From the Guidelines
The treatment for Staphylococcus pseudintermedius bacteremia with 2 positive blood cultures should involve a 2-4 week course of appropriate antibiotics based on susceptibility testing, with initial empiric therapy including intravenous beta-lactam antibiotics such as oxacillin or cefazolin if methicillin-susceptible, or vancomycin if methicillin-resistant strains are suspected. When considering the management of Staphylococcus pseudintermedius bacteremia, it's crucial to prioritize morbidity, mortality, and quality of life as outcomes. Although the provided evidence primarily focuses on Staphylococcus aureus bacteremia 1, the principles of antibiotic choice, source control, and treatment duration can be applied to Staphylococcus pseudintermedius bacteremia. Key considerations in the treatment of Staphylococcus pseudintermedius bacteremia include:
- Initial empiric therapy with intravenous beta-lactam antibiotics such as oxacillin or cefazolin for methicillin-susceptible strains, or vancomycin for methicillin-resistant strains
- Tailoring therapy according to susceptibility results
- Source control, including removal of potential foci of infection such as intravascular devices
- Repeating blood cultures to confirm clearance of bacteremia
- Considering infectious disease consultation due to the relatively uncommon nature of this pathogen in human bloodstream infections. Given the similarities between Staphylococcus aureus and Staphylococcus pseudintermedius, and the lack of specific guidelines for the latter, a treatment approach similar to that for Staphylococcus aureus bacteremia, as outlined in the provided evidence 1, can be considered, with adjustments based on susceptibility testing and individual patient factors.
From the Research
Treatment of Staphylococcus pseudintermedius Bacteremia
- The treatment of Staphylococcus pseudintermedius bacteremia is not directly addressed in the provided studies, but we can look at the treatment of similar infections for guidance 2, 3, 4, 5, 6.
- Staphylococcus pseudintermedius is a concern due to its close similarities to human pathogens in the Staphylococcus intermedius group (SIG) and its potential for multidrug resistance 4.
- Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia treatment may provide some insight, as vancomycin and daptomycin are standard therapies for MRSA bacteremia 3, 5.
Antibiotic Options
- Vancomycin is a standard treatment for resistant staphylococcal infections, but it carries specific risks, such as renal dysfunction 2.
- Daptomycin is an alternative to vancomycin, especially for MRSA isolates with high vancomycin minimum inhibitory concentrations 3.
- Linezolid has been shown to be effective against MRSA bacteremia, with comparable effectiveness and safety to vancomycin, teicoplanin, or daptomycin 5.
- Other antibiotics, such as ceftaroline, trimethoprim-sulfamethoxazole, and tigecycline, may also be effective against Staphylococcus pseudintermedius isolates 2, 6.
Susceptibility of Staphylococcus pseudintermedius Isolates
- Staphylococcus pseudintermedius isolates have been shown to be susceptible to various antibiotics, including ceftaroline, daptomycin, linezolid, and vancomycin 6.
- However, methicillin-resistant Staphylococcus pseudintermedius isolates may be less susceptible to certain antibiotics, such as doxycycline, clindamycin, and trimethoprim-sulfamethoxazole 6.