title: Coagulase-negative staphylococci in multiple blood cultures: strain relatedness and determinants of same-strain bacteremia.
abstract: The frequency of strain relatedness was determined among randomly selected patients with coagulase-negative staphylococcal infections as determined in multiple blood cultures by plasmid typing, determination of species, and antibiotyping. Strain relatedness was demonstrated in 21 of 47 episodes of bacteremia (44.7%) among 34 patients, with a similar percentage among patients with two or one positive blood culture in 24 h (14 of 30 [46.7%] versus 7 of 17 [41.2%], respectively). Same-strain bacteremia was more frequent in cases of infection among patients with a corresponding fever (15 of 21 [71.4%]), among patients infected with organisms from an identifiable source (7 of 9 [77.8%]) and with non-Staphylococcus epidermidis species (9 of 11 [81.8%]), and among patients with nosocomially acquired infections (18 of 36 [50%]). Comparing episodes with or without strain relatedness, no difference was noted in the time to growth (2.1 +/- 1.4 versus 1.9 +/- 0.9 days, respectively), in bacterial growth in two culture bottles (5 of 14 [35.7%] versus 8 of 24 [33.3%], respectively), and in the presence of additional negative blood cultures (9 of 21 [42.9%] versus 11 of 26 [42.3%], respectively). The antibiotypes of all related strains and 7 of 44 (15.9%) unrelated pairs were identical. These findings demonstrate that coagulase-negative staphylococci from multiple blood cultures are frequently unrelated, suggesting a high prevalence of contamination. In the absence of precise measures for demonstrating strain relatedness, the combination of a clinical assessment with antibiotype determination appears to be a suitable alternative.
authors.affiliation: St. John Hospital and Medical Center, Detroit, Michigan, USA.
authors.forename: R
authors.initials: R
authors.lastname: Khatib
authors.forename: K M
authors.initials: KM
authors.lastname: Riederer
authors.forename: J A
authors.initials: JA
authors.lastname: Clark
authors.forename: S
authors.initials: S
authors.lastname: Khatib
authors.forename: L E
authors.initials: LE
authors.lastname: Briski
authors.forename: F M
authors.initials: FM
authors.lastname: Wilson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000382:microbiology*; D015373:Bacterial Typing Techniques; D001431:Bacteriological Techniques; D002648:Child; D002675:Child, Preschool; D003030:Coagulase / Q000378:metabolism*; D004269:DNA, Bacterial / Q000235:genetics / Q000302:isolation & purification; D004352:Drug Resistance, Microbial; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D013045:Species Specificity; D013203:Staphylococcal Infections / Q000382:microbiology*; D013210:Staphylococcus / Q000145:classification* / Q000201:enzymology* / Q000302:isolation & purification
chemical_list: D003030:Coagulase; D004269:DNA, Bacterial