Updated: 1/21/2019

Staphylococcus epidermidis

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Snapshot
  • A 65-year-old man presents to the emergency department with a headache, nausea, and altered mental status. His symptoms developed a few days ago and have since worsened. He was recently diagnosed with normal-pressure hydrocephalus and had placement of a ventriculoperitoneal shunt. Physical examination is notable for diffuse abdominal pain. Direct aspiration of the cerebral spinal fluid shunt is obtained, and CSF analysis demonstrates a leukocytosis, elevated protein, and decreased glucose. CSF Gram stain demonstrates gram-positive cocci in clusters. CSF cultures are pending. Preparations are made for removal of the shunt and he is started on vancomycin and ceftazidime.
Introduction
  • Classification
    • gram-positive, catalase-positive, coagulase-negative, urease-positive cocci in clusters
      • novobiocin sensitive
  • Reservoir
    • component of normal skin flora
      • commonly a contaminant
  • Pathogenesis
    • adhesion of the microorganism to the device, leading to colonization
      • extracellular polysaccharide allows for the formation of a protective biofilm on the device
        • the biofilm serves as a barrier that protects the bacteria from antibiotics and host defense mechanisms
  • Associated conditions
    • device-associated and healthcare-associated infections
      • e.g., hip implant, heart valve, ventriculoperitoneal shunt, and intravenous catheters
Presentation
  • Symptoms/physical exam
    • local signs of infection (e.g., erythema, purulent discharge, and swelling)
    • fever
    • pain at the device site
Treatment
  • Conservative
    • source control
      • indication
        • part of the initial management of device-associated infection
      • examples
        • incision and drainage
        • removal of the infected prosthetic device
  • Medical
    • empiric antibiotic therapy
      • indication
        • part of the initial management of device-associated infection
      • examples
        • vancomycin
      • comments
        • antibiotics are narrowed once the organism is isolated and susceptibility testing is performed
Complications
  • Sepsis
  • Prosthetic valve endocarditis
  • Meningitis
  • Exit site signs of infections
    • purulent drainage
    • erythema and swelling
 
 

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