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Updated: Jan 21 2019

Staphylococcus epidermidis

Images
https://upload.medbullets.com/topic/104027/images/urine catheter.jpg
  • 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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