title: Staphylococcus epidermidis colonization is highly clonal across US cardiac centers.
abstract: BACKGROUND
  Little is known about the clonality of Staphylococcus epidermidis in the United States, although it is the predominant pathogen in infections involving prosthetic materials, including ventricular assist devices (VADs).
  
  
  METHODS
  Seventy-five VAD recipients at 4 geographically diverse US cardiac centers were prospectively followed up to 1 year of VAD support. The anterior nares, sternum, and (future) driveline exit site were cultured for S. epidermidis before VAD insertion and at 7 times after surgery. Infection isolates were also collected. Isolates were typed by pulsed-field gel electrophoresis. A subset underwent susceptibility testing and staphylococcal chromosomal cassette mec and multilocus sequence typing.
  
  
  RESULTS
  A total of 1559 cultures yielded 565 S. epidermidis isolates; 254 of 548 typed isolates (46%) belonged to 1 of 7 clonal types as defined by pulsed-field gel electrophoresis. These clones were identified in up to 27 people distributed across all 4 cardiac centers. They caused 3 of 6 VAD-related infections. Disseminated clones were more antibiotic resistant than were less prevalent isolates (eg, 79% vs 54% methicillin resistant; P = .0021).
  
  
  CONCLUSIONS
  This study revealed that healthcare-associated S. epidermidis infection is remarkably clonal. We describe S. epidermidis clones that are highly resistant to antibiotics distributed across US cardiac centers. These clones may have determinants that enhance transmissibility, persistence, or invasiveness. Clinical Trials Registration. NCT01471795.
authors.affiliation: Department of Medicine, Division of Infectious Diseases, Columbia University College of Physicians & Surgeons, New York, New York 10032, USA. rj216@columbia.edu
authors.forename: Rachel J
authors.initials: RJ
authors.lastname: Gordon
authors.forename: Maria
authors.initials: M
authors.lastname: Miragaia
authors.forename: Alan D
authors.initials: AD
authors.lastname: Weinberg
authors.forename: Caroline J
authors.initials: CJ
authors.lastname: Lee
authors.forename: Joana
authors.initials: J
authors.lastname: Rolo
authors.forename: Julie C
authors.initials: JC
authors.lastname: Giacalone
authors.forename: Mark S
authors.initials: MS
authors.lastname: Slaughter
authors.forename: Pat
authors.initials: P
authors.lastname: Pappas
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Naka
authors.forename: Alfred J
authors.initials: AJ
authors.lastname: Tector
authors.forename: Herminia
authors.initials: H
authors.lastname: de Lencastre
authors.forename: Franklin D
authors.initials: FD
authors.lastname: Lowy
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D015373:Bacterial Typing Techniques; D016521:Electrophoresis, Gel, Pulsed-Field; D005260:Female; D006353:Heart-Assist Devices / Q000382:microbiology*; D006801:Humans; D008297:Male; D016106:Methicillin Resistance / Q000187:drug effects*; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D058885:Multilocus Sequence Typing / Q000379:methods; D011446:Prospective Studies; D013048:Specimen Handling; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000382:microbiology*; D013212:Staphylococcus epidermidis / Q000145:classification* / Q000187:drug effects; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents