS in neonates. Due to technical difficulties, often only one culture is collected prior to antibiotic therapy. No clinical/laboratory variables were associated with the diagnosis of true CoNS bacteremia. [ABSTRACT FROM AUTHOR]

Background: Bloodstream infections are a leading cause of morbidity and mortality among in-patients globally. Blood culture is the ‘gold standard’ test for the diagnosis of bloodstream infections. The value of this valuable investigation in the diagnosis of infections however may be affected when an organism of questionable evidence is isolated, which occurs mainly due to contamination during the pre-analytical phase. Blood culture contamination can lead to the administration of unnecessary antibiotics, wastage of hospital resources, and risks to patient life. Hence, this study aimed to analyse the blood culture contamination rate in a private tertiary hospital in southwest Nigeria. Methodology: This was a retrospective observational study of patients with clinical features of bloodstream infections at Babcock University Teaching Hospital, Ilishan-Remo, Ogun State, Nigeria between January 2018 and December 2022. Blood culture results of patients in the wards or units of the hospital were reviewed, and contamination rates and organisms isolated from positive blood cultures were documented. Data were analysed using SPSS version 22.0 Results: A total of 1,612 non-repetitive blood cultures were obtained from 1,612 patients (910 males and 702 females) during the study period, out of which 397 (24.6%) were positive, 1215 (75.4%) were negative, and 124 (7.7%) were deemed as contaminants. The contamination rate was higher in females (8.7%) than in males (6.9%), although the difference was not statistically significant (x²=1.501, OR=0.7816, 95% CI=0.5416-1.128, p=0.2204). The contamination rate was higher in adults (8.1%) than children (7.3%) with the highest contamination occurring in the age group 35-39 years (9.0%), although the difference was not statistically significant (x²=0.3227, OR=0.8835, 95% CI=0.6120-1.276, p=0.5700). The female surgical ward (11.9%) had the highest contamination rate while the accident and emergency had the lowest contamination rate (1.3%) but the difference was not statistically significant (x²=11.825, p=0.2970). Coagulase-negative staphylococci were the predominant blood culture contaminants. The contamination rate increased during the 5 years from 4.8% in 2018 to 9.4% in 2022 Conclusion: The rate of blood culture contamination in our study is higher than the acceptable international rate, and mainly due to normal skin microbiota, suggesting challenges during sample collection. There is a need for a multidimensional approach to minimize blood culture contamination and hence avoid unnecessary antibiotic use. [ABSTRACT FROM AUTHOR]

Coagulase-negative Staphylococcus (CoNS) species inhibiting Staphylococcus aureus has been described in the skin of atopic dermatitis (AD) patients. This study evaluated whether Staphylococcus spp. from the skin and nares of AD and non-AD children produced antimicrobial substances (AMS). AMS production was screened by an overlay method and tested against NaOH, proteases and 30 indicator strains. Clonality was assessed by pulsed-field gel electrophoresis. Proteinaceous AMS-producers were investigated for autoimmunity by the overlay method and presence of bacteriocin genes by polymerase chain reaction. Two AMS-producers had their genome screened for AMS genes. A methicillin-resistant S. aureus (MRSA) produced proteinaceous AMS that inhibited 51.7% of the staphylococcal indicator strains, and it was active against 60% of the colonies selected from the AD child where it was isolated. On the other hand, 57 (8.8%) CoNS from the nares and skin of AD and non-AD children, most of them S. epidermidis (45.6%), reduced the growth of S. aureus and other CoNS species. Bacteriocin-related genes were detected in the genomes of AMS-producers. AMS production by CoNS inhibited S. aureus and other skin microbiota species from children with AD. Furthermore, an MRSA colonizing a child with AD produced AMS, reinforcing its contribution to dysbiosis and disease severity. [ABSTRACT FROM AUTHOR]

Background: Ruminant mastitis continues to be a cause of economic losses in the dairy industry and remains a major public health hazard globally. Objectives: This cross‐sectional study was carried out in Mukurweini Sub‐County of Nyeri County, Kenya, to investigate the prevalence of bacteria causing mastitis, risk factors associated with goat mastitis and the antibiotic resistance profiles of bacteria isolated from the goat milk. Methods: Farm level data on risk factors for mastitis was obtained from 56 farmers using a semi structured questionnaire. A total of 189 goat milk samples were collected. The goat's udder was observed for signs of clinical mastitis and the California Mastitis Test (CMT) used to test the milk for sub‐clinical mastitis. All samples were then cultured for morphological identification of bacteria and strain typing by Matrix Assisted Laser Desorption/Ionization (MALDI)‐Time of Flight (ToF) technique. Antimicrobial susceptibility of the isolated Staphylococcus aureus, coagulase‐negative Staphylococcus (CoNS), Escherichia coli, Klebsiella oxytoca, Pseudomonas spp., Enterobacter spp., Proteus vulgaris and Escherichia vulneris to eight commonly used antibiotics was done by the disc diffusion method and validated by determining the presence of antibiotic resistance genes (mecA and blaTEM) using polymerase chain reaction method. Results: The prevalence of clinical mastitis was 1.1% (2/189) while that of sub‐clinical mastitis was 84.7% (160/189). Higher (p < 0.05) prevalence of mastitis was observed in goats whose houses were cleaned fortnightly and in cases where farmers used same towel to dry different does' udders during the milking process. Thirteen different bacterial species were isolated from the milk samples and identified by MALDI‐ToF, and these included S. aureus (22.0%), CoNS (20.3%), E. coli (18.1%), Pseudomonas spp. (14.3%), Enterobacter spp. (10.4%), K. oxytoca (6.0%), E. vulneris (1.7%), P. vulgaris (1.7%), Raoutella ornithinolytica (1.7%), Stenotrophomonas maltophilia (1.1%), Pantoea agglomerans (1.1%), Serratia marcescens (1.1%) and Cedeceas spp. (0.6%). One hundred pathogenic bacterial isolates were randomly selected and tested for antibiotic sensitivity to eight antibiotics out of which S. aureus were 97.5% resistant to Oxacillin and 100% sensitive to Ciprofloxacin. The CoNSs were 100% resistant to Oxacillin and 100% sensitive to Ciprofloxacin. E. coli were 93.9% resistant to Oxacillin, 69.7% sensitive to Ciprofloxacin and 87.9% sensitive to both Amoxicillin/Clavulanic acid and Meropenem. The antimicrobial resistant genes detected in S. aureus and E. coli were mecA [66.7%, 0%], and blaTEM [20% and 78.3%], respectively. Conclusion: In conclusion, the study showed that most of the does were affected by subclinical mastitis with the main causative bacteria being Staphylococci spp. and coliforms. Farmers need to be trained on improved control of mastitis by adoption of good milking practices and use of CMT kit for early detection of mastitis. Occurrence of multidrug resistance by key mastitis causing pathogens was shown to be prevalent and therefore there is need for development of intervention strategies. [ABSTRACT FROM AUTHOR]

Staphylococcus simulans (S. simulans) is a coagulase-negative staphylococcus that is commonly found in animal pathogens. S. simulans rarely causes infections in clinical practice due to its low pathogenic ability and opportunistic pathogen, which results in few relevant clinical reports. In this paper, the authors primarily report a patient infected with S. simulans after a high supracondylar osteotomy and the S. simulans was identified by the means of the next-generation sequencing technology. This case report provides new evidence for the further research of S. simulans and paves the way for its clinical therapy. [ABSTRACT FROM AUTHOR]

Abstract Background Ruminant mastitis continues to be a cause of economic losses in the dairy industry and remains a major public health hazard globally. Objectives This cross‐sectional study was carried out in Mukurweini Sub‐County of Nyeri County, Kenya, to investigate the prevalence of bacteria causing mastitis, risk factors associated with goat mastitis and the antibiotic resistance profiles of bacteria isolated from the goat milk. Methods Farm level data on risk factors for mastitis was obtained from 56 farmers using a semi structured questionnaire. A total of 189 goat milk samples were collected. The goat's udder was observed for signs of clinical mastitis and the California Mastitis Test (CMT) used to test the milk for sub‐clinical mastitis. All samples were then cultured for morphological identification of bacteria and strain typing by Matrix Assisted Laser Desorption/Ionization (MALDI)‐Time of Flight (ToF) technique. Antimicrobial susceptibility of the isolated Staphylococcus aureus, coagulase‐negative Staphylococcus (CoNS), Escherichia coli, Klebsiella oxytoca, Pseudomonas spp., Enterobacter spp., Proteus vulgaris and Escherichia vulneris to eight commonly used antibiotics was done by the disc diffusion method and validated by determining the presence of antibiotic resistance genes (mecA and blaTEM) using polymerase chain reaction method. Results The prevalence of clinical mastitis was 1.1% (2/189) while that of sub‐clinical mastitis was 84.7% (160/189). Higher (p

Ahmed Isse Ali,1 Abdullahi Ali Mohamed,2 Ibrahim Mohamed Hirsi,2 Mohamed Nur Ali2 1Department of Dermatology, Mogadishu-Somali Turkey Training and Research Hospital, Mogadishu, Somalia; 2Department of Pediatric, Mogadishu-Somali Turkey Training and Research Hospital, Mogadishu, SomaliaCorrespondence: Ahmed Isse Ali, Email daade100@gmail.comIntroduction and Importance: Ecthyma gangrenosum is a skin lesion that can be caused by either bacterial hematogenous seeding or a primary skin infection. Despite being the most frequent causal agent, Pseudomonas aeruginosa is not the only bacteria that has been involved. Other types of bacteria may also be implicated in the etiology of EG: cocci bacteria, both gram-positive and gram-negative.Case Presentation: Here, we report the case of a 10-month-old male infant who developed ecthyma gangrenosum after a measles infection. At the time of admission, the patient had a high fever of about 40.3°C and appeared conscious. Physical examination revealed several skin lesions that were in various stages of development and appeared as nodules with a central crust and round, ulcerated, necrotic papules in the face, chest, and upper extremities. Laboratory tests showed CRP of 25 mg/l, LDH of 579 U/L, WBC of 15.06 × 1000/mm3, and absolute neutrophils of 1930/mm3 (12.8%). The result of the culture showed coagulase-negative Staphylococcus. According to the drug susceptibility test results, intravenous Vancomycin (20 mg/kg per dose, 3 times daily) should be started. A coagulase-negative Staphylococcus was eliminated as a result of this defervescence. The necrotic lesion was surgically removed from the patient.Clinical Discussion: Ecthyma gangrenosum is the all-over-the-body cutaneous manifestation of pseudomonas infection in sepsis patients. Patients who suffer from severe illnesses. Immune deficiencies commonly increase the chance of acquiring EG. Our patient had a history of measles, which led to neutropenia before developing EG. The management of ecthyma gangrenosum requires early identification and antimicrobial treatment.Conclusion: We describe a measles patient who developed coagulase-negative Staphylococcus ecthyma gangrenosum and had good results from both surgical debridement and systemic antibiotics. Our case serves as an example of the uncommon presentation of ecthyma gangrenosum. This example emphasizes the value of an early diagnosis and vigorous antimicrobial therapy in cases where ecthyma gangrenosum is clinically suspected.Keywords: ecthyma gangrenosum, coagulase-negative Staphylococcus, measles

Background: Coagulase-negative Staphylococcus (CoNS) are known commensals and often contaminate neonatal blood cultures. Their unique ability to form biofilms, however, helps them evade immune mechanisms and antibiotics and cause neonatal sepsis (NS) in hospitalized neonates. True or probable Coagulase-negative Staphylococcus blood stream infection (CoNS BSI) must be differentiated from contaminants so that antibiotics are used judiciously and hospital stay is minimized. Aims and Objectives: The primary objective of the study was to estimate the proportion of NS and contaminants among CoNS-positive blood cultures in the index neonatal unit and the host and health-care variables associated with CoNS BSI. The secondary objective was to estimate the susceptibility of CoNS isolates to antibiotics used. Materials and Methods: This was a retrospective study from digital records, from January 2018 to December 2022. Results: 25% of CoNS isolates were associated with NS (health-care infections) and 75% were contaminants. Over 90% of CoNS BSI was associated with central lines (CLs) and prolonged hospital stay. All isolates were resistant to oxacillin while resistance to gentamicin rose annually to over 68%. Susceptibility to linezolid and vancomycin was present, but a few strains were resistant to them. Conclusion: CoNS were an important cause of NS in the index hospital. Prolonged hospital stays and CLs were associated with increased incidence of CoNS sepsis and must be minimized where possible. Antibiotic resistance was high, and reserve drugs could also become ineffective.

Background: Coagulase-negative Staphylococcus (CoNS) are known commensals and often contaminate neonatal blood cultures. Their unique ability to form biofilms, however, helps them evade immune mechanisms and antibiotics and cause neonatal sepsis (NS) in hospitalized neonates. True or probable Coagulase-negative Staphylococcus blood stream infection (CoNS BSI) must be differentiated from contaminants so that antibiotics are used judiciously and hospital stay is minimized. Aims and Objectives: The primary objective of the study was to estimate the proportion of NS and contaminants among CoNS-positive blood cultures in the index neonatal unit and the host and health-care variables associated with CoNS BSI. The secondary objective was to estimate the susceptibility of CoNS isolates to antibiotics used. Materials and Methods: This was a retrospective study from digital records, from January 2018 to December 2022. Results: 25% of CoNS isolates were associated with NS (health-care infections) and 75% were contaminants. Over 90% of CoNS BSI was associated with central lines (CLs) and prolonged hospital stay. All isolates were resistant to oxacillin while resistance to gentamicin rose annually to over 68%. Susceptibility to linezolid and vancomycin was present, but a few strains were resistant to them. Conclusion: CoNS were an important cause of NS in the index hospital. Prolonged hospital stays and CLs were associated with increased incidence of CoNS sepsis and must be minimized where possible. Antibiotic resistance was high, and reserve drugs could also become ineffective. [ABSTRACT FROM AUTHOR]

An 89-year-old man developed delayed-onset endophthalmitis with a retrolenticular plaque 14 years after cataract surgery. Both Leuconostoc and coagulase-negative Staphylococcus species were isolated. This case demonstrates the longest reported delay in the presentation of endophthalmitis, identifies an uncommon pathogen in plaque-associated chronic endophthalmitis, and suggests possible treatment strategies. Purpose: To report a case of delayed-onset endophthalmitis presenting 14 years after an uncomplicated cataract surgery. Methods: Case report. Results: An 89-year-old pseudophakic man complained of redness and reduced visual acuity in his right eye. He had no history of trauma or systemic infection, and his only surgery on the right eye was an uncomplicated cataract surgery 14 years before. On physical examination, he was found to have keratic precipitates and a white posterior capsular plaque in the right eye. He was treated with a right pars plana vitrectomy and intraocular lens removal. Microbiological classification of the samples revealed the presence of a Leuconostoc species within the vitreous humor and coagulase-negative staphylococci on the lens. Two months after placement of the intraocular lens, he achieved a best-corrected visual acuity of 20/200 in his right eye. Conclusion: To the best of our knowledge, this is the first reported case of delayed-onset endophthalmitis occurring more than 10 years after an uncomplicated cataract surgery. This case highlights a highly unusual presentation of delayed-onset endophthalmitis and reports a potential novel microbiological cause of plaque formation. [ABSTRACT FROM AUTHOR]

The presence of opportunistic bacteria such as coagulase-negative Staphylococcus (CoNS) in drinking water poses public health concerns because of its potential to cause human infection and due to its antimicrobial resistance (AMR) diversity. This study evaluated the occurrence, virulence markers and AMR of CoNS in 468 drinking water samples from 15 public fountains located in four urban parks of São Paulo city (Brazil). Out of 104 samples positive for the presence of Staphylococcus genus, we detected CoNS in 75 of them (16%), which did not meet the Brazilian sanitary standards for residual chlorine. All isolates were of concern to public health for being responsible for infection in humans from low to high severity, nine of them are considered the most of concern due to 63.6% being multiresistant to antimicrobials. The results demonstrated that CoNS in drinking water must not be neglected. It is concluded that the presence of resistant staphylococci in drinking water is a potential health risk, which urges feasible and quick control measures to protect human health, especially in crowded public places. HIGHLIGHTS Coagulase-negative Staphylococcus (CoNS) was detected in chlorinated drinking water.; High diversity of CoNs was found in drinking water.; Ten species of CoNS and 25 phylogenetic variations were identified.; High frequency of antibiotic-resistant CoNs was observed.; A strain of S. haemolyticus carrying mecA gene and resistant to oxacillin and cefoxitin (MRSH) was identified.;

Abstract Background Coagulase-negative staphylococci can cause hospital-acquired infections, especially in immunocompromised hosts. Bacterial meningitis is a potentially fatal infection of the central nervous system, causing high mortality and morbidity. In general, the causative agents of meningitis, coagulase-negative staphylococci, are associated with direct implantation of a foreign body and the presence of a cerebrospinal fluid (CSF) shunt. Here, we describe a case of nosocomial meningitis caused by Staphylococcus haemolyticus in a child with neutropenia who had no intracranial foreign devices. Case presentation A 15-year-old boy with relapsed acute myeloid leukemia undergoing chemotherapy through a central venous catheter developed fever on Day 13 post-initiation of chemotherapy. There was no history of implantation of neurosurgical devices. Two blood cultures obtained on Day 14 were positive for Staphylococcus haemolyticus. Clinical improvement was noted, and treatment with vancomycin and removal of the central venous catheter resulted in negative repeat blood cultures on Day 18. However, the patient developed a tendency for somnolence and improper speech, along with persistent fever on Day 26. A lumber puncture was performed on Day 27, resulting in positive culture of Staphylococcus haemolyticus. He was diagnosed with meningitis and the dosage of vancomycin was increased. A repeat CSF culture was positive for Staphylococcus haemolyticus on Day 40, so oral rifampicin was added. CSF findings on Day 46 revealed a low concentration of vancomycin, and treatment was switched from vancomycin plus rifampicin to linezolid. After Day 46, four subsequent cerebrospinal fluid tests of the CSF showed no growth of Staphylococcus haemolyticus. The patient’s symptoms were improved on Day 52. Brain and spinal magnetic resonance images was taken and it showed no abnormalities. Linezolid was continued until Day 72. The patient was discharged without any complications on Day 72. Conclusions To the best of our knowledge, this is the first reported case of Staphylococcus haemolyticus meningitis in a patient without a neurosurgical device. Typical symptoms or signs may be absent in a patient with meningitis who also has neutropenia. Repeated tests of the CSF, and prolonged duration of antibiotics should be considered if atypical pathogens are detected in immunocompromised hosts.

Introduction: The study aimed to improve the qualified rate of hand hygiene and reduce the incidence of peritonitis in peritoneal dialysis (PD) patients. Methods: A hand hygiene questionnaire was distributed to patients during home visits and outpatient visits in 2015 and 2020. Hand‐washing practices were evaluated by collecting cultures from the hands of patients after hand washing, evaluating their household environment, and recording the antimicrobial resistance of pathogenic bacteria. Results: Compared to patients in 2015, patients in 2020 had fewer errors in hand washing (p < 0.05), but the rate of qualification after hand washing was lower (p < 0.01). Furthermore, patients who used hand disinfectants after washing had a higher qualified rate. Coagulase‐negative staphylococcus (CNS) was the most common isolated bacteria. From 2015 to 2020, the annual incidence of CNS PD peritonitis did not decrease, while the proportion of methicillin‐resistant CNS decreased. Conclusion: The use of hand disinfectants after standard hand washing may help reduce the incidence of peritonitis in PD patients. [ABSTRACT FROM AUTHOR]

Introduction Since coronavirus disease 2019 (COVID-19) has limited treatment options, concern has been raised over secondary infections and antimicrobial resistance (AMR) patterns. It has been observed that patients who were infected with COVID-19 were predisposed to develop secondary infections. The purpose of the study is to ascertain the prevalence of the bacterial and fungal coinfections in COVID-19 patients, and also to assess the AMR patterns in the obtained isolates. Methods We have studied 200 clinical samples obtained from 122 COVID-19 positive patients. Pathogens were identified using Vitek 2 system. The demographic and clinical patterns were also observed. Results A total of 122 patients developed secondary infections. Patients aged more than 40 years were majorly affected (p-value

Abstract Purpose The objective of this study was to investigate the molecular characteristics and potential resistance mechanisms of linezolid-resistant (LZR) Staphylococcus capitis isolates from a tertiary hospital in China. Methods S. capitis isolates were obtained from clinical patient specimens; three of the isolates came from blood cultures and one from the hydrothorax. The agar dilution and E-test methods were used to identify antibiotic resistance. The chloramphenicol-florfenicol resistance (cfr) gene carrier status of the strains was determined by PCR. Whole-genome sequencing (WGS) was used to identify point mutations and L3, L4, and L22 mutations and to study the genetic environment of the cfr gene and the relationships between strains. Results The 4 isolates obtained in this study were all linezolid-resistant Staphylococcus strains. A similar of susceptibility profile pattern was observed in all four S. capitis strains, each of which exhibited a multidrug-resistant phenotype. A potentially novel mutation, C2128T, was identified, and the cfr genes of S. capitis strains were all positive. Additionally, the same mutations (C2128T and G2600T) were identified in all 23S rRNA sequences of the isolates, whereas mutations were lacking in the L3, L4, and L22 ribosomal proteins. The genetic environments surrounding cfr were identical in all four isolates. A schematic diagram of the phylogenetic tree showed that they were closely related to AYP1020, CR01, and TW2795, and a total of seven drug resistance genes were identified in these strains. Conclusions The study indicated that the resistance of the Staphylococcus capitis strains to linezolid was caused by multiple mechanisms, and a potential novel mutation, C2128T, that may have an impact on bacterial resistance was identified.

The presence of opportunistic bacteria such as coagulase-negative Staphylococcus (CoNS) in drinking water poses public health concerns because of its potential to cause human infection and due to its antimicrobial resistance (AMR) diversity. This study evaluated the occurrence, virulence markers and AMR of CoNS in 468 drinking water samples from 15 public fountains located in four urban parks of São Paulo city (Brazil). Out of 104 samples positive for the presence of Staphylococcus genus, we detected CoNS in 75 of them (16%), which did not meet the Brazilian sanitary standards for residual chlorine. All isolates were of concern to public health for being responsible for infection in humans from low to high severity, nine of them are considered the most of concern due to 63.6% being multiresistant to antimicrobials. The results demonstrated that CoNS in drinking water must not be neglected. It is concluded that the presence of resistant staphylococci in drinking water is a potential health risk, which urges feasible and quick control measures to protect human health, especially in crowded public places. [ABSTRACT FROM AUTHOR]

Background: Coagulase-negative staphylococci can cause hospital-acquired infections, especially in immunocompromised hosts. Bacterial meningitis is a potentially fatal infection of the central nervous system, causing high mortality and morbidity. In general, the causative agents of meningitis, coagulase-negative staphylococci, are associated with direct implantation of a foreign body and the presence of a cerebrospinal fluid (CSF) shunt. Here, we describe a case of nosocomial meningitis caused by Staphylococcus haemolyticus in a child with neutropenia who had no intracranial foreign devices. Case presentation: A 15-year-old boy with relapsed acute myeloid leukemia undergoing chemotherapy through a central venous catheter developed fever on Day 13 post-initiation of chemotherapy. There was no history of implantation of neurosurgical devices. Two blood cultures obtained on Day 14 were positive for Staphylococcus haemolyticus. Clinical improvement was noted, and treatment with vancomycin and removal of the central venous catheter resulted in negative repeat blood cultures on Day 18. However, the patient developed a tendency for somnolence and improper speech, along with persistent fever on Day 26. A lumber puncture was performed on Day 27, resulting in positive culture of Staphylococcus haemolyticus. He was diagnosed with meningitis and the dosage of vancomycin was increased. A repeat CSF culture was positive for Staphylococcus haemolyticus on Day 40, so oral rifampicin was added. CSF findings on Day 46 revealed a low concentration of vancomycin, and treatment was switched from vancomycin plus rifampicin to linezolid. After Day 46, four subsequent cerebrospinal fluid tests of the CSF showed no growth of Staphylococcus haemolyticus. The patient's symptoms were improved on Day 52. Brain and spinal magnetic resonance images was taken and it showed no abnormalities. Linezolid was continued until Day 72. The patient was discharged without any complications on Day 72. Conclusions: To the best of our knowledge, this is the first reported case of Staphylococcus haemolyticus meningitis in a patient without a neurosurgical device. Typical symptoms or signs may be absent in a patient with meningitis who also has neutropenia. Repeated tests of the CSF, and prolonged duration of antibiotics should be considered if atypical pathogens are detected in immunocompromised hosts. [ABSTRACT FROM AUTHOR]

ABSTRACT Staphylococcus haemolyticus is a major cause of late-onset sepsis in neonates, and endemic clones are often multidrug-resistant. The bacteria can also act as a genetic reservoir for more pathogenic bacteria. Molecular epidemiology is important in understanding bacterial pathogenicity and preventing infection. To describe the molecular epidemiology of S. haemolyticus isolated from neonatal blood cultures at a Swedish neonatal intensive care unit (NICU) over 4 decades, including antibiotic resistance genes (ARGs), virulence factors, and comparison to international isolates. Isolates were whole-genome sequenced, and single nucleotide polymorphisms in the core genome were used to map the relatedness. The occurrence of previously described ARGs and virulence genes were investigated. Disc diffusion and gradient tests were used to determine phenotypic resistance. The results revealed a clonal outbreak of S. haemolyticus at this NICU during the 1990s. Multidrug resistance was present in 28 (82%) of all isolates and concomitant resistance to aminoglycoside and methicillin occurred in 27 (79%). No isolates were vancomycin resistant. Genes encoding ARGs and virulence factors occurred frequently. The isolates in the outbreak were more homogenous in their genotypic and phenotypic patterns. Genotypic and phenotypic resistance combinations were consistent. Pathogenic traits previously described in S. haemolyticus occurred frequently in the present isolates, perhaps due to the hospital selection pressure resulting in epidemiological success. The clonal outbreak revealed by this study emphasizes the importance of adhering to hygiene procedures in order to prevent future endemic outbreaks. IMPORTANCE This study investigated the relatedness of Staphylococcus haemolyticus isolated from neonatal blood and revealed a clonal outbreak in the 1990s at a Swedish neonatal intensive care unit. The outbreak clone has earlier been isolated in Japan and Norway. Virulence and antibiotic resistance genes previously associated with clinical S. haemolyticus were frequently occuring in the present study as well. The majority of the isolates were multidrug-resistant. These traits should be considered important for S. haemolyticus epidemiological success and are probably caused by the hospital selection pressure. Thus, this study emphasizes the importance of restrictive antibiotic use and following the hygiene procedures, to prevent further antibiotic resistance spread and future endemic outbreaks.

Purpose: The objective of this study was to investigate the molecular characteristics and potential resistance mechanisms of linezolid-resistant (LZR) Staphylococcus capitis isolates from a tertiary hospital in China. Methods: S. capitis isolates were obtained from clinical patient specimens; three of the isolates came from blood cultures and one from the hydrothorax. The agar dilution and E-test methods were used to identify antibiotic resistance. The chloramphenicol-florfenicol resistance (cfr) gene carrier status of the strains was determined by PCR. Whole-genome sequencing (WGS) was used to identify point mutations and L3, L4, and L22 mutations and to study the genetic environment of the cfr gene and the relationships between strains. Results: The 4 isolates obtained in this study were all linezolid-resistant Staphylococcus strains. A similar of susceptibility profile pattern was observed in all four S. capitis strains, each of which exhibited a multidrug-resistant phenotype. A potentially novel mutation, C2128T, was identified, and the cfr genes of S. capitis strains were all positive. Additionally, the same mutations (C2128T and G2600T) were identified in all 23S rRNA sequences of the isolates, whereas mutations were lacking in the L3, L4, and L22 ribosomal proteins. The genetic environments surrounding cfr were identical in all four isolates. A schematic diagram of the phylogenetic tree showed that they were closely related to AYP1020, CR01, and TW2795, and a total of seven drug resistance genes were identified in these strains. Conclusions: The study indicated that the resistance of the Staphylococcus capitis strains to linezolid was caused by multiple mechanisms, and a potential novel mutation, C2128T, that may have an impact on bacterial resistance was identified. [ABSTRACT FROM AUTHOR]

The spread of methicillin resistance and virulence among staphylococci in the community poses a public health concern. In this study, we investigated the prevalence of Staphylococcus species colonizing the oral cavity and hand (skin) of healthy university students and their phenotypic and genetic characteristics in northern Japan. Among a total of 332 subjects, 6 and 110 methicillin-resistant and susceptible Staphylococcus aureus (MRSA and MSSA, respectively) isolates were recovered from 105 subjects. MRSA isolates were genotyped as CC5, CC8, CC45, and CC59 with SCCmec-IIa or IV, among which an isolate of ST6562 (single-locus variant of ST8) harbored SCCmec-IVa, PVL genes and ACME-I, which are the same traits as the USA300 clone. ST1223 S. argenteus was isolated from the oral cavity and hand of a single student. Coagulase-negative Staphylococcus (CoNS) was recovered from 154 subjects (172 isolates), and classified into 17 species, with S. capitis being the most common (38%), followed by S. warneri (24%) and S. epidermidis (15%), including nine mecA-positive isolates. S. capitis was differentiated into seven clusters/subclusters, and genetic factors associated with the NRCS-A clone (nsr, tarJ, ebh) were detected in 10–21% of isolates. The colonization of the USA300-like MRSA variant and S. capitis with the traits of the NRCS-A clone in healthy individuals was noteworthy. [ABSTRACT FROM AUTHOR]

Objective To observe the resistance genes and strain homology of Linezolid-resistant coagulase-negative Staphylococci (LRCoNS), and to analyze the risk factors of LRCoNS infection. Methods The drug resistance of 45 LRCoNS strains was observed by drug sensitivity test, drug resistance gene was observed by PCR, and the homology of strains was observed by pulse field gel electrophoresis. Clinical data of 45 patients with LRCoNS infection and 90 patients with Linezolid-sensitive coagulase-negative Staphylococci (LSCoNS) infection were collected. Multivariate Logistic regression analysis was used to analyze the risk factors of LRCoNS infection. Results The 45 strains of LRCoNS were highly resistant to β-lactam antibiotics, ciprofloxacin and clindamycin, and were more susceptible to vancomycin, tigecycline, rifampicin and tetracycline. Among the 45 LRCoNS, 21 carried the cfr gene, 4 carried the optrA gene, 33 had mutations in different alleles in the V functional region of 23S rRNA, 20 strains had ribosomal protein L3 gene site mutations, and 4 strains had ribosome protein L4 gene site mutations, and the multidrug resistance gene poxtA was not detected. The similarity of 24 Staphylococcus capitis strains was > 90%, the similarity of 13 of the 14 Staphylococcus epidermidis strains was > 90%, and the similarity of 4 of the 6 Staphylococcus korii strains was > 90%. Age > 60 years, coexisting malignant tumors, and history of linezolid use were independent risk factors for LRCoNS infection. Conclusions The drug resistance genes of the 45 strains of LRCoNS are mainly mutations in the V functional region of 23S rRNA gene and cfr gene, with high bacterial species homology. Age > 60 years, coexisting malignant tumors, and history of linezolid use are independent risk factors for LRCoNS infection. [ABSTRACT FROM AUTHOR]

Introduction Since coronavirus disease 2019 (COVID-19) has limited treatment options, concern has been raised over secondary infections and antimicrobial resistance (AMR) patterns. It has been observed that patients who were infected with COVID-19 were predisposed to develop secondary infections. The purpose of the study is to ascertain the prevalence of the bacterial and fungal coinfections in COVID-19 patients, and also to assess the AMR patterns in the obtained isolates. Methods We have studied 200 clinical samples obtained from 122 COVID-19 positive patients. Pathogens were identified using Vitek 2 system. The demographic and clinical patterns were also observed. Results A total of 122 patients developed secondary infections. Patients aged more than 40 years were majorly affected (p -value < 0.0001). Respiratory samples (n = 96) were predominant. Klebsiella pneumoniae (n = 68) was the most common pathogen isolated followed by Acinetobacter baumannii (n = 54) and an overall 6% rise in the Carbapenem resistance was observed in the isolates. Conclusion To contain the secondary infections in COVID-19 patients, it is imperative to adhere to antimicrobial stewardship program and timely revise the empirical antibiotic policy. [ABSTRACT FROM AUTHOR]

We report the case of a 69-year-old female who underwent a Baerveldt implant placement for severe-stage primary open-angle glaucoma and developed a bacterial infection of the conjunctiva and abscess of the scleral patch graft with subsequent tube exposure. The infection was identified 3 weeks postoperatively and a topical antibiotic was immediately initiated. A concurrent systemic staphylococcal infection was discovered by an outside physician and oral cephalexin was initiated. Despite antibiotic treatment, the conjunctival erosion progressed, and tube revision was required. Culture of the abscess revealed coagulase-negative Staphylococcus. As alluded to above, the patient also had multiple abscesses on the skin that cultured positive for Staphylococcus aureus. To our knowledge, this is the first case in the literature of coagulase-negative Staphylococcus causing an early postoperative abscess of the scleral patch graft following glaucoma drainage device placement.

Background: Coagulase-negative staphylococci (CoNS) are biofilm-producing pathogens whose role in periprosthetic joint infection (PJI) is increasing. There is little data on the prognosis and treatment considerations in the setting of PJI. We sought to evaluate the clinical characteristics, outcomes, and complications in these patients.Methods: This is a retrospective cohort study of adult patients at a single tertiary medical center from 2009 to 2020 with culture-proven CoNS PJI after total knee arthroplasty, as diagnosed by Musculoskeletal Infection Society criteria. The primary outcome was treatment success, with failure defined as recurrent CoNS PJI, recurrent PJI with a new pathogen, and/or chronic oral antibiotic suppression at one year postoperatively.Results: We identified 55 patients with a CoNS total knee arthroplasty PJI with a mean follow-up of 29.8 months (SD: 16.3 months). The most commonly isolated organism was Staphylococcus epidermidis (n = 36, 65.5%). The overall prevalence of methicillin resistance was 63%. Surgical treatment included surgical debridement, antibiotics, and implant retention in 25 (45.5%) cases and two-stage revision (22 articulating and eight static antibiotic-impregnated spacers). At one-year follow-up, only 47% of patients had successful management of their infection. The surgical debridement, antibiotics, and implant retention cohort had the higher rate of treatment failure (60.0%) compared to two-stage revision (46.7%).Conclusion: These results indicate a poor rate of success in treating CoNS PJI. This likely represents the interplay of inherent virulence through biofilm formation and decreased antibiotic efficacy. [ABSTRACT FROM AUTHOR]

Introduction Posterior lumbar interbody fusion (PLIF) has been widely used to treat various degenerative spinal diseases. However, surgical site infection (SSI) post-PLIF is often difficult to cure. This study aimed to clarify the difference in clinical course due to the causative organism and develop a treatment strategy for SSI post-PLIF. Methods Between January 2011 and March 2019, 581 PLIF surgeries were performed at our hospital. Deep SSI occurred in 14 patients who were followed up for more than 2 years. Causative bacterial species were diagnosed by preoperative puncture and/or intraoperative drainage or by tissue culture in 13 patients and by intradiscal puncture in one patient who underwent conservative treatment. Of the 13 patients who underwent surgeries for infection, 10 had Propionibacterium acnes (Group A; n = 4) or coagulase-negative Staphylococcus (CNS) (Group B; n = 6) as the causative bacterial species. Groups A and B were retrospectively compared in terms of age, sex, number of segments, presence of diabetes mellitus, operation time, blood loss, C-reactive protein on hematological examination, the elapsed time to diagnosis (ETD), the presence of clinical findings such as heat, redness, swelling, and discharge from the wound and healing time. Results All infections were eradicated with surgery except in one patient whose causative bacteria was CNS; cages were finally removed in 11 patients. There was a significant difference (P = 0.0105) in the ETD and clinical findings (P = 0.0476) between Groups A and B. Posterior one-stage simultaneous revision (POSSR) was performed in nine patients, of whom eight were cured and one required additional surgery. Conclusions The ETD and clinical findings were significantly different in SSI cases caused by different bacteria, which will be useful in predicting the causative bacteria in future cases. For the treatment of deep SSI post-PLIF, POSSR was effective. [ABSTRACT FROM AUTHOR]

Urinary tract infections (UTIs) are one of the microbial infections caused mainly by bacteria, which account for majority of patients' visit to out-patients' clinics. Organisms in the genus Kocuria are emerging pathogens presently associated with UTIs, and are usually misidentified as coagulase-negative staphylococci (CoNS) because they are phenotypically similar. The aim of the study was to characterize bacteria associated with UTIs among out-patients suspected of having UTIs, and screen for Kocuria species, suspected among the isolates. Urine samples were collected aseptically from a total of 267 patients attending out-patients' clinic at Enugu State University of Science and Technology Teaching Hospital, Parklane Enugu. Bacteria were isolated from the urine samples using appropriate microbiological and biochemical techniques. 16S rRNA gene sequencing was finally used to confirm isolates suspected to be Kocuria species as coagulasenegative Staphylococcus. Out of the 267 urine samples, 102 (38.2%) had UTIs. The bacteria mostly associated with the UTIs were Escherichia coli 41 (38.3%), followed by Klebsiella pneumoniae 23 (21.5%), Staphylococcus aureus 17 (15.9%), Coagulase-negative Staphylococcus 12 (11.2%), Enterococcus spp. 9 (8.4%) and Pseudomonas aeruginosa 5 (4.7%). This study showed that urinary tract infections caused by coagulase negative Staphylococcus can be attributed to Kocuria spp., when only phenotypic method of identification is employed. Therefore, genome-based methods such as 16S rRNA gene sequencing should be adopted for more accurate identification of clinical isolates. [ABSTRACT FROM AUTHOR]

Staphylococcus is a major bacterial species that contaminates retail meat products. The objective of this study was to clarify the prevalence, antimicrobial resistance and genetic determinants of Staphylococcus/Mammaliicoccus species in retail ground meat in Japan. From a total of 146 retail ground meat samples (chicken, pork, mixed beef/pork) purchased during a 5-month period, 10 S. aureus and 112 isolates of coagulase-negative staphylococcus (CoNS)/Mammaliicoccus comprising 20 species were recovered. S. aureus isolates were classified into five genetic types, i.e., coa-IIa/ST5, coa-VIc/ST352 (CC97), coa-VIIb/ST398, coa-Xa/ST15, and coa-XIc/ST9, which were all related to those of livestock-associated clones. All the staphylococcal isolates were mecA-negative and mostly susceptible to all the antimicrobials tested, except for ampicillin among S. aureus (resistance proportion; 50%). Among CoNS, the fosfomycin resistance gene fosB was prevalent (30/112; 26.8%), primarily in S. capitis, S. warneri, and S. saprophyticus. Phylogenetic analysis of fosB revealed the presence of seven clusters, showing broad diversity with 65–81% identity among different clusters. In the CoNS isolates from ground meat samples, fosB was assigned into three clusters, and S. saprophyticus harbored the most divergent fosB with three genetic groups. These findings suggested the circulation of multiple fosB-carrying plasmids among some CoNS species. [ABSTRACT FROM AUTHOR]

Abstract Background Exotoxins secreted from Staphylococcus aureus or Streptococcus pyogenes act as superantigens that induce systemic release of inflammatory cytokines and are a common cause of toxic shock syndrome (TSS). However, little is known about TSS caused by coagulase-negative staphylococci (CoNS) and the underlying mechanisms. Here, we present a rare case of TSS caused by Staphylococcus simulans (S. simulans). Case presentation We report the case of a 75-year-old woman who developed pneumococcal pneumonia and bacteremia from S. simulans following an influenza infection. The patient met the clinical criteria for probable TSS, and her symptoms included fever of 39.5 °C, diffuse macular erythroderma, conjunctival congestion, vomiting, diarrhea, liver dysfunction, and disorientation. Therefore, the following treatment was initiated for bacterial pneumonia complicating influenza A with suspected TSS: meropenem (1 g every 8 h), vancomycin (1 g every 12 h), and clindamycin (600 mg every 8 h). Blood cultures taken on the day after admission were positive for CoNS, whereas sputum and pharyngeal cultures grew Streptococcus pneumoniae (Geckler group 4) and methicillin-sensitive S. aureus, respectively. However, exotoxins thought to cause TSS, such as TSS toxin-1 and various enterotoxins, were not detected. The patient’s therapy was switched to cefazolin (2 g every 8 h) and clindamycin (600 mg every 8 h) for 14 days based on microbiologic test results. She developed desquamation of the fingers on hospital day 8 and was diagnosed with TSS. Conventional exotoxins, such as TSST-1, and S. aureus enterotoxins were not detected in culture samples. The serum levels of inflammatory cytokines, such as neopterin and IL-6, were high. CD8+ T cells were activated in peripheral blood. Vβ2+ population activation, which is characteristic for TSST-1, was not observed in the Vβ usage of CD8+ T cells in T cell receptor Vβ repertoire distribution analysis. Conclusions We present a case of S. simulans-induced TSS. Taken together, we speculate that no specific exotoxins are involved in the induction of TSS in this patient. A likely mechanism is uncontrolled cytokine release (i.e., cytokine storm) induced by non-specific immune reactions against CoNS proliferation.

Isolation of coagulase-negative Staphylococci (CoNS) in urine cultures of children is usually considered a contamination of the sample, except for Staphylococcus saprophyticus in older children. The aim of this study was to describe the characteristics of children in whom CoNS was considered a true urinary pathogen. The medical records of all children aged 0 to 18 years at Shaare Zedek Medical Center between 2013 and 2020 who were diagnosed with CoNS urinary tract infection (UTI) were reviewed for demographic, clinical, and laboratory data. CoNS were identified as the causative organism of UTIs in 30 children, none of whom was bacteremic. Male sex, younger age, and infection with non-S. saprophyticus CoNS were associated with higher risk of pyelonephritis in comparison to cystitis. Eleven (37%) children had previously known or newly diagnosed underlying urinary tract abnormalities. All patients recovered. CoNS were found to be an uncommon urinary pathogen among children but can cause pyelonephritis, especially in young children and in males. Conclusion: The finding of CoNS pyelonephritis requires thorough search for urinary abnormalities. What is Known: • Isolation of most CoNS species in urine cultures in children is usually considered contamination of the sample. • Staphylococcus saprophyticus causes cystitis in teenager females. What is New: • CoNS other than S. saprophyticus can cause pyelonephritis, especially in young children and in males. • CoNS pyelonephritis is associated with underlying urinary tract abnormalities. [ABSTRACT FROM AUTHOR]

Abstract Background Coagulase-negative staphylococcus (CoNS) is considered to be the major reservoirs for genes facilitating the evolution of S. aureus as a successful pathogen. The present study aimed to determine the occurrence of genes conferring resistance to fluoroquinolone, determining of the prevalence of insertion sequence elements IS256, IS257 and different superantigens (SAgs) among CoNS isolates obtained from various clinical sources. Materials and methods The current study conducted on a total of the 91 CoNS species recovered from clinical specimens in Hamadan hospitals in western Iran in 2017–2019. The antimicrobial susceptibility testing was performed using disk diffusion method and the presence of the IS256 and IS257, genes conferring resistance to fluoroquinolone and enterotoxins/enterotoxin-like encoding genes were investigated by polymerase chain reaction (PCR) method. Results Among genes encoding classic enterotoxins, sec was the most frequent which was carried by 48.4% of the 91 isolates, followed by seb in 27.5% of the isolates. None of the CoNS isolates was found to be positive to enterotoxin-like encoding genes. In 11(12%) of all isolates that were phenotypically resistant to levofloxacin, 9 isolates (81.8%) were positive for gyrB, 8 isolates (72.7%) were positive for gyrA, 8 isolates (72.7%) harbored grlB and 7 isolates (63.6%) were found to carry grlA. The IS256 and IS257 were identified in 31.8% and 74.7% of the isolates, respectively. The results of statistical analysis showed a significant association between the occurrence of staphylococcal enterotoxins (SEs) encoding genes and antimicrobial resistance. Conclusion Antimicrobial resistant determinants and SEs are co-present in clinical CoNS isolates that confer selective advantage for colonization and survival in hospital settings. The coexistence of insertion elements and antibiotic resistance indicate their role in pathogenesis and infectious diseases.

Background Ear infections encompass otitis media (OM) which is a significant cause of hearing loss and otitis externa (OE) which may affect the surrounding tissues leading to serious complications. This study reports the common pathogens causing ear infections. Methods Microbiological, clinical, and demographic data of ear-infected patients who visited King Fahad Hospital in Al-Baha, Saudi Arabia, during the period from January 2019 to June 2023 were enrolled in this study. Result  This study enrolled 307 patients aged 1-94 years, with a median age of 40 years (IQR=22-57). Overall, the detectable infection rate was 81.1% (n=249), while 18.9% (n=58) had no identified aetiology. Of all isolates, 178 (58%) were bacterial, while 71 (23.1%) were fungal. Staphylococcus aureus ( S. aureus ) followed by Pseudomonas aeruginosa  ( P. aeruginosa ), Enterobacteriaceae , andcoagulase-negative Staphylococcus (CoNS) were the main bacterial isolates. Of the total 63 S. aureus isolates, 21 (33%) were methicillin-resistant (MRSA). A cohort of 227 subjects were diagnosed with either OM (n=178; 79.5%), OE (n=46; 20.5%), or both OM and OE (n=3; 1%). Of those with OM, children constituted 89.1% (41/46) as compared to 75.3% (134/178) of adults (p=0.041). The main isolates from OM patients were S. aureus followed by P. aeruginosa and fungi. Of 49 OE patients, 16 (32.7%) had no identified pathogen, while 15 (30.6%) had fungi, and 13 (29.5%) had P. aeruginosa. Conclusions Ear infections in general were mainly bacterial followed by fungal with a considerable proportion of unidentified aetiology. A significant proportion of S. aureus isolates were MRSA.  S. aureus followed by P. aeruginosa and fungi were the main causes of OM, while fungi followed by P. aeruginosa were the main causes of OE., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Ethics Research Committee (ERC) of the Faculty of Medicine, Al-Baha University issued approval REC/MIC/BU-FM/2023/10R. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Alfahemi et al.)

Mastitis is one of the most common infections worldwide. This infection poses risks to animal and public health. Therefore, determination of mastitis pathogens is important for the prevention of the infection. Generally, the combination of antimicrobials is an effective, reliable and common treatment approach. In this study, it was aimed to determine the bacterial mastitis pathogens in goat's milk and antimicrobial resistance profiles of these pathogens. A total of 190 goat milk samples were examined with standard microbiological analysis in the period of 2018-2019. Bacterial mastitis pathogens were obtained in 33.2% of all samples. Totally, 79 different bacterial agents were isolated due to multiple-bacterial isolation. Major genus was detected as Staphylococcus spp. (66%): coagulase-negative Staphylococcus (CNS) 44% and coagulase-positive Staphylococcus (CPS) 22%. This group was followed by respectively Bacillus spp. (17.6%), catalase-negative cocci (PNC) (14%), Mannheimia spp. (1.2%) and Micrococcus spp. (1.2%). The most prevalent species were identified Staphylococcus caprae (27%), Staphylococcus aureus and Staphylococcus chromogenes (13%), Aerococcus viridans and Bacillus cereus (7.6%). Considering the antimicrobial resistance test, tetracycline has the highest resistance rate (31%) among the tested antimicrobials. A total of 4 multi-drug resistant isolates were found: an Enterococcus faecalis and three Streptococcus uberis isolates. The highest resistance rate (35.7%) was observed for penicillin in all Bacillus spp. isolates. [ABSTRACT FROM AUTHOR]

Background and Objectives: Coagulase-negative staphylococci (CoNS) have emerged as a major pathogen in nosocomial meningitis. This study was designed to describe the clinical profile, laboratory parameters, treatment, and outcomes of CoNS meningitis in patients admitted to Hamad General Hospital, Qatar. Materials and Methods: This retrospective hospital-based study described the patients with CoNS meningitis from 2009 to 2013. Results: Twelve patients were recruited for the study, of which there were 10 (83.3%) males and 2 (16.7%) females with a median age of 39 years (interquartile range [IQR]: 29-46 years). Fever was the most common presenting symptom being present in all patients, followed by mental alterations 7 (58.3%). All CoNS meningitis cases in this study were nosocomially acquired after neurosurgery and in most cases after external ventricular drain (EVD) insertion. The median time between the procedure and acquisition of infection was 13 days (IQR: 10-15.7 days). The isolated species include 8 (66.7%) Staphylococcus epidermidis, 2 (16.7%) Staphylococcus capitis, and 2 (16.7%) Staphylococcus haemolyticus. All CoNS isolates were sensitive to vancomycin while 75% of them were oxacillin resistance. In the eight patients with EVDs, the infected EVDs were removed, while all patients received empirical antibiotics involving mainly vancomycin and ceftriaxone that were modified upon receipt of culture results. All patients were cured, and no mortality was reported. Conclusions: CoNS meningitis is a recognized complication related to the introduction of neurosurgical devices. Because of its nonspecific clinical presentation, treating physicians should have a high suspicion index. If CoNS meningitis is highly suspected, vancomycin is the empirical treatment of choice while awaiting results of sensitivity. [ABSTRACT FROM AUTHOR]

Bed bugs are common urban pests. Unlike many other blood-feeding human ectoparasites, bed bugs are not known to be vectors of human infectious diseases, but clinical and epidemiological studies to directly interrogate this link have been limited. Here, we aimed to determine whether bed bugs were associated with infectious diseases in a set of infested patients presenting to emergency departments (ED) in the greater Cleveland, OH area. We performed a retrospective case-control study involving 332 ED patients with bed bugs and 4,952 control patients, seen from February 1, 2011, through February 1, 2017. Cases and controls were matched by age, sex, and the presenting ED. Additionally, data were adjusted for ≥20 sociodemographic variables, triage data, and comorbidities in multivariable regression analyses. Seventeen laboratory values, ten different ED and inpatient diagnoses, chest radiographs, infectious disease consults, and blood cultures were examined. The odds of bed bug infestation were significantly higher for patients that had positive blood cultures, had blood cultures growing coagulase-negative Staphylococcus, were diagnosed with pneumonia, were diagnosed with cellulitis, received an infectious disease consult, received a chest radiograph, and had higher percentages of eosinophils in the blood (P < .05 for all). Additional investigations are needed to determine whether bed bugs directly contribute to disease by transmitting causative agents, whether bed bug exposure contributes secondarily contributes to infections, or whether these associations are better explained by other environmental and social determinants of health.

Catheter related blood stream infections is a complication in patients with central venous catheter. The aim of this study was to compare vancomycin-heparin-lock and non-heparin, high-dose vancomycin-lock as treatment in patients admitted to palliative home care. With non-heparin, high-dose vancomycin-lock a high concentration of 5 mg/mL vancomycin is attained instead of only 500 ug/mL when dissolved in heparin. The non-heparin method also has the advantage of being easier and cheaper but might entail an increased risk of clotting. Medical records from patients enrolled at a palliative home care unit in Stockholm between 2016 and 2018 were reviewed retrospectively. Three divisions used vancomycin-heparin-lock and the other 3 divisions used non-heparin, high-dose vancomycin-lock. Inclusion criteria were a central venous catheter related blood stream infection treated with one of the two methods for >7 days and a follow-up blood culture at the end of treatment. Twenty-five patients fulfilled the inclusion criteria, 12 treated with vancomycin-heparin-lock and 13 with non-heparin, high-dose vancomycin-lock. There was no significant difference in resolved infections between the two treatments, 6 of 12 for vancomycin-heparin-lock and 10 of 13 for non-heparin, high-dose vancomycin-lock (p =.23). In the non-heparin group one central venous catheter was removed due to clotting although the infection had resolved. Overall, removal of central venous catheter was similar in the two groups (6 of 12 and 4 of 13, p =.43). The current study does not support superiority of one treatment over the other. However, larger, randomized studies are needed, before firm conclusions can be drawn. [ABSTRACT FROM AUTHOR]

Aim To determine the spectrum of causative agent of prosthetic joint infections in orthopaedics. Methods In the group of 50 patients with periprosthetic infection the results of microbiological analysis of minimally two samples gained intraoperatively were analysed. Results The only pathogen in the group of acute infection was Staphylococcus (S.) aureus. In case of delayed infection the most frequent pathogen was also S. aureus and in case of late infection it was coagulase-negative staphylococcus. Conclusion A better understanding of the most common agents responsible for prosthetic joint infection helps us to properly prepare the patient (by eradicating of potential focus) with adequate antibiotic prophylaxis and early treatment of suspected infections to further reduce the incidence of infectious complications in orthopaedics. It is important to bear in mind that patients who have undergone total joint replacement have a risk of infection for the rest of their lives.

Introduction: The study sought to characterise antimicrobial resistance among coagulase-negative Staphylococcus (CNS) species recovered from broiler chickens and turkeys in Poland including the presence of 12 antimicrobial resistance genes and five classical genes of staphylococcal enterotoxins. Material and Methods: A panel of 11 antimicrobial disks evaluated the phenotypic sensitivity of the tested strains to antibiotics. Five multiplex PCR assays were performed using primer pairs for specific detection of antibiotic resistance genes and staphylococcal enterotoxin A to E genes. Results: Selected antimicrobial agent susceptibility testing revealed 100% of such in in vitro conditions to cefoxitin among strains of Staphylococcus sciuri and S. chromogenes. The blaZ (for ß-lactam) and mecA (for methicillin resistance) genes were in 58.3% and 27.5% of strains, respectively. Among genes resistant to tetracyclines, tetK was most frequent. Fewer (CNS) strains showed genes resistant to macrolides, lincosamides, and florfenicol/chloramphenicol. Multiplex PCR for classical enterotoxins (A-E) detected the see gene in two S. hominis strains, while the seb gene producing enterotoxin B was found in one strain of S. epidermidis. Conclusion: CNS strains of Staphylococcus isolated from poultry were either phenotypically or genotypically multidrug resistant. Testing for the presence of the five classical enterotoxin genes showed that CNS strains, as in the case of S. aureus strains, can be a source of food intoxications.

Introduction: Staphylococcal infections can cause significant morbidity in patients undergoing dialysis. This study evaluated the effects of HIV infection on nasal carriage of Staphylococcus aureus, staphylococcal peritonitis, and catheter infection rates in patients with end-stage renal failure managed with continuous ambulatory peritoneal dialysis (CAPD). Methods: Sixty HIV-positive and 59 HIV-negative CAPD patients were enrolled and followed up for up to 18 months. S. aureus nasal carriage (detected by nasal swab culture), Staphylococcal peritonitis (diagnosed by clinical presentation, and CAPD effluent Staphylococcal culture and white blood cell count ≥100 cells/µL), and catheter infections (including exit site and tunnel infections) were assessed monthly. Results: At 18 months, S. aureus nasal carriage rates were 43.3% and 30.5% (p = 0.147) and the methicillin-resistant S. aureus (MRSA) nasal carriage rates were 31.7% and 13.6% (p = 0.018) for the HIV-positive and HIV-negative cohorts, respectively. The HIV-positive cohort was associated with increased hazards for staphylococcal peritonitis, (adjusted hazard ratio [AHR] 2.85, 95% confidence interval [CI] 1.19–6.84, p = 0.019) due to increased coagulase-negative staphylococcal (CNS) peritonitis rate in the HIV-positive cohort compared with the HIV-negative cohort (0.435 vs. 0.089 episodes/person-years; AHR 7.64, CI 2.18–26.82, p = 0.001). On multivariable analysis, CD4+ cell count

The spread of methicillin resistance and virulence among staphylococci in the community poses a public health concern. In this study, we investigated the prevalence of Staphylococcus species colonizing the oral cavity and hand (skin) of healthy university students and their phenotypic and genetic characteristics in northern Japan. Among a total of 332 subjects, 6 and 110 methicillin-resistant and susceptible Staphylococcus aureus (MRSA and MSSA, respectively) isolates were recovered from 105 subjects. MRSA isolates were genotyped as CC5, CC8, CC45, and CC59 with SCCmec-IIa or IV, among which an isolate of ST6562 (single-locus variant of ST8) harbored SCCmec-IVa, PVL genes and ACME-I, which are the same traits as the USA300 clone. ST1223 S. argenteus was isolated from the oral cavity and hand of a single student. Coagulase-negative Staphylococcus (CoNS) was recovered from 154 subjects (172 isolates), and classified into 17 species, with S. capitis being the most common (38%), followed by S. warneri (24%) and S. epidermidis (15%), including nine mecA-positive isolates. S. capitis was differentiated into seven clusters/subclusters, and genetic factors associated with the NRCS-A clone (nsr, tarJ, ebh) were detected in 10–21% of isolates. The colonization of the USA300-like MRSA variant and S. capitis with the traits of the NRCS-A clone in healthy individuals was noteworthy.

Mastitis is one of the most important illnesses in specialized dairy herds worldwide due to the effects on production and animal health. The types caused by CNS has a special importance in a production where the main pathogens are controlled. The objective of the present work is to determine the prevalence of CNS in a dairy herd in Boyacá and also quantify the effects of every species of CNS in SCC. 40 cows were selected and sampled during 6 months, CMT was performed, and results from 1 to trace were sampled. The routine bacteriological test was also performed for CNS identification, and the isolating of CNS was performed through rpoB gene identification and through the type of strain using the pulse gel electrophoresis procedure. Out of 960 samples, 619 were positive for CNS growth. The most prevalent species were Staphylococcus epidermidis, S. chromogenes, S. sciuri, S. simulans, S. haemolyticus and S. capitis. The results that were found here are similar to the results observed in different parts of the world, which confirms that they are pathogens that must be constantly evaluated because they can go unnoticed in routine controls, especially in those farms where major pathogens are not a serious problem. The results determined in this study demonstrate that CNS generates a slight increase in somatic cells. [ABSTRACT FROM AUTHOR]

Staphylococcus haemolyticus is a rare cause of bacterial meningitis and most commonly occurs as a nosocomial infection in patients’ post-neurosurgery. We report a patient post-allogenic stem cell transplant, with no prior history of neurosurgical procedures, who developed S. haemolyticus meningitis and bacteremia following central catheter-related bloodstream infection. The patient failed therapy with vancomycin and daptomycin but was successfully treated with a prolonged course of linezolid. We review the pharmacological management of coagulase negative Staphylococcus (CoNS) meningitis, with a focus on the pharmacokinetic properties of vancomycin, daptomycin and linezolid within the cerebrospinal fluid (CSF).

Staphylococcus is a major bacterial species that contaminates retail meat products. The objective of this study was to clarify the prevalence, antimicrobial resistance and genetic determinants of Staphylococcus/Mammaliicoccus species in retail ground meat in Japan. From a total of 146 retail ground meat samples (chicken, pork, mixed beef/pork) purchased during a 5-month period, 10 S. aureus and 112 isolates of coagulase-negative staphylococcus (CoNS)/Mammaliicoccus comprising 20 species were recovered. S. aureus isolates were classified into five genetic types, i.e., coa-IIa/ST5, coa-VIc/ST352 (CC97), coa-VIIb/ST398, coa-Xa/ST15, and coa-XIc/ST9, which were all related to those of livestock-associated clones. All the staphylococcal isolates were mecA-negative and mostly susceptible to all the antimicrobials tested, except for ampicillin among S. aureus (resistance proportion; 50%). Among CoNS, the fosfomycin resistance gene fosB was prevalent (30/112; 26.8%), primarily in S. capitis, S. warneri, and S. saprophyticus. Phylogenetic analysis of fosB revealed the presence of seven clusters, showing broad diversity with 65–81% identity among different clusters. In the CoNS isolates from ground meat samples, fosB was assigned into three clusters, and S. saprophyticus harbored the most divergent fosB with three genetic groups. These findings suggested the circulation of multiple fosB-carrying plasmids among some CoNS species.

Background: Exotoxins secreted from Staphylococcus aureus or Streptococcus pyogenes act as superantigens that induce systemic release of inflammatory cytokines and are a common cause of toxic shock syndrome (TSS). However, little is known about TSS caused by coagulase-negative staphylococci (CoNS) and the underlying mechanisms. Here, we present a rare case of TSS caused by Staphylococcus simulans (S. simulans).Case Presentation: We report the case of a 75-year-old woman who developed pneumococcal pneumonia and bacteremia from S. simulans following an influenza infection. The patient met the clinical criteria for probable TSS, and her symptoms included fever of 39.5 °C, diffuse macular erythroderma, conjunctival congestion, vomiting, diarrhea, liver dysfunction, and disorientation. Therefore, the following treatment was initiated for bacterial pneumonia complicating influenza A with suspected TSS: meropenem (1 g every 8 h), vancomycin (1 g every 12 h), and clindamycin (600 mg every 8 h). Blood cultures taken on the day after admission were positive for CoNS, whereas sputum and pharyngeal cultures grew Streptococcus pneumoniae (Geckler group 4) and methicillin-sensitive S. aureus, respectively. However, exotoxins thought to cause TSS, such as TSS toxin-1 and various enterotoxins, were not detected. The patient's therapy was switched to cefazolin (2 g every 8 h) and clindamycin (600 mg every 8 h) for 14 days based on microbiologic test results. She developed desquamation of the fingers on hospital day 8 and was diagnosed with TSS. Conventional exotoxins, such as TSST-1, and S. aureus enterotoxins were not detected in culture samples. The serum levels of inflammatory cytokines, such as neopterin and IL-6, were high. CD8+ T cells were activated in peripheral blood. Vβ2+ population activation, which is characteristic for TSST-1, was not observed in the Vβ usage of CD8+ T cells in T cell receptor Vβ repertoire distribution analysis.Conclusions: We present a case of S. simulans-induced TSS. Taken together, we speculate that no specific exotoxins are involved in the induction of TSS in this patient. A likely mechanism is uncontrolled cytokine release (i.e., cytokine storm) induced by non-specific immune reactions against CoNS proliferation. [ABSTRACT FROM AUTHOR]

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Background Intravenous fluid therapy, including peripheral parenteral nutrition (PPN), administered via a peripheral intravenous catheter (PVC) can occasionally lead to bloodstream infections (BSIs). PPN may thus be a risk factor for PVC-related BSI (PVC-BSI). However, the risk factors and incidence of PVC-BSI have not been previously reported, and evidence for these conditions remains unclear. Methods We retrospectively collected data from 391 patients who underwent PPN therapy with PVC at the Fukujuji Hospital from August 2022 to November 2023. We compared 20 patients who developed BSI during PPN therapy (BSI group) with 371 who did not develop BSI during PPN therapy (no-infection group). Results The incidence rate of PVC-BSI during PPN therapy was 5.1%. The BSI group had a significantly longer average daily infusion time of PPNs (median 24.0 [range 6.0-24.0] h vs. 6.0 [2.0-24.0] h, p<0.001) and of all intravenous fluids (median 24.0 [range 8.8-24.0] h vs. 10.3 [2.0-24.0] h, p<0.001) than the no infection group. An average daily infusion time of PPNs ≥12.0 h and an average daily infusion time of intravenous fluids ≥18.0 h were identified as predictive risk factors for BSI. When both risk factors were present, the sensitivity, specificity, and odds ratio for the development of BSI were 85.0%, 83.2%, and 27.9, respectively. Conclusion This study identified the incidence of and risk factors for developing BSI, such as a longer average daily infusion time of PPNs and all intravenous fluids, in patients receiving PPN therapy.

Abstract INTRODUCTION: Contaminated hospital environments contribute to the transmission of microorganisms associated with healthcare. Contaminated surfaces handled by patients or healthcare professionals are a source of microorganism transmission by hand. Methicillin-resistant Staphylococcus bacteria are among the main agents responsible for increasing healthcare-associated infections in Brazil and worldwide. METHODS: The objective of this study was to screen and characterize methicillin-resistant Staphylococcus spp. on surfaces near patients in an intensive care unit. Microbiological samples, collected from ten beds in an intensive care unit with five sampling sites, were inoculated into a methicillin-resistant Staphylococcus aureus chromogenic medium. MALDI-TOF and PCR analyses were used to identify the bacteria. Antimicrobial susceptibility was determined using the disk diffusion test. The presence of the mecA gene was investigated using PCR. RESULTS: We observed that 44 out of the 50 sampling sites presented grown isolates in the methicillin-resistant Staphylococcus aureus medium. The incidence of isolated microorganisms on the right side rail, left side rail, tables, infusion pump keypad, and cardiac monitor were 18.8 %, 36.7 %, 10.9 %, 2.4 %, and 31 %, respectively. The 42 isolates included in this study were identified as coagulase-negative Staphylococcus. All of these microorganisms were multidrug-resistant and mecA gene-positive. CONCLUSIONS: This study identified the presence of methicillin-resistant coagulase-negative Staphylococcus on the beds of an intensive care unit, providing evidence for the necessity of assertive actions to decrease the risk of healthcare-associated infections at the site.

Coagulase-negative staphylococci are commensals that are known to be prevalent in most environments, and they are also an important reservoir of antimicrobial-resistant genes. Staphylococcal infections in animal husbandry are a high economic burden. Thus, we aimed to determine the prevalence and species diversity of methicillin-resistant coagulase-negative staphylococci (MRCoNS) in poultry slaughtered for human consumption and to study the antimicrobial resistance of the isolates. Swab samples were recovered from 220 commercial chickens, homebred chickens and quails. Species identification was performed using MALDI-TOF. Antimicrobial susceptibility testing was performed by the disc diffusion method against 14 antimicrobials. The presence of antimicrobial-resistant genes was investigated by polymerase chain reaction. Totals of 11 (19.6%), 13 (20.3%), and 51 (51%) MRCoNS were isolated from commercial chickens, homebred chickens and quails, respectively. S. lentus was isolated from all homebred chickens, whereas 11 S. lentus and 2 S. urealyticus were isolated from commercial chickens. As for quails, the most prevalent MRCoNS were S. urealyticus. Almost all isolates had a multidrug-resistant profile and carried the mecA gene. Most isolates showed resistance to erythromycin, clindamycin, penicillin, tetracycline, ciprofloxacin and fusidic acid and harbored the ermA, ermB, ermC, mphC tetK, tetL, tetM and tetO genes. This study showed a frequent occurrence of multidrug resistance in MRCoNS isolated from healthy poultry in Portugal.

Abstract Background Staphylococcus epidermidis can cause nosocomial meningitis in the presence of prosthetic devices. We describe a case of Staphylococcus epidermidis meningitis in a patient with neutropenia who had no intracranial foreign body, and we review the literature on meningitis that is caused by coagulase-negative Staphylococcus spp. without a neurosurgical device. Case presentation A 47-year-old Japanese man with acute myeloid leukemia receiving chemotherapy through a totally implantable central venous catheter developed fever and headache. The patient had a history of craniotomy for anaplastic oligodendroglioma without an indwelling neurosurgical device. The results of two blood cultures and a cerebrospinal fluid culture were positive for Staphylococcus epidermidis. Clinical improvement was observed with treatment with vancomycin and removal of the central venous catheter despite prolonged neutropenia. Conclusions To the best of our knowledge, this is the first reported case of Staphylococcus epidermidis meningitis in a patient with neutropenia without a neurosurgical device who was successfully treated.

Shoulder periprosthetic infections are predominantly caused by bacteria residing in the skin of healthy individuals. Knowledge of the factors associated with the loads of the different cutaneous bacteria in individuals having shoulder arthroplasty may help identify patients at higher risk of periprosthetic infection and help guide preventive measures. For this reason, we tested the hypothesis that easy-to-obtain preoperative characteristics were significantly associated with the cutaneous microbiology and the loads of specific bacteria in shoulders having joint replacement. This study identified the microbiology of the unprepared epidermal skin surface and of the dermal edge freshly incised at surgery in 332 patients having primary shoulder arthroplasty. The load of bacteria in each sample was characterized as a value based on the laboratory report: 0 for "no growth"; 0.1 for "one colony only" or for "broth only"; and 1, 2, 3, and 4 for 1+, 2+, 3+, and 4+ growth, respectively. The relationships between preoperative patient characteristics and these semiquantitative results of the cutaneous cultures were analyzed. Cultures of the unprepared epidermal skin surface showed positive results for a wide variety of organisms, including Cutibacterium in 72%, coagulase-negative Staphylococcus in 61%, and a spectrum of other organisms in 32%. By contrast, cultures of the freshly incised dermal edge showed a great preponderance of Cutibacterium (34%) in comparison to low levels of coagulase-negative Staphylococcus (8%) and other organisms (2%). An increased dermal load of Cutibacterium was significantly associated with male sex, younger patient age, American Society of Anesthesiologists class 1, use of testosterone supplements, prior shoulder surgery, and higher Cutibacterium loads on the unprepared skin surface. Although the microbiology of the unprepared skin surface is diverse, the same is not true for the freshly incised dermis, where Cutibacterium is the predominant organism. Readily available preoperative patient characteristics are significantly associated with the load of Cutibacterium in the incised dermis. Preoperative cultures of the unprepared skin surface appear to be a new method for predicting the type and load of bacteria found in the freshly incised dermis at the time of surgery. Additional studies are needed to determine whether preoperative cultures of the unprepared epidermal skin surface can provide a method for identifying patients at increased risk of shoulder periprosthetic infections. [ABSTRACT FROM AUTHOR]

Detection of coagulase-negative Staphylococcus in blood culture may be a result of either bacteremia or contamination. This often leads to diagnostic uncertainly. Our objective was to develop a method for differentiating whether a coagulase-negative Staphylococcus sp. positive blood culture represents bacteremia or contamination based on positive bottle detection pattern and time to positivity (TTP). This study included 155 and 51 adults with positive blood cultures for Staphylococcus epidermidis and Staphylococcus hominis , respectively, over a three-year period from 2016 to 2018. Positive blood culture cases were categorized as either bacteremia or contamination based on the clinically available information, and the detection pattern and TTP in each category were investigated. A total of 57, 92, and 6 S. epidermidis positive blood cultures were categorized as bacteremia, contamination, and undetermined, respectively, whereas 15 and 36 S. hominis positive blood cultures were categorized as bacteremia and contamination, respectively. For positive blood cultures categorized as bacteremia, all four bottles in two sets of blood cultures were positive in 47/47 S. epidermidis and 14/14 S. hominis, respectively, whereas either one bottle in each of two sets or three bottles in two sets were positive in 10/19 S. epidermidis and 1/4 S. hominis, respectively; most of those TTPs were <48 h. Among them, the TTP in catheter-related blood stream infection was <24 h. Although clinical assessment is crucial to differentiate between bacteremia and contamination, a combination of positive bottle detection pattern and TTP is a valuable diagnostic auxiliary tool. [ABSTRACT FROM AUTHOR]