Zoonotic Staphylococcus pseudintermedius sinonasal infections: risk factors and resistance patterns

• Published in: International forum of allergy & rhinology 2019-07, Vol.9 (7), p.724-729
• Main Authors: Ference, Elisabeth H., Danielian, Arman, Kim, Han Wool, Yoo, Fredrick, Kuan, Edward C., Suh, Jeffrey D.
• Format: Article
• Language: English
• Subjects: Animals; Anti-Bacterial Agents - therapeutic use; Cat Diseases - transmission; Cats; Chronic Disease; chronic rhinosinusitis; Clindamycin; Dog Diseases - transmission; Dogs; Doxycycline; Drug Resistance, Bacterial; endoscopic sinus surgery; Female; Humans; immunodeficiency; Immunosuppression; Infections; irrigations; Male; Middle Aged; Multidrug resistance; Nasal Mucosa - microbiology; Oxacillin; Patients; Penicillin; Pets - microbiology; postoperative; Rhinitis; Rhinitis - drug therapy; Rhinitis - microbiology; Rhinosinusitis; Risk Factors; Sinusitis; Sinusitis - drug therapy; Sinusitis - microbiology; Skin; Staphylococcal Infections - drug therapy; Staphylococcal Infections - microbiology; Staphylococcal Infections - veterinary; Staphylococcus; Staphylococcus pseudintermedius; Sulfamethoxazole; Surgery; Trimethoprim; Zoonoses - transmission
• ISSN: 2042-6976; 2042-6984
• DOI: 10.1002/alr.22329

Background Staphylococcus pseudintermedius is a Gram‐positive bacteria that colonizes the skin and orifices of healthy canines and felines. It has recently been identified as a cause of sinonasal infections in humans. Methods This study was a retrospective review of chronic rhinosinusitis (CRS) patients with S pseudintermedius‒positive sinonasal cultures and comparison to a prospectively collected control sample of patients who underwent culture for acute exacerbation of CRS. Results Thirty‐three patients with CRS had nasal cultures positive for S pseudintermedius. Of the positive cultures, 82% demonstrated resistance to penicillin, 58% to clindamycin, 45% to trimethoprim‐sulfamethoxazole, 33% to doxycycline, and 27% to oxacillin. Ninety‐seven percent of patients with S pseudintermedius were dog owners. There was no significant difference in age, gender, recent endoscopic sinus surgery, or immunosuppression or deficiency between S pseudintermedius patients and patients undergoing culture for acute exacerbation of CRS, but S pseudintermedius infection was associated with dog ownership (p < 0.01). S pseudintermedius infection was not associated with behaviors such as a dog sleeping in the bedroom, routinely licking humans, or being diagnosed with a soft tissue infection. Conclusion Although a rare cause of infection in humans, S pseudintermedius should be considered in sinonasal infections refractory to standard medical management, especially if the patient has regular contact with dogs. S pseudintermedius is not readily identified with routine laboratory diagnostic testing and often demonstrates multidrug resistance, making it a pathogen that is commonly misdiagnosed and difficult to treat.