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Old 05-04-2021, 04:10 AM
 
12 posts, read 12,773 times
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the Positive Coag Staph aures the main culprit that cause soft tissue infection in human.

But there also the NEGATIVE Coagulase Staph.

I have a weird case of infection from the NEGATIVE kind of Staph.

Anyways, can you your story of Staph infection?

And is possible for the lab to read the wrong Staph, like it a positive coag staph, but they read it as a Negative Coag staph?

I will share my story below, if you not interest to read it you can just skip the portion below: sorry TMI I guess




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I got infectied with a NEGATIVE Coagulase Staph infection.

This was confirmed by an culture where it show light growth of NEGATIVE Coag Staph Simulans. This specific staph is the main infection in cattles, horses, cows etc... It rarely infected human (only few cases documented) and those that got infected were herders and butchers, as they are the one that deal with these animals on daily basis.

However sometimes this Staph Simulans does live on human normal skin flora but usually don't cause harm.

Noted, there is NO cattles or horses where I live, I live right in the city not the rural, so there no herders, butchers, etc.. I think you know what I mean. It just so weird that I got infected with this specific staph.

And worst, out of all the place it can infected me, it infected my belly button. My belly button was oozing out foul smell mushy pus mixed with red blood. Doctor did a culture, result said: Light growth, bacteria Staph Simulans, a NEGATIVE Coagulase staph, that up to today there only a few cases document that it cause harm to human.

I don't have any pets, no where near me has sheep, horses, cattles, etc... How the hell I got this thing in my deep belly button! It just so weird.

It is possible for the lab to read the wrong Staph, like it a positive coag staph, but they read it as a Negative Coag staph?
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Old 05-04-2021, 11:38 AM
 
Location: San Diego, California
1,147 posts, read 837,379 times
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You are misinterpreting the situation. Laboratories and laboratory professionals who read culture plates have a wide latitude on reading and working up of isolates along with reporting formats. There is always apprehension and caution used with regards as to how and what to report that is growing in order not to mislead the doctor. Some doctors will treat everything that is reported and that should not be the case. It is up the the pathologist to provide that direction and policy as to what is clinically significant with regards to isolates encountered. In order to minimize misinterpretation, but still convey what is important, the laboratory will have policies on reporting formats with regards to certain isolates.

We are taught that the source of the swab is everything and we all know the organisms that are capable of causing disease with that swab source. Isolates from non-sterile sites are known to have commensal organisms that are typical for that specimen source. Those organisms when grown are typically called normal flora and reported as such. The skin the mouth the gut genital areas all contain normal flora and should be reported vaguely to transmit a lowered level of concern. Most of the time the laboratory will report out simply coagulase negative staph and not the specific genus and species as there are many different types of coagulase negative staph. In some cases they might not even be staph. Most of the time they look at the plate and see some white bacteria growing vs yellow in comparison to staph aureus and with a loop get some bacteria and mix it with coagulase reagent on a slide and see if it clumps together or if it is finely dispersed. They also do a catalase test to distinguish staph from strep. If it stays dispersed it is called coagulase negative staph and if it clumped then presumptive staph aureus is made and susceptibility to antibiotics are run in order to find the appropriate antibiotic. We do not run antibiotic susceptibilities on coagulase negative staph in order to not misled the doctor into believing he has to be treated.

If one has a blood culture which is considered a sterile site and bacteria found there should not be there and consideration much be carried out as to any organisms grown in culture. There are more advanced and rapid methods for identification that involve nucleic acid analysis of flagged bottles determined to be positive. Those rapid identifications can go to specie level identification depending on the organism matching criteria so if the instrument is capable of detecting staph aureus and reports a negative and shows a positive for staph species only then it will be reported out as coagulase negative staph as a preliminary and whether or not it is MRSA or not and the presence of resistant factors present or not. This directs the doctor to the proper antibiotic to use if they so wish. In order to determine the significance of the isolate with regards to blood cultures one must take into account that contamination with skin isolates can occur during the blood draw process and not be a bacteria that is an active infection in the blood. This is a false positive that laboratories try to keep below 5% of blood culture draws. The only way to determine the significance of such an isolate is to collect more than one bottle or one set of cultures. When ruling out a blood infection normally three sets of cultures are drawn on a patient. If one bottle out of four or six is found positive for coagulase negative staph then it will be considered a contaminate and no action will be taken on such an isolate in terms of treatment.

The way we convey to the doctor whether or not we think an isolate is clinically significant is by way of testing the isolate for many antibiotics and reporting that panel. This provides the doctor a clearer picture as to which antibiotic to use. In the case of commensal organisms that are quite common the antibiotic resistance is quite high. Coagulase negative staph are all mecA positive similar to methicillin staph MRSA. They can be a challenge to treat because of such high resistance. We do not report out the antibiotic panel in isolates we do not think are clinically significant on purpose so doctors won't know what to treat with. Sometimes even if we do report out a panel of antibiotics for a particular isolate we won't report out all antibiotics tested agains that isolate in order to convey to the doctor that he should not use a very strong last stand antibiotic in order to reduce antibiotic resistance out in the community. Some information is hidden. That information is conveyed only if the doctor, preferably only an infectious disease specialist requests that specific antibiotic resistance information it will be given.

The laboratory reporting format safeguards some clinical practices in helping doctors determine clinical significance and treatment appropriateness for any given isolate. Eventually it all boils down to how to treat the infection and it should be a red flag when antibiotic susceptibility is not reported with a culture.

"S simulans is a CoNS and a well-established animal pathogen affecting cows, sheep, goats, and horses. It is commonly implicated in bovine mastitis.2 Reports of S simulans as the sole pathogen in human infections are rare; however, we hypothesize that our patient may have acquired infection from his farm and regular handling of animals, an identifiable risk factor. S simulans has also been implicated in osteoarticular infections, native valve endocarditis, and diabetic osteitis,3, 4, 5 with diabetes and prosthetic joints identified as additional risk factors."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5143409/
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Old 05-20-2021, 08:28 AM
 
12 posts, read 12,773 times
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Hi there Medical Lab Guy Sir, a few questions.

How likely for Staph simulans (light growth) be a culture contaminate? It just so weird because only few cases of S. stimulans in medical literature and the ones in there are infection from butcher, herders, etc.. make sense since they the ones that deal with cows, horses, cattles on the daily basis.
But I live in the city, and I don't own pets, let alone anywhere near big animals like cows and horses. I wonder how the heck S. simulans got into my deep belly button.


oh, one more thing, on the culture result. There was another bacteria listed, but it could be a contaminant too.
It was Finegoldia magna. This bacteria common found in the gut and urine tract, etc.. So I wonder how the heck this got into my belly button. Well, it could also found on the skin too.
But Finegoldia Magna usually they count as contaminant, especially from a soft skin culture (which mine was).

So there no way this can be misread by the lab right? So these 2 bacteria are on my skin.

oh, and it is posible for me to have a "cyst" under my belly button and now it bursted (that was why the cheesy pus and blood were oozing out?).

Anyhoo, my urine result was all normal, I pee very normal and clear, so the UTI rule out. Urine result everything normal.


But the pus in my belly button result come out S. simulans and Finegoldia magna.

You don't think the chance for the lab people to misread the S. simulans from the S. aureus? Because S. aureus is a serious thing. But mine specificly list S. simulans.

and I did have a list of antibiotics resistant and susceptible to that specific negative coag S. simulans. So I guess the lab really believe it this staph and cause my belly button infection, or else why would they run antibiotics resistant/susceptibility right?

btw, I'm not diabetic, and I don't have any prosthetic neither. And no where near any animals. How the hell I got this thing, it just so bizzard.

Last edited by worldcup; 05-20-2021 at 08:41 AM..
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Old 05-20-2021, 11:57 AM
 
Location: San Diego, California
1,147 posts, read 837,379 times
Reputation: 3502
You are asking for a specific interpretation on your case which I usually defer to the doctor for that. I give general information in terms of common laboratory practices. I always assume that OP's give incomplete, impartial information that one needs to have for a full evaluation of the situation.

In general Staph aureus is pathogenic because it has virulence factors such as coagulase which provides a defense against host immune responses by walling itself off with that enzyme. The walling off is what we call a boil. So staph can cause boils. It's such an important distinctive enzyme that is easy to perform which results in the clumping of the bacteria on a slide. When exposed to plasma the S. aureus will clump together. All other staph that doesn't clump is called coagulase negative staph because they all have the same clinical implication in not having invasive properties in causing disease in none sterile sites. They only take on importance when they get passed the skin and end up in sterile body sites especially in those who are immune compromised.

Most of the time wounds on the skin are treated empirically which is normally assumed to be staph or strep. What one is also looking for which can impact treatment is the presence of gram negative rods. The two microbes mentioned are both gram positive cocci.

One can also look at the gram stain to see if there is white cells and what they contain with regards to intracellular bacteria or not. That would validate an infection and the type of bacteria that may be causing that infection. One likes to see many white blood cells with intracellular bacteria and large amounts of one type of bacteria growing on culture. The few growth of organisms growing on culture and being mixed flora brings into question their significance.

There shouldn't be any major problems treating such an infection with typical antibiotics unless you are immunocompromised. One needs eyes on the wound to see what is going on. Incisions may be made to lance anything there and drain the wound. Not sure if that was done or not.
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