Catalase-negative Staphylococcus aureus: a rare cause of catheter-related bacteremia
Authors: B. Friedberg, E. Hauer, M. Belkhirat, J. Watine, A. Le Coustumier
Journal: Clinical Microbiology and Infection (2003)

A 61-year-old man was admitted to hospital with major agitation and confusion due to hypercalcemia (4.63 mmol/L) secondary to lymphoma with renal failure (creatininemia = 301 mmol/L). A jugular catheter was inserted and used to infuse clodronate and to rehydrate the patient (hypernatremia of 152 mmol/L). On the fourth day, the catheter was withdrawn because of fever (40 °C). The catheter was inoculated on the usual culture media, which were incubated at 37 °C under normal and CO2-enriched atmospheres. After 24 h, colonies that looked like Staphylococcus had grown, despite the catalase test being negative. Staphylococcus aureus was strongly suspected because the Pastorex Staph test (Biorad, Marne La Coquette, France) and Rapidec Staph test (Biomérieux, Marcy l'Etoile, France) were both positive. The results of the agar diffusion antibiogram are summarized in Table 1 [1Soussy CJ Carret G Cavallo JD et al.Antibiogram Committee of the French Microbiology Society, Report, 2000-2001.Pathol Biol. 2000; 48: 832-871PubMed Google Scholar]. Two blood cultures (Bactalert 120, Organon Teknika, Oklahoma City, OK, USA), which were performed when the catheter was removed, were positive in less than 24 h with the same organism. The S. aureus identification was confirmed by the ‘Institut de Bactériologie’ at the Strasbourg teaching hospital (Alsace, France): the coagulase test was positive with rabbit plasma (Biorad), and the identification profile was acceptable at 99.4% with the ID32 Staph device (Biomérieux).Table 1Principal features of catalase-negative S. aureus responsible for 37 cases of human carriage or infection [3Silhadi KS. Caractérisation de souches de Staphylococcus aureus à catalase négative isolées dans six sites différents. Th D Pharm, Lyon, 1998.Google Scholar, 4Over U Tuc Y Soyletir G Catalase-negative Staphylococcus aureus: a rare isolate of human infection.Clin Microbiol Infect. 2000; 6: 681-682Crossref PubMed Scopus (20) Google Scholar, 5Al-Awagi A Kambal AM El-Boghadadly S El-sheikh M Cellulitis due to catalase-negative Staphylococcus aureus.Infection. 1996; 24: 54Crossref PubMed Scopus (8) Google Scholar, 6Bertrand X Huguenin Y Talon D First report of a catalase-negative methicillin-resistant Staphylococcus aureus.Diagn Microbiol Infect Dis. 2002; 43: 245-246Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar, 7Carlson JR Gorin DC Catalase-negative Staphylococcus aureus.Clin Microbiol News. 1981; 3: 33-34Abstract Full Text PDF Scopus (10) Google Scholar, 8Crawford PA Hand MF Richards SJ Masterton RG Septicaemia caused by a catalase-negative Staphylococcus aureus.J Hosp Infect. 1994; 27 (comment: J Hosp Infect 1995; 30: 159).: 320-322Abstract Full Text PDF PubMed Scopus (12) Google Scholar, 9Klepies SL Boord M Sweilk-Jones S Catalase-negative Staphylococcus aureus.Clin Microbiol News. 1996; 18: 126-127Abstract Full Text PDF Scopus (7) Google Scholar, 10Le Coustumier Al, Brun Y, Bès M, Le Coustumier An, Fleurette J, Etienne J. A stunning outbreak of infections due to catalase negative Staphylococcus aureus [abstract P288]. In: 8th International Symposium on Staphylococci and Staphylococcal Infections, Aix-les-Bains. Aix-les-Bains, France, 1996: p288.Google Scholar, 11Lee N Chang LC Chiu CP A case of carbuncle caused by a catalase-negative strain of staphylococcus aureus.Diagn Microbiol Infect Dis. 1996; 24: 221-223Abstract Full Text PDF PubMed Scopus (10) Google Scholar, 12Lucas PR Seeley HW A catalase-negative Micrococcus pyogenes var. aureus.J Bacteriol. 1955; 69: 231PubMed Google Scholar, 13Millar M Wilcock A Sanderson Y Kite P McDonnell MK Catalase negative Staphylococcus aureus.J Clin Pathol. 1986; 39: 695Crossref PubMed Scopus (13) Google Scholar, 14Nice CS Catalase-negative Staphylococcus aureus isolated from a leg ulcer.J Hosp Infect. 1995; 30 (comment: J Hosp Infect 1994; 27: 320-2).: 159Abstract Full Text PDF PubMed Scopus (8) Google Scholar, 15Schumacher-Perdreau F Peters G Kocur M Chemical and physiological properties of a catalase-negative Staphylococcus aureus strain.in: Jeljaszewicz J Staphylococci and staphylococcal infections, supplement 10. Gustav Fischer Verlag, Stuttgart1981: 61-65Google Scholar, 16Tu KK Palutke WA Isolation and characterization of a catalase-negative strain of Staphylococcus aureus.J Clin Microbiol. 1976; 3: 77-78PubMed Google Scholar]PublicationsYear of publicationType of infection (number of patients)Resistance to antibioticsbAntibiotics: P, penicillin; Ox, oxacillin; K, kanamycin; Tm, tobramycin; G, gentamicin; E, erythromycin; Cl, clindamycin; Of, ofloxacin; T, tetracycline; Fu, fusidic acid; multisusceptible? = lack of information about antibiotics tested; antibiotics in parentheses = results vary according to isolates.Silhadi [3Silhadi KS. Caractérisation de souches de Staphylococcus aureus à catalase négative isolées dans six sites différents. Th D Pharm, Lyon, 1998.Google Scholar]1998Septicemia (1), infected wound (1), two nosocomial epidemics (9), unknown (7)aObservations already published by Le Coustumier et al. not taken into account.Very variable, from multisusceptible to multiresistantOver et al. [4Over U Tuc Y Soyletir G Catalase-negative Staphylococcus aureus: a rare isolate of human infection.Clin Microbiol Infect. 2000; 6: 681-682Crossref PubMed Scopus (20) Google Scholar]2000Abcess (1)Susceptible methicillinAl-Awagi et al. [5Al-Awagi A Kambal AM El-Boghadadly S El-sheikh M Cellulitis due to catalase-negative Staphylococcus aureus.Infection. 1996; 24: 54Crossref PubMed Scopus (8) Google Scholar]1996Leg ulcer (1)P, TBertrand et al. [6Bertrand X Huguenin Y Talon D First report of a catalase-negative methicillin-resistant Staphylococcus aureus.Diagn Microbiol Infect Dis. 2002; 43: 245-246Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar]2002Bronchial infection (1)P, Ox, Tm, E, OfCarlson and Gorin [7Carlson JR Gorin DC Catalase-negative Staphylococcus aureus.Clin Microbiol News. 1981; 3: 33-34Abstract Full Text PDF Scopus (10) Google Scholar]1981Leg ulcer (1)PCrawford et al. [8Crawford PA Hand MF Richards SJ Masterton RG Septicaemia caused by a catalase-negative Staphylococcus aureus.J Hosp Infect. 1994; 27 (comment: J Hosp Infect 1995; 30: 159).: 320-322Abstract Full Text PDF PubMed Scopus (12) Google Scholar]1994Septicemia (1)Multisusceptible?Klepies et al. [9Klepies SL Boord M Sweilk-Jones S Catalase-negative Staphylococcus aureus.Clin Microbiol News. 1996; 18: 126-127Abstract Full Text PDF Scopus (7) Google Scholar]1996Infected wound (1)P, E, ClLe Coustumier et al. [10Le Coustumier Al, Brun Y, Bès M, Le Coustumier An, Fleurette J, Etienne J. A stunning outbreak of infections due to catalase negative Staphylococcus aureus [abstract P288]. In: 8th International Symposium on Staphylococci and Staphylococcal Infections, Aix-les-Bains. Aix-les-Bains, France, 1996: p288.Google Scholar]1996Postsurgical urinary infections (6)P (Ox), KTm(G), E, Of (Fu)Lee et al. [11Lee N Chang LC Chiu CP A case of carbuncle caused by a catalase-negative strain of staphylococcus aureus.Diagn Microbiol Infect Dis. 1996; 24: 221-223Abstract Full Text PDF PubMed Scopus (10) Google Scholar]1996Carbuncle (1)?Lucas and Seeley [12Lucas PR Seeley HW A catalase-negative Micrococcus pyogenes var. aureus.J Bacteriol. 1955; 69: 231PubMed Google Scholar]1955Urinary carriage (1)?Millar et al. [13Millar M Wilcock A Sanderson Y Kite P McDonnell MK Catalase negative Staphylococcus aureus.J Clin Pathol. 1986; 39: 695Crossref PubMed Scopus (13) Google Scholar]1986Paronychia (1)PNice [14Nice CS Catalase-negative Staphylococcus aureus isolated from a leg ulcer.J Hosp Infect. 1995; 30 (comment: J Hosp Infect 1994; 27: 320-2).: 159Abstract Full Text PDF PubMed Scopus (8) Google Scholar]1995Leg ulcer (1)PSchumacher-Perdreau et al. [15Schumacher-Perdreau F Peters G Kocur M Chemical and physiological properties of a catalase-negative Staphylococcus aureus strain.in: Jeljaszewicz J Staphylococci and staphylococcal infections, supplement 10. Gustav Fischer Verlag, Stuttgart1981: 61-65Google Scholar]1981Pyelonephritis (1)?Tu and Palutke [16Tu KK Palutke WA Isolation and characterization of a catalase-negative strain of Staphylococcus aureus.J Clin Microbiol. 1976; 3: 77-78PubMed Google Scholar]1976Septicemia (1)PPresent observation2003Cathether-related bacteremia (1)Pa Observations already published by Le Coustumier et al. not taken into account.b Antibiotics: P, penicillin; Ox, oxacillin; K, kanamycin; Tm, tobramycin; G, gentamicin; E, erythromycin; Cl, clindamycin; Of, ofloxacin; T, tetracycline; Fu, fusidic acid; multisusceptible? = lack of information about antibiotics tested; antibiotics in parentheses = results vary according to isolates. Open table in a new tab The feverish episode subsided under oxacillin therapy, 1 g × 3/day for 7 days. The production of catalase is a more or less constant feature of Staphylococcus spp. It is universally used to distinguish, among Gram-positive cocci, Staphylococcus from Streptococcus. In the case of an atypical isolate such as ours, incorrect or delayed identifications are possible, especially in specimens containing more than one bacterial species. Catalase is an oxidoreductase that allows bacteria to better resist intracellular killing by hydrogen peroxide [2Brun Y Bes M Précis de bactériologie clinique.in: Freney J Chapitre Staphylococcus. Edition ESKA, 2000: 802Google Scholar,3Silhadi KS. Caractérisation de souches de Staphylococcus aureus à catalase négative isolées dans six sites différents. Th D Pharm, Lyon, 1998.Google Scholar]. It has been suggested that catalase might be a virulence factor in S. aureus [3Silhadi KS. Caractérisation de souches de Staphylococcus aureus à catalase négative isolées dans six sites différents. Th D Pharm, Lyon, 1998.Google Scholar,4Over U Tuc Y Soyletir G Catalase-negative Staphylococcus aureus: a rare isolate of human infection.Clin Microbiol Infect. 2000; 6: 681-682Crossref PubMed Scopus (20) Google Scholar]. In our case, the isolate was responsible for fever which subsided after removal of the catheter and after oxacillin treatment, but the patient was immunosuppressed because of cancer. Reports in which such isolates were responsible for infection in immunocompetent subjects are very rare [3Silhadi KS. Caractérisation de souches de Staphylococcus aureus à catalase négative isolées dans six sites différents. Th D Pharm, Lyon, 1998.Google Scholar,4Over U Tuc Y Soyletir G Catalase-negative Staphylococcus aureus: a rare isolate of human infection.Clin Microbiol Infect. 2000; 6: 681-682Crossref PubMed Scopus (20) Google Scholar], and represent, at best, a very small minority of the 36 other published cases of human carriage or infection with catalase-negative S. aureus that we have retrieved from the biomedical literature, and which we have summarized in Table 1 [3Silhadi KS. Caractérisation de souches de Staphylococcus aureus à catalase négative isolées dans six sites différents. Th D Pharm, Lyon, 1998.Google Scholar, 4Over U Tuc Y Soyletir G Catalase-negative Staphylococcus aureus: a rare isolate of human infection.Clin Microbiol Infect. 2000; 6: 681-682Crossref PubMed Scopus (20) Google Scholar, 5Al-Awagi A Kambal AM El-Boghadadly S El-sheikh M Cellulitis due to catalase-negative Staphylococcus aureus.Infection. 1996; 24: 54Crossref PubMed Scopus (8) Google Scholar, 6Bertrand X Huguenin Y Talon D First report of a catalase-negative methicillin-resistant Staphylococcus aureus.Diagn Microbiol Infect Dis. 2002; 43: 245-246Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar, 7Carlson JR Gorin DC Catalase-negative Staphylococcus aureus.Clin Microbiol News. 1981; 3: 33-34Abstract Full Text PDF Scopus (10) Google Scholar, 8Crawford PA Hand MF Richards SJ Masterton RG Septicaemia caused by a catalase-negative Staphylococcus aureus.J Hosp Infect. 1994; 27 (comment: J Hosp Infect 1995; 30: 159).: 320-322Abstract Full Text PDF PubMed Scopus (12) Google Scholar, 9Klepies SL Boord M Sweilk-Jones S Catalase-negative Staphylococcus aureus.Clin Microbiol News. 1996; 18: 126-127Abstract Full Text PDF Scopus (7) Google Scholar, 10Le Coustumier Al, Brun Y, Bès M, Le Coustumier An, Fleurette J, Etienne J. A stunning outbreak of infections due to catalase negative Staphylococcus aureus [abstract P288]. In: 8th International Symposium on Staphylococci and Staphylococcal Infections, Aix-les-Bains. Aix-les-Bains, France, 1996: p288.Google Scholar, 11Lee N Chang LC Chiu CP A case of carbuncle caused by a catalase-negative strain of staphylococcus aureus.Diagn Microbiol Infect Dis. 1996; 24: 221-223Abstract Full Text PDF PubMed Scopus (10) Google Scholar, 12Lucas PR Seeley HW A catalase-negative Micrococcus pyogenes var. aureus.J Bacteriol. 1955; 69: 231PubMed Google Scholar, 13Millar M Wilcock A Sanderson Y Kite P McDonnell MK Catalase negative Staphylococcus aureus.J Clin Pathol. 1986; 39: 695Crossref PubMed Scopus (13) Google Scholar, 14Nice CS Catalase-negative Staphylococcus aureus isolated from a leg ulcer.J Hosp Infect. 1995; 30 (comment: J Hosp Infect 1994; 27: 320-2).: 159Abstract Full Text PDF PubMed Scopus (8) Google Scholar, 15Schumacher-Perdreau F Peters G Kocur M Chemical and physiological properties of a catalase-negative Staphylococcus aureus strain.in: Jeljaszewicz J Staphylococci and staphylococcal infections, supplement 10. Gustav Fischer Verlag, Stuttgart1981: 61-65Google Scholar, 16Tu KK Palutke WA Isolation and characterization of a catalase-negative strain of Staphylococcus aureus.J Clin Microbiol. 1976; 3: 77-78PubMed Google Scholar]. The uncertainties regarding the pathogenic role of this organism seem to us to constitute a good reason to publish observations such as ours. To our knowledge, except for the publications of Silhadi and of Le Coustumier et al. [3Silhadi KS. Caractérisation de souches de Staphylococcus aureus à catalase négative isolées dans six sites différents. Th D Pharm, Lyon, 1998.Google Scholar,10Le Coustumier Al, Brun Y, Bès M, Le Coustumier An, Fleurette J, Etienne J. A stunning outbreak of infections due to catalase negative Staphylococcus aureus [abstract P288]. In: 8th International Symposium on Staphylococci and Staphylococcal Infections, Aix-les-Bains. Aix-les-Bains, France, 1996: p288.Google Scholar], all other published observations of catalase-negative S. aureus concerned isolated cases. What was particularly remarkable in the report of Le Coustumier was not only the fact that their catalase-negative isolates of S. aureus were responsible for an outbreak of postsurgical urinary infections in six hospitalized patients, over a period of 14 months, but also that their isolates were heterogeneously resistant to methicillin at the beginning of the outbreak, and then became homogeneously resistant; finally, at the end of the outbreak, the catalase-negative isolates had become fully susceptible to methicillin. The clonal nature of the epidemic isolates of Le Coustumier et al. was proved later by Silhadi [3Silhadi KS. Caractérisation de souches de Staphylococcus aureus à catalase négative isolées dans six sites différents. Th D Pharm, Lyon, 1998.Google Scholar]. In his retrospective study, Silhadi studied 34 catalase-negative isolates collected by the French National Reference Center for Staphylococcus (CNR, J. Etienne, Hôpital Edouard Herriot, Lyon, France), which had been obtained from 24 patients in ten geographic areas, far from each other, in France or Switzerland. Silhadi demonstrated that apart from the epidemic isolates of Le Coustumier et al., and from the isolates obtained during two other nosocomial outbreaks, all other isolates belonged to different clones. Silhadi also explored one of the possible mechanisms that might be responsible for the loss of catalase activity in the 34 isolates from the CNR, heme biosynthesis deficiency, but he failed to clearly demonstrate any such deficiency [3Silhadi KS. Caractérisation de souches de Staphylococcus aureus à catalase négative isolées dans six sites différents. Th D Pharm, Lyon, 1998.Google Scholar]. More recently, Bertrand et al. [6Bertrand X Huguenin Y Talon D First report of a catalase-negative methicillin-resistant Staphylococcus aureus.Diagn Microbiol Infect Dis. 2002; 43: 245-246Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar] showed that their methicillin-resistant and catalase-negative isolate belonged to the major epidemic clone that has spread in their region. It is also noteworthy that the 37 available observations originate from various parts of the world and that the antibiotic resistance profiles are highly variable (Table 1). In conclusion, we draw colleagues' attention to this sort of unusual isolate, which may be worth reporting and/or sending to regional or national reference centers.