title: Clinical Significance and Pathogenesis of Staphylococcal Small Colony Variants in Persistent Infections.
abstract: Small colony variants (SCVs) were first described more than 100 years ago for Staphylococcus aureus and various coagulase-negative staphylococci. Two decades ago, an association between chronic staphylococcal infections and the presence of SCVs was observed. Since then, many clinical studies and observations have been published which tie recurrent, persistent staphylococcal infections, including device-associated infections, bone and tissue infections, and airway infections of cystic fibrosis patients, to this special phenotype. By their intracellular lifestyle, SCVs exhibit so-called phenotypic (or functional) resistance beyond the classical resistance mechanisms, and they can often be retrieved from therapy-refractory courses of infection. In this review, the various clinical infections where SCVs can be expected and isolated, diagnostic procedures for optimized species confirmation, and the pathogenesis of SCVs, including defined underlying molecular mechanisms and the phenotype switch phenomenon, are presented. Moreover, relevant animal models and suggested treatment regimens, as well as the requirements for future research areas, are highlighted.
authors.affiliation: Institute of Medical Microbiology, University Hospital Münster, Münster, Germany kahl@uni-muenster.de.
authors.forename: Barbara C
authors.initials: BC
authors.lastname: Kahl
authors.affiliation: Institute of Medical Microbiology, University Hospital Münster, Münster, Germany.
authors.forename: Karsten
authors.initials: K
authors.lastname: Becker
authors.affiliation: Institute of Medical Microbiology, Jena University Hospital, Jena, Germany.
authors.forename: Bettina
authors.initials: B
authors.lastname: Löffler
mesh_terms: D000818:Animals; D015373:Bacterial Typing Techniques; D003428:Cross Infection / Q000382:microbiology; D004195:Disease Models, Animal; D006801:Humans; D010641:Phenotype; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000473:pathology / Q000635:transmission*; D013211:Staphylococcus aureus / Q000145:classification* / Q000302:isolation & purification