aWest Los Angeles Veterans Affairs Medical Center, California
bDavid Geffen School of Medicine at University of California, Los Angeles
Author disclosures
The authors report no actual or potential conflicts of interest or outside sources of funding with regard to this article.
Disclaimer
The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc., the US Government, or any of its agencies. This article may discuss unlabeled or investigational use of certain drugs. Please review the complete prescribing information for specific drugs or drug combinations—including indications, contraindications, warnings, and adverse effects—before administering pharmacologic therapy to patients.
Ethics and consent
Written informed consent was obtained from the patient.
Due to their virulence, bloodstream infections caused by S aureus and S lugdunensis often require more than timely antimicrobial treatment to ensure eradication. Consultation with an infectious disease specialist to manage patients with S aureus bacteremia has been proven to reduce mortality.25 A similar mortality benefit is seen when infectious disease specialists are consulted for S lugdunensis bacteremia.26 This mortality benefit is likely explained by S lugdunensis’ propensity to cause aggressive, metastatic infections. In such cases, infectious disease consultants may recommend additional imaging (eg, transthoracic echocardiogram) to evaluate for occult sources of infection, advocate for appropriate source control, and guide the selection of an appropriate antibiotic course to ensure resolution of the bacteremia.
Conclusions
S lugdunensis is an increasingly recognized cause of nosocomial bloodstream infections. Given the commonalities in virulence that S lugdunensis shares with S aureus, treatment of bacteremia caused by either species should follow similar management principles: prompt initiation of IV antistaphylococcal therapy, a thorough evaluation for the source(s) of bacteremia as well as metastatic complications, and consultation with an infectious disease specialist. This case report also highlights the importance of considering a patient’s AVF as a potential source for infection even in the absence of localized signs of infection. The buttonhole method of AVF cannulation was thought to be a major contributor to the development and persistence of our patient’s bacteremia. This risk should be discussed with patients using a shared decision-making approach when developing a dialysis treatment plan.
