title: Staphylococcus lugdunensis: a rare but destructive cause of coagulase-negative staphylococcus infective endocarditis.
abstract: BACKGROUND
  Staphylococcus lugdunensis is a coagulase-negative organism that causes a rare but destructive form of infective endocarditis (IE). We sought to evaluate the clinical and echocardiographic profile of S. lugdunensis IE at our institution and compare it to that of Staphylococcus aureus IE.
  
  
  METHODS
  Utilizing microbiology isolates, we retrospectively reviewed cases of S. lugdunensis bacteraemia admitted to our institution between 2002 and 2011 and included cases that met the modified Duke's criteria and those with device infection. We used univariate analysis to compare the clinical and echocardiographic features and outcomes of these patients with 76 cases of S. aureus IE.
  
  
  RESULTS
  We identified 15 cases of S. lugdunensis IE (10 native, two prosthetic, three device only), amongst whom five cases had underlying structural valvular heart disease. Echocardiography revealed bulky vegetations in 12, abscesses in three, perforation in four, and valve dehiscence in one case. Overall, 7/12 (58%) of valvular IE involved left-sided valves; six of these underwent successful surgical intervention. S. lugdunensis IE resulted in marked valvular destruction similar to S. aureus IE but was more likely to affect patients with prior structural valvular heart disease (42 vs. 7%, p=0.004).
  
  
  CONCLUSIONS
  Unlike other coagulase-negative staphylococci, S. lugdunensis causes a rare but destructive form of IE that can involve structurally normal native valves. Echocardiographic imaging is characterized by bulky vegetations and profound valvular destruction similar to that seen with S. aureus IE, thus isolation of this organism in the blood should not be disregarded as a contaminant. Confirmation of left-sided valvular endocarditis warrants surgical intervention.
authors: Cleveland Clinic Foundation, Cleveland, USA.
authors: Marwa A
authors: MA
authors: Sabe
authors: Cleveland Clinic Foundation, Cleveland, USA.
authors: Nabin K
authors: NK
authors: Shrestha
authors: Cleveland Clinic Foundation, Cleveland, USA.
authors: Steven
authors: S
authors: Gordon
authors: Cleveland Clinic Foundation, Cleveland, USA menonv@ccf.org.
authors: Venu
authors: V
authors: Menon
mesh_terms: D000328:Adult; D000368:Aged; D018618:Echocardiography, Doppler, Color; D017548:Echocardiography, Transesophageal; D004697:Endocarditis, Bacterial / Q000000981:diagnostic imaging*; D005260:Female; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000000981:diagnostic imaging*; D057787:Staphylococcus lugdunensis
keywords: Infective endocarditis; Staphylococcus aureus; Staphylococcus lugdunensis