From the Guidelines
Staphylococcus saprophyticus in urine should not be treated unless it is causing a urinary tract infection (UTI) with symptoms, as the current evidence suggests that asymptomatic bacteriuria (ASB) with this organism does not require treatment in most cases 1. The Infectious Diseases Society of America recommends against treating ASB in patients without symptoms, as it can lead to harm, including adverse effects, increasing costs, and contributing to antimicrobial resistance 1.
Key Considerations
- The presence of S. saprophyticus in urine does not necessarily indicate the need for treatment, as it can be a colonizer in some cases.
- Treatment of ASB with S. saprophyticus has not been shown to prevent symptomatic UTI, pyelonephritis, or renal scarring 1.
- The use of antibiotics for ASB can lead to harm, including adverse effects and the development of antimicrobial resistance 1.
Recommendations for Practice
- Patients with asymptomatic S. saprophyticus in their urine should not be treated with antibiotics unless they develop symptoms of a UTI.
- Patients with symptoms of a UTI, such as dysuria, frequency, or urgency, should be treated with antibiotics, with the choice of antibiotic depending on the severity of the infection and the susceptibility of the organism 1.
- Patients should be educated on the importance of completing the full course of antibiotics, even if symptoms resolve quickly, and to seek medical attention if symptoms worsen or do not improve within 48 hours of starting treatment.
From the FDA Drug Label
Urinary Tract Infections caused by ... Staphylococcus saprophyticus, or ... Acute Uncomplicated Cystitis in females caused by ... Staphylococcus saprophyticus.
Yes, Staphylococcus saprophyticus should be treated in the urine, as ciprofloxacin is indicated for the treatment of urinary tract infections caused by this microorganism 2.
- The drug label explicitly lists Staphylococcus saprophyticus as one of the microorganisms that can be treated with ciprofloxacin for urinary tract infections.
From the Research
Treatment of Staphylococcus saprophyticus in Urine
- Staphylococcus saprophyticus is a common cause of urinary tract infections (UTIs), particularly in young women 3.
- It is the second most frequent causative microorganism in acute uncomplicated UTIs in this demographic 4.
- The bacterium can cause symptomatic cystitis and renal involvement, and its presence in urine specimens should not be dismissed as contamination 3.
- Studies have shown that S. saprophyticus is susceptible to certain antibiotics, such as trimethoprim, trimethoprim/sulfamethoxazole, and nitrofurantoin 5.
- However, methicillin resistance is a concern, with 5.6% of isolates found to be resistant 5.
- Accurate strain identification and antimicrobial susceptibility testing are necessary to detect true bacteremia and guide appropriate treatment 6.
Antibiotic Treatment Options
- Trimethoprim, trimethoprim/sulfamethoxazole, and nitrofurantoin are recommended for the treatment of urinary S. saprophyticus infections 5.
- Ceftriaxone may not be effective against S. saprophyticus, with high minimum inhibitory concentrations (MICs) observed in some studies 7.
- Amoxicillin-clavulanic acid may also be ineffective, with variable MICs reported 7.
Clinical Considerations
- Patients with UTIs caused by S. saprophyticus may present with symptomatic cystitis and renal involvement 3.
- The urine sediment of a patient with UTI caused by S. saprophyticus has a characteristic appearance microscopically 3.
- Chemical screening methods for bacteriuria may not always succeed in diagnosing UTI caused by S. saprophyticus 3.
- Obstructive pyelonephritis can lead to S. saprophyticus bacteremia, highlighting the importance of prompt and effective treatment 6.