Staphylococcus epidermidis bloodstream infections are a cause of septic shock in intensive care unit patients

Julien Demiselle (1) , Pierre Meyer (2, 3) , Thierry Lavigne (4) , Julian Kaurin , Hamid Merdji , Maleka Schenck , Antoine Studer (1) , Ralf Janssen-Langenstein , Julie Helms (5) , Baptiste Hoellinger , Vincent Castelain (6) , Antoine Grillon (4) , Francis Schneider (7) , Ferhat Meziani (1) , Raphaël Clere-Jehl (5)

1 NanoRegMed - Nanomédecine Régénérative
2 IGBMC - Institut de génétique et biologie moléculaire et cellulaire
3 IGBMC - Institut de Génétique et de Biologie Moléculaire et Cellulaire
4 Virulence bactérienne précoce : fonctions cellulaires et contrôle de l'infection aiguë et subaiguë
5 IRM - Immuno-Rhumatologie Moléculaire
6 MSP - Mitochondrie, Stress oxydant et Protection musculaire
7 BB - Biomatériaux et Bioingénierie

Objectives: Staphylococcus epidermidis (SE) is a supposedly low-virulence agent, which may cause proven bloodstream infections (BSIs), with little-known consequences on intensive care unit (ICU) patients. We aimed at studying ICU patients diagnosed with BSIs caused by SE (SE-BSIs). Methods: We constituted a retrospective cohort in two medical ICUs. SE-BSIs were defined by two or more independent SE-positive blood cultures of the same strain, within 48 hours, without concurrent infection. Results: We included 59 patients; 58% were men (n = 34), with median age of 67 (interquartile range 60-74) years and a simplified acute physiology score II of 59 (36-74) points, and 56% were immunocompromised (n = 33). Among the 37 (63%) patients requiring norepinephrine initiation or increase at the onset of SE-BSI versus patients not requiring vasopressors (37%; n = 22), concomitant arterial lactate levels reached 2.8 (1.9-5.8) versus 1.5 (1.3-2.2) mmol/l (P <0.01), whereas the mean blood pressure was 49 (42-54) versus 61 (56-65) mm Hg (P = 0.01) and the mortality was 46% (n = 17) vs 14% (n = 3) at day 28 (P = 0.01), respectively. Regarding antibiotics, the susceptibility rates toward linezolid and vancomycin were 71% (n = 41/58) and 100% (n = 54/54), respectively. At the time of SE-BSI, all but one patient had a central venous access device. Conclusion: This work highlights SE-BSIs as a cause of septic shock, mostly in immunocompromised ICU patients, with increasing concerns about resistance to antibiotics and central line management. Keywords: Critical care; Immunocompromised host; Lymphopenia; Neoplasms; Septic shock; Staphylococcus epidermidis.

Domaines: Médecine humaine et pathologie

Julien Demiselle, Pierre Meyer, Thierry Lavigne, Julian Kaurin, Hamid Merdji, et al.. Staphylococcus epidermidis bloodstream infections are a cause of septic shock in intensive care unit patients. International Journal of Infectious Diseases, 2023, 135, pp.45-48. ⟨10.1016/j.ijid.2023.07.014⟩. ⟨hal-04238099⟩