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Staphylococcus lugdunensis: a neglected pathogen of infections involving fracture-fixation devices

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Abstract

Purpose

Cases of fracture-fixation device infection involving Staphylococcus lugdunensis are not frequent. The clinical characteristics and the choice of treatment strategies of these infections are not obviously known to date.

Methods

We performed a review of fracture-fixation device infection involving S. lugdunensis managed by our centres.

Results

Among the 38 cases of fracture-fixation device infection involving S. lugdunensis, 53% were located in the tibia. Most of our cases (87%) were chronic infections. Purulent discharge, which occurred in 79% of cases, was the most frequent clinical symptom, followed by pain in 63%, local inflammation in 55%, and fever in 37%. Bacteremia and severe sepsis occurred in 10% and 18% of cases, respectively. Four cases (10%) were treated exclusively with antimicrobial treatment alone. Thirty-four cases (89%) were treated with a combination of surgery with antimicrobial therapy including surgical debridement, antibiotics and osteosynthesis device retention in six cases (16%), and osteosynthesis device removal in 27 cases (71%). The mean length of antibiotic treatment was 119 days. The relapse rate was high that was not related to selection of resistant strains. Polymicrobial infection had no impact on clinical outcome. A combination of surgery with antimicrobial therapy was identified as a significant prognostic factor associated with remission (p = 0.042).

Conclusions

S. lugdunensis is probably involved in more infections than has been reported. Using appropriate microbiological methods laboratories should routinely identify the species of all coagulase-negative Staphylococci isolates involved in fracture-fixation device infection to better achieve the treatment strategies of fracture-fixation device infection involving S. lugdunensis.

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Acknowledgements

The authors would like to thank Catherine Peruffo for their helpfulness in this study.

Author information

Authors and Affiliations

  1. 19–21 Boulevard Jean Moulin, Marseille, 13005, France

    Piseth Seng & Andreas Stein

  2. Service de Maladies Infectieuses Tropicales et Infections Chroniques (MITIC), IHU Méditerranée Infection, 19–21 Boulevard Jean Moulin, 13005, Marseille, France

    Piseth Seng, Madou Traore & Andreas Stein

  3. Aix-Marseille Université, Unité de recherche sur les maladies infectieuses et tropicales émergentes (URMITE), UM63, CNRS 7278, IRD 198, INSERM 1095, IHU–Méditerranée Infection, 19-21 Boulevard Jean Moulin, Marseille, France

    Piseth Seng, Jean-Christophe Lagier & Andreas Stein

  4. Service de Microbiologie – Centre Hospitalo-Universitaire de Nîmes, Nîmes, France

    Jean-Philippe Lavigne

  5. Unité d’infectiologie transversale, Centre Hospitalier du Pays d’Aix, Aix-en-Provence, France

    Laurence Maulin

  6. Chirurgie Orthopédique et Traumatologique Adulte, Hôpital Privé Résidence du Parc, Marseille, France

    Jean-François Thiery

  7. Laboratoire de biologie médicale, Hôpital Privé La Casamance, Aubagne, France

    Pierre-Yves Levy

  8. Service des Maladies infectieuses et Tropicales – Centre Hospitalo-Universitaire de Nice, Nice, France

    Pierre-Marie Roger

  9. Equipe Mobile d’Infectiologie, Hopital Joseph Ducuing, Toulouse, France

    Eric Bonnet

  10. Service des Maladies infectieuses et Tropicales – Centre Hospitalo-Universitaire de Nîmes, Nîmes, France

    Albert Sotto

Authors
  1. Piseth Seng
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  2. Madou Traore
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  3. Jean-Philippe Lavigne
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  4. Laurence Maulin
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  5. Jean-Christophe Lagier
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  6. Jean-François Thiery
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  7. Pierre-Yves Levy
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  8. Pierre-Marie Roger
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  10. Albert Sotto
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  11. Andreas Stein
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Contributions

Piseth Seng: 1st author, he was involved clinical data collection, conception, design and drafting the manuscript.

Madou Traore: 2nd author, clinical data collection, microbiological data collection, manuscript revision.

Jean-Philippe Lavigne: 3rd author, microbiological data verification, manuscript revision.

Laurence Maulin: 4th author; clinical data verification, manuscript revision.

Jean-Christophe Lagier: 5th author, clinical data verification, manuscript revision.

Jean-François Thiery: 6th author, surgical data verification, manuscript revision.Jean-François Thiery: 6th author, surgical data verification, manuscript revision.

Pierre-Yves Levy: 7th author, microbial data verification, manuscript revision.

Pierre-Marie Roger: 8th author , clinical data verification, manuscript revision.

Eric Bonnet: 9th author , clinical data verification, manuscript revision.

Albert Sotto: 10th author , clinical data verification, manuscript revision.

Andreas Stein: final author, clinical data verification, discussion section, final approval of the version to be published.

All authors read and approved the final manuscript.

Corresponding author

Correspondence to Piseth Seng.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Funding

There is no funding source.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study. This study was approved by the institutional research ethics board (Comité de Protection des Personnes Sud Méditerranée 1). Copies of the written approval are available for review by the Editor-in-Chief of this journal.

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Seng, P., Traore, M., Lavigne, JP. et al. Staphylococcus lugdunensis: a neglected pathogen of infections involving fracture-fixation devices. International Orthopaedics (SICOT) 41, 1085–1091 (2017). https://doi.org/10.1007/s00264-017-3476-4

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  • DOI: https://doi.org/10.1007/s00264-017-3476-4

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