A 55-year-old man who recently underwent coronary artery bypass graft surgery, developed fever and chills on postoperative day 3. Blood cultures grew coagulase-negative Staphylococcus, identified as Staphylococcus lugdunensis, which is sensitive to oxacillin and vancomycin. He also has a new systolic murmur and a newly prolonged PR interval on ECG. Repeated blood culture is negative.
Which of the following you should recommend now?
No further work up is needed
Treat with oxacillin for one week
Treat with vancomycin for one week
Order an echocardiogram
Staphylococcus lugdunensis: Though a coagulase-negative staphylococcus (CoNS), it behaves more like Staphylococcus aureus in terms of virulence and can cause endocarditis.
Staphylococcus epidermidis and Staphylococcus saprophyticus: Typically less virulent and more commonly associated with indwelling catheter infections rather than causing significant systemic illness like endocarditis.
Staphylococcus pseudintermedius: Primarily an animal pathogen.
Staphylococcus argenteus: Rare and less commonly associated with such presentations.
The clinical scenario of a new heart murmur, systemic symptoms, and positive blood cultures for a virulent coagulase-negative staphylococcus strongly points towards Staphylococcus lugdunensis as the most likely cause.