What is the treatment duration for coagulase-negative Staphylococcus (Staph) bacteremia?

From the Guidelines

Treatment duration for coagulase-negative Staphylococcus bacteremia is typically 5-7 days if the catheter is removed, and 10-14 days if the catheter is retained.

Key Considerations

• The treatment duration may vary depending on the presence of complications, such as septic thrombosis, endocarditis, or osteomyelitis, which may require longer treatment durations of 4-6 weeks or more 1.
• The use of antibiotic lock therapy (ALT) may be beneficial in salvaging the catheter, particularly for coagulase-negative staphylococcal infections, with treatment durations of 10-14 days 1.
• The decision to remove the catheter or retain it with ALT should be based on the individual patient's clinical presentation and the presence of complications.

Treatment Guidelines

• For uncomplicated coagulase-negative staphylococcal bacteremia, treatment with antibiotics for 5-7 days is recommended if the catheter is removed 1.
• For complicated infections, treatment with antibiotics for 10-14 days or more may be necessary, depending on the specific complication 1.
• ALT may be used in conjunction with systemic antibiotic therapy to salvage the catheter, with treatment durations of 10-14 days 1.

Important Considerations

• The diagnosis of coagulase-negative staphylococcal bacteremia should be based on multiple positive blood culture results, quantitative cultures of blood samples drawn from a catheter, and isolation of the same organism from quantitative catheter cultures and percutaneous blood cultures 1.
• The use of ALT should be based on a high likelihood of intraluminal infection, and patients should be selected for this treatment based on clinical presentation and microbiological data 1.

From the Research

Treatment Duration for Coagulase-Negative Staphylococcus Bacteremia

• The treatment duration for coagulase-negative Staphylococcus bacteremia is not explicitly stated in the provided studies, but some studies provide information on the duration of antibiotic therapy.
• A study published in 2019 2 found that withholding antimicrobial therapy in CoNS-CRBSI is neither associated with short-term complications nor with long-term recurrences, suggesting that a shorter treatment duration may be sufficient in some cases.
• Another study published in 2018 3 found that the use of an algorithm to guide testing and treatment compared with usual care resulted in a noninferior rate of clinical success, with a mean duration of therapy of 4.4 days for algorithm-based therapy vs 6.2 days for usual practice.
• A study published in 2024 4 found that the median scheduled duration of antibiotic therapy was 14.9 days and 19.5 days for patients with vancomycin MIC <2 µg/mL and ≥2 µg/mL, respectively, but there was no difference in clinical outcomes between the two groups.
• A study published in 2015 5 found that the 30-day mortality was 24% and CoNS bacteremia-related mortality was 14%, but there was no difference in the CoNS bacteremia-related mortality between the group with an inappropriate empirical treatment and that with an appropriate treatment.

Factors Affecting Treatment Duration

• The treatment duration may be affected by factors such as the presence of comorbid diseases, Pitt bacteremia scores, and retention of eradicable focus 5.
• The use of an algorithm to guide testing and treatment may also affect the treatment duration 3.
• The vancomycin MIC may not be a significant factor in determining the treatment duration, as a study found no difference in clinical outcomes between patients with vancomycin MIC <2 µg/mL and ≥2 µg/mL 4.