Staphylococcus epidermidis bloodstream infections are a cause of septic shock in ICU patients.

OBJECTIVES: Staphyloccus epidermidis (SE) is a supposedly low-virulence agent, which may cause proven bloodstream infections (BSI), with little-known consequences on ICU patients. We aimed at studying ICU patients diagnosed with SE-BSI.

METHODS: We constituted a retrospective cohort in two medical ICUs. SE-BSI were defined by two or more independent SE-positive blood cultures of the same strain, within 48 hours, without concurrent infection.

RESULTS: We included 59 patients, 58% men (n=34), with median age of 67 (IQR 60-74) and SAPS II of 59 points (36-74), 56% being immunocompromised (n=33). Among the 37 patients (63%) requiring norepinephrine initiation or increase at the onset of SE-BSI versus patients not requiring vasopressors (37%; n=22), concomitant arterial lactate levels reached 2.8 (1.9-5.8) vs. 1.5 (1.3-2.2) mmol/L (p<0.01) while mean blood pressure was 49 (42-54) vs. 61 (56-65) mmHg (p=0.01), and mortality attained 46% (n=17) vs. 14% (n=3) at day 28 (p=0.01), respectively. Regarding antibiotics, susceptibility rates towards linezolid and vancomycin were 71% (n=41/58), and 100% (n=54/54), respectively. At the time of SE-BSI, all but one patients had central venous access device.

CONCLUSIONS: This work highlights SE-BSI as a cause of septic shock, mostly in immunocompromised ICU patients, with raising concerns about resistance to antibiotics and central line management.