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Infection and Immunity, November 2008, p. 5127-5132, Vol. 76, No. 11
0019-9567/08/$08.00+0     doi:10.1128/IAI.00606-08
Copyright © 2008, American Society for Microbiology. All Rights Reserved.

Analysis of the Genotype and Virulence of Staphylococcus epidermidis Isolates from Patients with Infective Endocarditis{triangledown} ,{dagger}

Alastair B. Monk,1 Sam Boundy,1 Vivian H. Chu,5 Jill C. Bettinger,3 Jaime R. Robles,4 Vance G. Fowler Jr.,5 and Gordon L. Archer1,2*

Departments of Internal Medicine,1 Microbiology and Immunology,2 Pharmacology and Toxicology, School of Medicine,3 Department of Pharmacy, School of Pharmacy, Virginia Commonwealth University, Richmond, Virginia 23298,4 Department of Medicine, Duke University Medical Center, Durham, North Carolina 277105

Received 16 May 2008/ Returned for modification 3 July 2008/ Accepted 3 September 2008

Staphylococcus epidermidis is one of the most common causes of infections of prosthetic heart valves (prosthetic valve endocarditis [PVE]) and an increasingly common cause of infections of native heart valves (native valve endocarditis [NVE]). While S. epidermidis typically causes indolent infections of prosthetic devices, including prosthetic valves and intravascular catheters, S. epidermidis NVE is a virulent infection associated with valve destruction and high mortality. In order to see if the differences in the course of infection were due to characteristics of the infecting organisms, we examined 31 S. epidermidis NVE and 65 PVE isolates, as well as 21 isolates from blood cultures (representing bloodstream infections [BSI]) and 28 isolates from nasal specimens or cultures considered to indicate skin carriage. Multilocus sequence typing showed both NVE and PVE isolates to have more unique sequence types (types not shared by the other groups; 74 and 71%, respectively) than either BSI isolates (10%) or skin isolates (42%). Thirty NVE, 16 PVE, and a total of 9 of the nasal, skin, and BSI isolates were tested for virulence in Caenorhabditis elegans. Twenty-one (70%) of the 30 NVE isolates killed at least 50% of the worms by day 5, compared to 1 (6%) of 16 PVE isolates and 1 (11%) of 9 nasal, skin, or BSI isolates. In addition, the C. elegans survival rate as assessed by log rank analyses of Kaplan-Meier survival curves was significantly lower for NVE isolates than for each other group of isolates (P < 0.0001). There was no correlation between the production of poly-β(1-6)-N-acetylglucosamine exopolysaccharide and virulence in worms. This study is the first analysis suggesting that S. epidermidis isolates from patients with NVE constitute a more virulent subset within this species.

* Corresponding author. Mailing address: Virginia Commonwealth University School of Medicine, Sanger Hall Room 1-018, Box 980525, 1101 East Marshall St., Richmond, VA 23298. Phone: (804) 828-0673. Fax: (804) 828-5022. E-mail: garcher{at}vcu.edu

{triangledown} Published ahead of print on 15 September 2008.

{dagger} Supplemental material for this article may be found at http://iai.asm.org/.

Editor: J. N. Weiser

Infection and Immunity, November 2008, p. 5127-5132, Vol. 76, No. 11
0019-9567/08/$08.00+0     doi:10.1128/IAI.00606-08
Copyright © 2008, American Society for Microbiology. All Rights Reserved.



This article has been cited by other articles:

  • Li, M., Wang, X., Gao, Q., Lu, Y. (2009). Molecular characterization of Staphylococcus epidermidis strains isolated from a teaching hospital in Shanghai, China. J Med Microbiol 58: 456-461 [Abstract] [Full Text]  


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