Increasing clinical impact and microbiological difficulties in diagnosing coagulase-negative staphylococci in infective endocarditis – a review starting from a series of cases

Abstract

Coagulase-negative staphylococci (CoNS) are an emergent aetiology of infective endocarditis (IE) on native valves in previously healthy individuals, its presence is associated with prosthetic valves or with other cardiac implants. The identification of CoNS in cultures was customarily seen as contamination, but more recent epidemiological studies have revealed an increasing number of causative and virulent new CoNS species. Starting from two clinical cases of community-acquired CoNS IE on native valves, the review debates the difficulties in identifying CoNS as the causal pathogens, comprising differentiation of contamination from infection in IE, alongside the challenges raised by antibiotic resistance. Even if the risk of CoNS IE is more increased in subjects with prosthetic materials or other foreign devices and immunodeficiencies, native valve infections with these staphylococci are increasing and should be considered important pathogens in IE. Despite the lack of sensitive and specific tools to correctly differentiate contamination from infection in CoNS endocarditis, a comprehensive evaluation with clinical and paraclinical data accurately succeeds in establishing the diagnosis. The genetic profile of CoNS predisposes to antibiotic multi-resistance, making the treatment of IE challenging; the rapid identification of antibiotic susceptibility is essential to prescribe the appropriate therapy and improve outcomes.

Keywords:

• Coagulase-negative staphylococci
• infectious endocarditis
• native valves
• contaminant
• antibiotic resistance

Transparency

Declaration of funding

There is no sponsorship/funding to mention.

Declaration of financial/other relationships

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

Popa-Fotea NM and Micheu MM designed the review study. Popa-Fotea NM, Scafa-Udriste A, Grigore I, Scarlatescu A, Oprescu N, Cosmin Mihai performed the clinical research; Micheu MM provided help and advice on clinical data analysis. Popa-Fotea NM analyzed the data. Popa-Fotea NM and Micheu MM wrote the manuscript. All authors contributed to editorial changes in the manuscript. All authors read and approved the final manuscript.

Acknowledgements

No assistance in the preparation of this article is to be declared.