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Coagulase-negative staphylococci are associated to the mild inflammatory pattern of healthcare-associated meningitis: a retrospective study

  • S. Couffin
  • D. Lobo
  • F. Cook
  • P. H. Jost
  • V. Bitot
  • R. Birnbaum
  • B. Nebbad
  • B. Aït-Mamar
  • W. Lahiani
  • M. Martin
  • G. Dhonneur
  • R. Mounier
Original Article

Abstract

The epidemiology of healthcare-associated meningitis (HAM) is dominated by commensal bacteria from the skin, as coagulase-negative staphylococci (CoNS). We hypothesized that the pauci-symptomatic and mild inflammatory patterns of HAM are related to the low pathogenic state of CoNS. Our aim was to describe clinical and biological features of CoNS HAM, compared to other HAM. All consecutive patients with HAM admitted in our hospital were retrospectively included from 2007 to 2014. HAM due to CoNS were compared to HAM caused by other bacteria (controls) for clinical and laboratory patterns. Seventy-one cases of HAM were included, comprising 18 CoNS and 53 controls. Patients were not different in terms of baseline characteristics. CoNS HAM occurred later after the last surgery than controls (17 vs. 12 days, p = 0.029) and had higher Glasgow Coma Scale (GCS) score (14 vs. 13, p = 0.038). Cerebrospinal fluid (CSF) analysis revealed a lower pleocytosis (25 vs. 1340/mm3, p < 0.001), a higher glucose level (3.75 vs. 0.8 mmol/L, p < 0.001), and a lower protein level (744 vs. 1751 mg/L, p < 0.001) in the CoNS group than in the control group, respectively. HAM due to CoNS was significantly less symptomatic and less inflammatory than HAM due to other bacteria.

Notes

Source of funding

None.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the local ethical committee. All procedures were in accordance with the ethical standards of the national research committee and with the 1964 Helsinki declaration and its later amendments. For this type of study (retrospective), formal consent is not required.

References

  1. 1.
    van de Beek D, Drake JM, Tunkel AR (2010) Nosocomial bacterial meningitis. N Engl J Med 362(2):146–154CrossRefPubMedGoogle Scholar
  2. 2.
    Horan TC, Andrus M, Dudeck MA (2008) CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 36(5):309–332CrossRefPubMedGoogle Scholar
  3. 3.
    Mayhall CG, Archer NH, Lamb VA, Spadora AC, Baggett JW, Ward JD et al (1984) Ventriculostomy-related infections. A prospective epidemiologic study. N Engl J Med 310(9):553–559CrossRefPubMedGoogle Scholar
  4. 4.
    Conen A, Walti LN, Merlo A, Fluckiger U, Battegay M, Trampuz A (2008) Characteristics and treatment outcome of cerebrospinal fluid shunt-associated infections in adults: a retrospective analysis over an 11-year period. Clin Infect Dis 47(1):73–82CrossRefPubMedGoogle Scholar
  5. 5.
    Mounier R, Lobo D, Cook F, Fratani A, Attias A, Martin M et al (2015) Clinical, biological, and microbiological pattern associated with ventriculostomy-related infection: a retrospective longitudinal study. Acta Neurochir 157(12):2209–2217CrossRefPubMedGoogle Scholar
  6. 6.
    Muttaiyah S, Ritchie S, Upton A, Roberts S (2008) Clinical parameters do not predict infection in patients with external ventricular drains: a retrospective observational study of daily cerebrospinal fluid analysis. J Med Microbiol 57:207–209CrossRefPubMedGoogle Scholar
  7. 7.
    Walti LN, Conen A, Coward J, Jost GF, Trampuz A (2013) Characteristics of infections associated with external ventricular drains of cerebrospinal fluid. J Infect 66(5):424–431CrossRefPubMedGoogle Scholar
  8. 8.
    Schade RP, Schinkel J, Roelandse FW, Geskus RB, Visser LG, van Dijk MC et al (2006) Lack of value of routine analysis of cerebrospinal fluid for prediction and diagnosis of external drainage-related bacterial meningitis. J Neurosurg 104(1):101–108CrossRefPubMedGoogle Scholar
  9. 9.
    Pfisterer W, Mühlbauer M, Czech T, Reinprecht A (2003) Early diagnosis of external ventricular drainage infection: results of a prospective study. J Neurol Neurosurg Psychiatry 74(7):929–932CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Tunkel AR, Hasbun R, Bhimraj A, Byers K, Kaplan SL, Michael Scheld W et al (2017) 2017 Infectious Diseases Society of America’s clinical practice guidelines for healthcare-associated ventriculitis and meningitis. Clin Infect Dis 64:e34–e65.  https://doi.org/10.1093/cid/ciw861
  11. 11.
    Otto M (2009) Staphylococcus epidermidis—the ‘accidental’ pathogen. Nat Rev Microbiol 7(8):555–567CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Becker K, Heilmann C, Peters G (2014) Coagulase-negative staphylococci. Clin Microbiol Rev 27(4):870–926CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Lozier AP, Sciacca RR, Romagnoli MF, Connolly ES Jr (2002) Ventriculostomy-related infections: a critical review of the literature. Neurosurgery 51(1):170–182CrossRefPubMedGoogle Scholar
  14. 14.
    Williamson RA, Phillips-Bute BG, McDonagh DL, Gray MC, Zomorodi AR, Olson DM et al (2014) Predictors of extraventricular drain-associated bacterial ventriculitis. J Crit Care 29(1):77–82CrossRefPubMedGoogle Scholar
  15. 15.
    Korinek A-M, Fulla-Oller L, Boch AL, Golmard JL, Hadiji B, Puybasset L (2011) Morbidity of ventricular cerebrospinal fluid shunt surgery in adults: an 8-year study. Neurosurgery 68(4):985–995CrossRefPubMedGoogle Scholar
  16. 16.
    Korinek A-M, Baugnon T, Golmard JL, van Effenterre R, Coriat P, Puybasset L (2006) Risk factors for adult nosocomial meningitis after craniotomy: role of antibiotic prophylaxis. Neurosurgery 59(1):126–133CrossRefGoogle Scholar
  17. 17.
    Scheithauer S, Bürgel U, Ryang YM, Haase G, Schiefer J, Koch S et al (2009) Prospective surveillance of drain associated meningitis/ventriculitis in a neurosurgery and neurological intensive care unit. J Neurol Neurosurg Psychiatry 80(12):1381–1385CrossRefPubMedGoogle Scholar
  18. 18.
    Huang C-R, Lu C-H, Wu J-J, Chang H-W, Chien C-C, Lei C-B et al (2005) Coagulase-negative staphylococcal meningitis in adults: clinical characteristics and therapeutic outcomes. Infection 33(2):56–60CrossRefPubMedGoogle Scholar
  19. 19.
    Chang W-N, Lu C-H, Huang C-R, Chuang Y-C, Tsai N-W, Chen S-F et al (2007) Epidemiology of adult staphylococcal meningitis in southern Taiwan: a clinical comparison of Staphylococcus aureus infection and coagulase-negative staphylococcal infection. Jpn J Infect Dis 60(2):262–266PubMedGoogle Scholar
  20. 20.
    Khatib R, Riederer KM, Clark JA, Khatib S, Briski LE, Wilson FM (1995) Coagulase-negative staphylococci in multiple blood cultures: strain relatedness and determinants of same-strain bacteremia. J Clin Microbiol 33(4):816–820PubMedPubMedCentralGoogle Scholar
  21. 21.
    Société Française d’Anesthésie et de Réanimation (2011) Antibioprophylaxis in surgery and interventional medicine (adult patients). Actualization 2010. Ann Fr Anesth Reanim 30(2):168–190CrossRefGoogle Scholar
  22. 22.
    van de Beek D, de Gans J, Spanjaard L, Weisfelt M, Reitsma JB, Vermeulen M (2004) Clinical features and prognostic factors in adults with bacterial meningitis. N Engl J Med 351(18):1849–1859CrossRefPubMedGoogle Scholar
  23. 23.
    Bijlsma MW, Brouwer MC, Kasanmoentalib ES, Kloek AT, Lucas MJ, Tanck MW et al (2016) Community-acquired bacterial meningitis in adults in the Netherlands, 2006–14: a prospective cohort study. Lancet Infect Dis 16(3):339–347CrossRefPubMedGoogle Scholar
  24. 24.
    von Eiff C, Peters G, Heilmann C (2002) Pathogenesis of infections due to coagulase-negative staphylococci. Lancet Infect Dis 2(11):677–685CrossRefGoogle Scholar
  25. 25.
    Vuong C, Dürr M, Carmody AB, Peschel A, Klebanoff SJ, Otto M (2004) Regulated expression of pathogen-associated molecular pattern molecules in Staphylococcus epidermidis: quorum-sensing determines pro-inflammatory capacity and production of phenol-soluble modulins. Cell Microbiol 6(8):753–759CrossRefPubMedGoogle Scholar
  26. 26.
    Braxton EE, Ehrlich GD, Hall-Stoodley L, Stoodley P, Veeh R, Fux C et al (2005) Role of biofilms in neurosurgical device-related infections. Neurosurg Rev 28(4):249–255CrossRefPubMedGoogle Scholar
  27. 27.
    Rogers KL, Fey PD, Rupp ME (2009) Coagulase-negative staphylococcal infections. Infect Dis Clin North Am 23(1):73–98CrossRefPubMedGoogle Scholar
  28. 28.
    Costerton JW, Stewart PS, Greenberg EP (1999) Bacterial biofilms: a common cause of persistent infections. Science 284(5418):1318–1322CrossRefPubMedGoogle Scholar
  29. 29.
    Mounier R, Lobo D, Cook F, Martin M, Attias A, Aït-Mamar B et al (2015) From the skin to the brain: pathophysiology of colonization and infection of external ventricular drain, a prospective observational study. PLoS One 10(11):e0142320.  https://doi.org/10.1371/journal.pone.0142320
  30. 30.
    Mounier R, Kapandji N, Birnbaum R, Cook F, Rodriguez C, Nebbad B et al (2016) Biofilm-associated infection: the hidden face of cerebrospinal fluid shunt malfunction. Acta Neurochir 158(12):2321–2324CrossRefPubMedGoogle Scholar
  31. 31.
    Widerström M, Wiström J, Sjöstedt A, Monsen T (2012) Coagulase-negative staphylococci: update on the molecular epidemiology and clinical presentation, with a focus on Staphylococcus epidermidis and Staphylococcus saprophyticus. Eur J Clin Microbiol Infect Dis 31(1):7–20CrossRefPubMedGoogle Scholar
  32. 32.
    Ziebuhr W, Dietrich K, Trautmann M, Wilhelm M (2000) Chromosomal rearrangements affecting biofilm production and antibiotic resistance in a Staphylococcus epidermidis strain causing shunt-associated ventriculitis. Int J Med Microbiol 290(1):115–120CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Anaesthesia and Surgical Intensive CareHenri Mondor University Hospital of Paris, Paris XII School of MedicineCréteilFrance
  2. 2.Department of MicrobiologyHenri Mondor University Hospital of Paris, Paris XII School of MedicineCréteilFrance
  3. 3.Department of NeurosurgeryHenri Mondor University Hospital of Paris, Paris XII School of MedicineCréteilFrance

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