Skip to main content
Journal of Clinical Microbiology logoLink to Journal of Clinical Microbiology
. 1997 Jul;35(7):1746–1750. doi: 10.1128/jcm.35.7.1746-1750.1997

An epidemiological study of blood culture isolates of coagulase-negative staphylococci demonstrating hospital-acquired infection.

J P Burnie 1, M Naderi-Nasab 1, K W Loudon 1, R C Matthews 1
PMCID: PMC229833  PMID: 9196185

Abstract

We applied pulsed-field gel electrophoresis (PFGE) after SmaI digestion and random amplification of polymorphic DNA (RAPD) analysis with nine oligonucleotide primers to 146 blood culture isolates of Staphylococcus epidermidis and 25 blood culture isolates of Staphylococcus haemolyticus. These were obtained over a 12-month period from patients on the neonatal and hematology units of the Central Manchester Health Care Trust. PFGE demonstrated two clusters of isolates of S. epidermidis (type A and type B) on the neonatal ward and a single cluster (type C) on the hematology unit. Type A was represented by 10 indistinguishable isolates from nine patients, type B was represented by 20 isolates from 14 patients, and type C was represented by 26 isolates from 10 patients. Type A isolates were resistant to chloramphenicol and type C isolates were resistant to ciprofloxacin, mirroring current antibiotic usage. There was no evidence of cross infection due to S. haemolyticus. RAPD analysis, on the basis of a single band difference, produced 58 types of S. epidermidis and 12 types of S. haemolyticus with primer 8 (ATG TAA GCT CCT GGG GAT TCA C; 5' to 3') and 54 types of S. epidermidis and 10 types of S. haemolyticus with primer 9 (AAG TAA GTG ACT GGG GTG AGC G; 5' to 3'). Combining the results confirmed cross infection. Types A, B, and C were concurrently isolated from the hands of the staff of the appropriate unit. Partial control was achieved by withdrawing ciprofloxacin use in the case of the hematology unit and improving hand hygiene in both units.

Full Text

The Full Text of this article is available as a PDF (1.9 MB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bassam B. J., Caetano-Anollés G., Gresshoff P. M. DNA amplification fingerprinting of bacteria. Appl Microbiol Biotechnol. 1992 Oct;38(1):70–76. doi: 10.1007/BF00169422. [DOI] [PubMed] [Google Scholar]
  2. Bialkowska-Hobrzanska H., Jaskot D., Hammerberg O. Evaluation of restriction endonuclease fingerprinting of chromosomal DNA and plasmid profile analysis for characterization of multiresistant coagulase-negative staphylococci in bacteremic neonates. J Clin Microbiol. 1990 Feb;28(2):269–275. doi: 10.1128/jcm.28.2.269-275.1990. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Bingen E., Barc M. C., Brahimi N., Vilmer E., Beaufils F. Randomly amplified polymorphic DNA analysis provides rapid differentiation of methicillin-resistant coagulase-negative staphylococcus bacteremia isolates in pediatric hospital. J Clin Microbiol. 1995 Jun;33(6):1657–1659. doi: 10.1128/jcm.33.6.1657-1659.1995. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Bostock A., Khattak M. N., Matthews R., Burnie J. Comparison of PCR fingerprinting, by random amplification of polymorphic DNA, with other molecular typing methods for Candida albicans. J Gen Microbiol. 1993 Sep;139(9):2179–2184. doi: 10.1099/00221287-139-9-2179. [DOI] [PubMed] [Google Scholar]
  5. Boyce J. M., Potter-Bynoe G., Opal S. M., Dziobek L., Medeiros A. A. A common-source outbreak of Staphylococcus epidermidis infections among patients undergoing cardiac surgery. J Infect Dis. 1990 Mar;161(3):493–499. doi: 10.1093/infdis/161.3.493. [DOI] [PubMed] [Google Scholar]
  6. Breen J. D., Karchner A. W. Usefulness of pulsed-field gel electrophoresis in confirming endocarditis due to Staphylococcus lugdunensis. Clin Infect Dis. 1994 Nov;19(5):985–986. doi: 10.1093/clinids/19.5.985. [DOI] [PubMed] [Google Scholar]
  7. Bétrémieux P., Donnio P. Y., Pladys P. Use of ribotyping to investigate tracheal colonisation by Staphylococcus epidermidis as a source of bacteremia in ventilated newborns. Eur J Clin Microbiol Infect Dis. 1995 Apr;14(4):342–346. doi: 10.1007/BF02116529. [DOI] [PubMed] [Google Scholar]
  8. Degener J. E., Heck M. E., van Leeuwen W. J., Heemskerk C., Crielaard A., Joosten P., Caesar P. Nosocomial infection by Staphylococcus haemolyticus and typing methods for epidemiological study. J Clin Microbiol. 1994 Sep;32(9):2260–2265. doi: 10.1128/jcm.32.9.2260-2265.1994. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. George C. G., Kloos W. E. Comparison of the SmaI-digested chromosomes of Staphylococcus epidermidis and the closely related species Staphylococcus capitis and Staphylococcus caprae. Int J Syst Bacteriol. 1994 Jul;44(3):404–409. doi: 10.1099/00207713-44-3-404. [DOI] [PubMed] [Google Scholar]
  10. Huebner J., Pier G. B., Maslow J. N., Muller E., Shiro H., Parent M., Kropec A., Arbeit R. D., Goldmann D. A. Endemic nosocomial transmission of Staphylococcus epidermidis bacteremia isolates in a neonatal intensive care unit over 10 years. J Infect Dis. 1994 Mar;169(3):526–531. doi: 10.1093/infdis/169.3.526. [DOI] [PubMed] [Google Scholar]
  11. Hübner J., Kropec A. Cross infections due to coagulase-negative staphylococci in high-risk patients. Zentralbl Bakteriol. 1995 Dec;283(2):169–174. doi: 10.1016/s0934-8840(11)80198-2. [DOI] [PubMed] [Google Scholar]
  12. Jarvis W. R., Martone W. J. Predominant pathogens in hospital infections. J Antimicrob Chemother. 1992 Apr;29 (Suppl A):19–24. doi: 10.1093/jac/29.suppl_a.19. [DOI] [PubMed] [Google Scholar]
  13. Kacica M. A., Horgan M. J., Preston K. E., Lepow M., Venezia R. A. Relatedness of coagulase-negative staphylococci causing bacteremia in low-birthweight infants. Infect Control Hosp Epidemiol. 1994 Oct;15(10):658–662. doi: 10.1086/646829. [DOI] [PubMed] [Google Scholar]
  14. Khambaty F. M., Bennett R. W., Shah D. B. Application of pulsed-field gel electrophoresis to the epidemiological characterization of Staphylococcus intermedius implicated in a food-related outbreak. Epidemiol Infect. 1994 Aug;113(1):75–81. doi: 10.1017/s0950268800051487. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Khattak M. N., Matthews R. C. A comparison of the DNA fragment patterns of the mouse-virulent challenge strains and clinical isolates of Bordetella pertussis. J Infect. 1993 Sep;27(2):119–124. doi: 10.1016/0163-4453(93)94566-t. [DOI] [PubMed] [Google Scholar]
  16. Kotilainen P., Huovinen S., Järvinen H., Aro H., Huovinen P. Epidemiology of the colonization of inpatients and outpatients with ciprofloxacin-resistant coagulase-negative staphylococci. Clin Infect Dis. 1995 Sep;21(3):685–687. doi: 10.1093/clinids/21.3.685. [DOI] [PubMed] [Google Scholar]
  17. Lina B., Forey F., Tigaud J. D., Fleurette J. Chronic bacteraemia due to Staphylococcus epidermidis after bone marrow transplantation. J Med Microbiol. 1995 Mar;42(3):156–160. doi: 10.1099/00222615-42-3-156. [DOI] [PubMed] [Google Scholar]
  18. Lina B., Vandenesch F., Etienne J., Kreiswirth B., Fleurette J. Comparison of coagulase-negative staphylococci by pulsed-field electrophoresis. FEMS Microbiol Lett. 1992 Apr 15;71(2):133–138. doi: 10.1016/0378-1097(92)90501-e. [DOI] [PubMed] [Google Scholar]
  19. Linhardt F., Ziebuhr W., Meyer P., Witte W., Hacker J. Pulsed-field gel electrophoresis of genomic restriction fragments as a tool for the epidemiological analysis of Staphylococcus aureus and coagulase-negative staphylococci. FEMS Microbiol Lett. 1992 Aug 15;74(2-3):181–185. doi: 10.1016/0378-1097(92)90426-o. [DOI] [PubMed] [Google Scholar]
  20. Loudon K. W., Burnie J. P., Coke A. P., Matthews R. C. Application of polymerase chain reaction to fingerprinting Aspergillus fumigatus by random amplification of polymorphic DNA. J Clin Microbiol. 1993 May;31(5):1117–1121. doi: 10.1128/jcm.31.5.1117-1121.1993. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Low D. E., Schmidt B. K., Kirpalani H. M., Moodie R., Kreiswirth B., Matlow A., Ford-Jones E. L. An endemic strain of Staphylococcus haemolyticus colonizing and causing bacteremia in neonatal intensive care unit patients. Pediatrics. 1992 Apr;89(4 Pt 2):696–700. [PubMed] [Google Scholar]
  22. Lyytikäinen O., Saxén H., Ryhänen R., Vaara M., Vuopio-Varkila J. Persistence of a multiresistant clone of Staphylococcus epidermidis in a neonatal intensive-care unit for a four-year period. Clin Infect Dis. 1995 Jan;20(1):24–29. doi: 10.1093/clinids/20.1.24. [DOI] [PubMed] [Google Scholar]
  23. Martin M. A., Pfaller M. A., Wenzel R. P. Coagulase-negative staphylococcal bacteremia. Mortality and hospital stay. Ann Intern Med. 1989 Jan 1;110(1):9–16. doi: 10.7326/0003-4819-110-1-9. [DOI] [PubMed] [Google Scholar]
  24. Neumeister B., Kastner S., Conrad S., Klotz G., Bartmann P. Characterization of coagulase-negative staphylococci causing nosocomial infections in preterm infants. Eur J Clin Microbiol Infect Dis. 1995 Oct;14(10):856–863. doi: 10.1007/BF01691491. [DOI] [PubMed] [Google Scholar]
  25. Oppenheim B. A., Hartley J. W., Lee W., Burnie J. P. Outbreak of coagulase negative staphylococcus highly resistant to ciprofloxacin in a leukaemia unit. BMJ. 1989 Jul 29;299(6694):294–297. doi: 10.1136/bmj.299.6694.294. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Pantůcek R., Götz F., Doskar J., Rosypal S. Genomic variability of Staphylococcus aureus and the other coagulase-positive Staphylococcus species estimated by macrorestriction analysis using pulsed-field gel electrophoresis. Int J Syst Bacteriol. 1996 Jan;46(1):216–222. doi: 10.1099/00207713-46-1-216. [DOI] [PubMed] [Google Scholar]
  27. Parisi J. T., Hecht D. W. Plasmid profiles in epidemiologic studies of infections by Staphylococcus epidermidis. J Infect Dis. 1980 May;141(5):637–643. doi: 10.1093/infdis/141.5.637. [DOI] [PubMed] [Google Scholar]
  28. Pittet D., Wenzel R. P. Nosocomial bloodstream infections. Secular trends in rates, mortality, and contribution to total hospital deaths. Arch Intern Med. 1995 Jun 12;155(11):1177–1184. doi: 10.1001/archinte.155.11.1177. [DOI] [PubMed] [Google Scholar]
  29. Prevost G., Jaulhac B., Piemont Y. DNA fingerprinting by pulsed-field gel electrophoresis is more effective than ribotyping in distinguishing among methicillin-resistant Staphylococcus aureus isolates. J Clin Microbiol. 1992 Apr;30(4):967–973. doi: 10.1128/jcm.30.4.967-973.1992. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Saulnier P., Bourneix C., Prévost G., Andremont A. Random amplified polymorphic DNA assay is less discriminant than pulsed-field gel electrophoresis for typing strains of methicillin-resistant Staphylococcus aureus. J Clin Microbiol. 1993 Apr;31(4):982–985. doi: 10.1128/jcm.31.4.982-985.1993. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Schwalbe R. S., Stapleton J. T., Gilligan P. H. Emergence of vancomycin resistance in coagulase-negative staphylococci. N Engl J Med. 1987 Apr 9;316(15):927–931. doi: 10.1056/NEJM198704093161507. [DOI] [PubMed] [Google Scholar]
  32. Shayegani M., Parsons L. M., Waring A. L., Donhowe J., Goering R., Archinal W. A., Linden J. Molecular relatedness of Staphylococcus epidermidis isolates obtained during a platelet transfusion-associated episode of sepsis. J Clin Microbiol. 1991 Dec;29(12):2768–2773. doi: 10.1128/jcm.29.12.2768-2773.1991. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Snopková S., Götz F., Doskar J., Rosypal S. Pulsed-field gel electrophoresis of the genomic restriction fragments of coagulase-negative staphylococci. FEMS Microbiol Lett. 1994 Dec 1;124(2):131–139. doi: 10.1016/0378-1097(94)90240-2. [DOI] [PubMed] [Google Scholar]
  34. Spencer R. C. Predominant pathogens found in the European Prevalence of Infection in Intensive Care Study. Eur J Clin Microbiol Infect Dis. 1996 Apr;15(4):281–285. doi: 10.1007/BF01695658. [DOI] [PubMed] [Google Scholar]
  35. Tenover F. C., Arbeit R. D., Goering R. V., Mickelsen P. A., Murray B. E., Persing D. H., Swaminathan B. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol. 1995 Sep;33(9):2233–2239. doi: 10.1128/jcm.33.9.2233-2239.1995. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Veach L. A., Pfaller M. A., Barrett M., Koontz F. P., Wenzel R. P. Vancomycin resistance in Staphylococcus haemolyticus causing colonization and bloodstream infection. J Clin Microbiol. 1990 Sep;28(9):2064–2068. doi: 10.1128/jcm.28.9.2064-2068.1990. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Versalovic J., Koeuth T., Lupski J. R. Distribution of repetitive DNA sequences in eubacteria and application to fingerprinting of bacterial genomes. Nucleic Acids Res. 1991 Dec 25;19(24):6823–6831. doi: 10.1093/nar/19.24.6823. [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Walcher-Salesse S., Monzon-Moreno C., Aubert S., el Solh N. An epidemiological assessment of coagulase-negative staphylococci from an intensive care unit. J Med Microbiol. 1992 May;36(5):321–331. doi: 10.1099/00222615-36-5-321. [DOI] [PubMed] [Google Scholar]
  39. Welsh J., McClelland M. Fingerprinting genomes using PCR with arbitrary primers. Nucleic Acids Res. 1990 Dec 25;18(24):7213–7218. doi: 10.1093/nar/18.24.7213. [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Williams J. G., Kubelik A. R., Livak K. J., Rafalski J. A., Tingey S. V. DNA polymorphisms amplified by arbitrary primers are useful as genetic markers. Nucleic Acids Res. 1990 Nov 25;18(22):6531–6535. doi: 10.1093/nar/18.22.6531. [DOI] [PMC free article] [PubMed] [Google Scholar]
  41. van Belkum A., Bax R., Peerbooms P., Goessens W. H., van Leeuwen N., Quint W. G. Comparison of phage typing and DNA fingerprinting by polymerase chain reaction for discrimination of methicillin-resistant Staphylococcus aureus strains. J Clin Microbiol. 1993 Apr;31(4):798–803. doi: 10.1128/jcm.31.4.798-803.1993. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Journal of Clinical Microbiology are provided here courtesy of American Society for Microbiology (ASM)

RESOURCES