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. 2014 Jun 4;9(6):e99045.
doi: 10.1371/journal.pone.0099045. eCollection 2014.

Long-term molecular epidemiology of Staphylococcus epidermidis blood culture isolates from patients with hematological malignancies

Erik Ahlstrand  1 , Bengt Hellmark  2 , Karolina Svensson  2 , Bo Söderquist  3
Affiliations

Long-term molecular epidemiology of Staphylococcus epidermidis blood culture isolates from patients with hematological malignancies

Erik Ahlstrand et al. PLoS One. .

Abstract

Staphylococcus epidermidis is an important cause of bloodstream infections in patients with hematological malignancies. Knowledge of the long-term epidemiology of these infections is limited. We surveyed all S. epidermidis blood culture isolates from patients treated for hematological malignancies at the University Hospital of Örebro, Sweden from 1980 to 2009. A total of 373 S. epidermidis isolates were identified and multilocus sequence typing, staphylococcal chromosome cassette mec (SCCmec) typing and standard antibiotic susceptibility testing were employed to characterize these isolates. The majority of the isolates 361/373 (97%) belonged to clonal complex 2, and the 373 isolates were divided into 45 sequence types (STs); Simpson's Diversity Index was 0.56. The most prevalent STs were ST2 (243/373, 65%) and ST215 (28/373, 8%). Ninety three percent (226/243) of the ST2 isolates displayed either SCCmec type III or IV. ST2 and 215 were isolated during the entire study period, and together these STs caused temporal peaks in the number of positive blood cultures of S. epidermidis. Methicillin resistance was detected in 213/273 (78%) of all isolates. In the two predominating STs, ST2 and ST215, methicillin resistance was detected in 256/271 isolates (95%), compared with 34/100 (34%) in other STs (p<0.001). In conclusion, in this long-term study of patients with hematological malignancies, we demonstrate a predominance of methicillin-resistant ST2 among S. epidermidis blood culture isolates.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. eBURST analysis of the S. epidermidis sequence types (STs) belonging to clonal complex 2 observed in this study compared with STs in the multilocus sequence typing (MLST) database via the MLST website (http://www.mlst.net) as of 1 August 2013.
STs in large digits are STs found in this study. Not previously described STs are depicted in gray (ST520-528).
Figure 2
Figure 2. The number of positive blood cultures of S. epidermidis in patients with hematological malignancies.
Each bar represents a 5-year period and is divided in ST2-SCCmec I, ST2-SCCmec III, ST2-SCCmec IV, ST2 with nontypable SCCmec or mecA negative, ST215 and other sequence types.
Figure 3
Figure 3. The number of positive blood cultures of coagulase-negative staphylococci (CoNS) in Örebro County, Sweden (filled squares); CoNS at the Division of Hematology, Örebro University Hospital (filled diamonds); and S. epidermidis in patients with hematological malignancies, Örebro University Hospital (study population, open triangles).
The total number of blood cultures performed in Örebro County from 1999 to 2009 is also shown (crosses).
See this image and copyright information in PMC

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