0. Discussion To the best of our knowledge, this is

the first report of prevalence of S. lugdunensis in clinical specimens obtained from mainland China. An earlier case of S. lugdunensis was reported in a 31-year-old Chinese patient (suffering from right ear sinus) in Singapore in 2000 [23]. Recently, community acquired S. lugdunensis were reported in clinical infections associated with co-morbidities in Southern Taiwan [24]; however the study did not observe widespread antimicrobial resistance even though there was widespread genetic diversity in the confirmed isolates. In the current study, our detection rate was 0.7% (5/670), which is comparatively on the lower end [12, 14, 15], but similar to what has been reported in Korea [13]. In the revised this website manuscript, we have described in details (in the legend of Table 1) what –ve (negative)

signifies for the tube coagulase, slide coagulase, and latex agglutination selleck compound test, respectively. The latex agglutination test and slide coagulase test are used for rapid identification or for ruling out Staphylococcus aureus. However, some Staphylococcus isolates produce a membrane-bound form of the clumping factor, which can yield a positive result in slide coagulase and/or rapid latex agglutination tests, thus requiring the confirmatory tube coagulase test. However, an isolate that is positive in the Latex Agglutination test has a high probability of a positive slide coagulase test and our assay for Isolate 2 does not conform to this, whereas Isolate 4 does. In addition, recent results have shown that the

prevalence of the fibrinogen-binding adhesion (fbl) is 100% in Staphylococcus lugdunensis isolates Montelukast Sodium [25]. However, one recent study reported that of the 17 Staphylococcus lugdunensis isolates studied, though fbl gene could be detected in all cases, only 47% gave a positive slide coagulase test result [26]. This perhaps suggests that varying levels of fbl gene product dictates the apparent sensitivity of Staphylococcus lugdunensis isolates to slide coagulase test. On comparing the results for Isolate 2 and 4 (both positive for latex agglutination test, but only Isolate 4 positive in slide coagulase test), they differ markedly in drug resistance and β-lactamase expression, with Isolate 4 being susceptible to all drugs tested and the only isolate not expressing β-lactamase. It is difficult to say whether the fbl gene expression pattern dictates this apparent difference between these isolates; however, it will be very interesting to see in the future if there is any difference in sensitivity to latex agglutination and slide coagulase test based on fbl gene expression in Staphylococcus lugdunensis isolates. We used PYR and ODC tests to preliminarily screen CNS isolates, VITEK 2 GP and API 20 Staph to validate, and gap gene sequence to confirm S. lugdunensis isolates.