Comment; Biofilms are probably under-appreciated in their role in facilitating development and spread of disease. It’s not just about drug resistance in the lab, I suspect biofilm forming organisms and their role with plasmid transfer are responsible for more illness than is widely recognized.
Karsten Becker,*Christine Heilmann,*and Georg Peters*
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SUMMARY
The definition of the heterogeneous group of coagulase-negative staphylococci (CoNS) is still based on diagnostic procedures that fulfill the clinical need to differentiate between Staphylococcus aureus and those staphylococci classified historically as being less or nonpathogenic. Due to patient- and procedure-related changes, CoNS now represent one of the major nosocomial pathogens, with S. epidermidis and S. haemolyticus being the most significant species. They account substantially for foreign body-related infections and infections in preterm newborns. While S. saprophyticus has been associated with acute urethritis, S. lugdunensis has a unique status, in some aspects resembling S. aureus in causing infectious endocarditis. In addition to CoNS found as food-associated saprophytes, many other CoNS species colonize the skin and mucous membranes of humans and animals and are less frequently involved in clinically manifested infections. This blurred gradation in terms of pathogenicity is reflected by species- and strain-specific virulence factors and the development of different host-defending strategies. Clearly, CoNS possess fewer virulence properties than S. aureus, with a respectively different disease spectrum. In this regard, host susceptibility is much more important. Therapeutically, CoNS are challenging due to the large proportion of methicillin-resistant strains and increasing numbers of isolates with less susceptibility to glycopeptides.
The definition of the heterogeneous group of coagulase-negative staphylococci (CoNS) is still based on diagnostic procedures that fulfill the clinical need to differentiate between Staphylococcus aureus and those staphylococci classified historically as being less or nonpathogenic. Due to patient- and procedure-related changes, CoNS now represent one of the major nosocomial pathogens, with S. epidermidis and S. haemolyticus being the most significant species. They account substantially for foreign body-related infections and infections in preterm newborns. While S. saprophyticus has been associated with acute urethritis, S. lugdunensis has a unique status, in some aspects resembling S. aureus in causing infectious endocarditis. In addition to CoNS found as food-associated saprophytes, many other CoNS species colonize the skin and mucous membranes of humans and animals and are less frequently involved in clinically manifested infections. This blurred gradation in terms of pathogenicity is reflected by species- and strain-specific virulence factors and the development of different host-defending strategies. Clearly, CoNS possess fewer virulence properties than S. aureus, with a respectively different disease spectrum. In this regard, host susceptibility is much more important. Therapeutically, CoNS are challenging due to the large proportion of methicillin-resistant strains and increasing numbers of isolates with less susceptibility to glycopeptides.
CONCLUSIONS
CoNS resemble very heterogeneous and versatile Gram-positive bacteria. Their main ecological niches are skin and mucous membranes of humans and animals, and they are therefore always in a very close, and mainly symbiotic, relationship with their natural hosts. This also holds for the CoNS species preferentially found on humans. Except for S. saprophyticus and S. lugdunensis, CoNS rarely attack a healthy host, because of a lack of aggressive virulence properties. However, groups of especially susceptible patients are increasing, either due to still undeveloped or impaired host response functions or due to inserted or implanted foreign bodies. Consequently, CoNS have become a major nosocomial pathogen. Despite the normally subacute and low inflammatory course of these infections, they present a substantial clinical burden because of broad and severe treatment difficulties. In the case of foreign body infections, the removal of the infected device is most often ultimately required.
Many questions regarding the phylogeny, ecology, and pathogenesis of CoNS are still not answered. Just recently available new methodological tools will enable further research approaches. This may lead to new measures for effective therapy and for the prevention of CoNS infections.
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