What are the recommended antibiotic treatments for a wound infection with Staphylococcus aureus and Pantoae agglomerans?

From the Guidelines

For a wound infection with Staphylococcus aureus and Pantoae agglomerans, the recommended antibiotic treatment typically includes a combination of antibiotics to cover both organisms, with trimethoprim-sulfamethoxazole (TMP-SMX) and ciprofloxacin being potential first-line options, as suggested by guidelines from the Infectious Diseases Society of America 1.

Key Considerations

• The choice of antibiotic should be guided by culture and susceptibility results, as well as the severity of the infection and the patient's clinical response.
• For methicillin-resistant S. aureus (MRSA), vancomycin may be necessary, especially in severe cases or when other treatments are not effective.
• Local wound care, including regular cleaning, debridement of necrotic tissue, and appropriate dressing changes, is essential alongside antibiotic therapy.

Antibiotic Options

• Trimethoprim-sulfamethoxazole (TMP-SMX): 1-2 double-strength tablets twice daily for adults, or 8-12 mg/kg/day (based on trimethoprim component) divided twice daily for children.
• Ciprofloxacin: 500-750 mg twice daily for adults or 20-30 mg/kg/day divided twice daily for children.
• Vancomycin (for MRSA): 15-20 mg/kg IV every 8-12 hours.

Treatment Duration

• Typically 7-14 days, depending on the severity of the infection and the patient's clinical response.

Important Notes

• Cultures and susceptibility testing should guide therapy adjustments.
• Severe infections may require initial intravenous therapy before transitioning to oral antibiotics once clinical improvement occurs.
• The use of rifampin as a single agent or as adjunctive therapy for the treatment of SSTI is not recommended, as stated in the guidelines 1.

From the FDA Drug Label

STAPHYLOCOCCUS AUREUS PANTOEA AGGLOMERANS Drug MIC Interps Drug MIC Interps CEFTAROLINE <=0.5 S AMOXICILLIN/CLA <=8/4 S CIPROFLOXACIN <=1 S AMPICILLIN >16 R CLINDAMYCIN <=0.5 R CEFAZOLIN <=2 S DAPTOMYCIN <=0.5 S CEFTAZIDIME <=1 S ERYTHROMYCIN >4 R CEFTRIAXONE <=1 S GENTAMICIN <=4 S CEFUROXIME 16 I LEVOFLOXACIN <=1 S CIPROFLOXACIN <=0.25 S LINEZOLID 2 S GENTAMICIN <=4 S OXACILLIN <=0.25 S LEVOFLOXACIN <=0.5 S RIFAMPIN <=1 S MEROPENEM <=1 S TETRACYCLINE <=4 S PIPERACILLIN/TA <=16 S TIGECYCLINE S TETRACYCLINE <=4 S TRIMETHOPRIM/SUL <=0.5/9.5 S TOBRAMYCIN <=2 S VANCOMYCIN 1 S TRIMETHOPRIM/SU <=2/38 S

The recommended antibiotic treatments for a wound infection with Staphylococcus aureus and Pantoae agglomerans are:

• Ceftaroline: has shown susceptibility with a MIC of <=0.5
• Daptomycin: has shown susceptibility with a MIC of <=0.5
• Vancomycin: has shown susceptibility with a MIC of 1
• Linezolid: has shown susceptibility with a MIC of 2
• Tigecycline: has shown susceptibility For Pantoae agglomerans:
• Amoxicillin/Clavulanate: has shown susceptibility with a MIC of <=8/4
• Cefazolin: has shown susceptibility with a MIC of <=2
• Ceftazidime: has shown susceptibility with a MIC of <=1
• Ceftriaxone: has shown susceptibility with a MIC of <=1
• Levofloxacin: has shown susceptibility with a MIC of <=0.5
• Meropenem: has shown susceptibility with a MIC of <=1
• Piperacillin/Tazobactam: has shown susceptibility with a MIC of <=16 2 2

From the Research

Antibiotic Treatment Options for Staphylococcus aureus and Pantoae agglomerans

The wound culture results indicate the presence of Staphylococcus aureus and Pantoae agglomerans. Based on the provided evidence, the following antibiotic treatment options are recommended:

• For Staphylococcus aureus:
  • Ceftaroline 3, 4
  • Daptomycin 5, 6
  • Linezolid 5, 4
  • Vancomycin 7, 5, 4, 6
• For Pantoae agglomerans:
  • Amoxicillin-clavulanate
  • Ampicillin-sulbactam
  • Piperacillin-tazobactam
  • Cefazolin
  • Ceftazidime
  • Ceftriaxone
  • Gentamicin
  • Levofloxacin
  • Meropenem
  • Trimethoprim-sulfamethoxazole

Considerations for Antibiotic Resistance

• Staphylococcus aureus is presumed to be resistant to clindamycin based on detection of inducible clindamycin resistance (D-test positive) 7.
• More than 90% of S. aureus are resistant to penicillin in the United States, and routine testing is not always indicated for penicillins 7.
• The use of rifampicin should not be used alone for antimicrobial therapy 7.

Recommended Treatment Approach

Based on the provided evidence, a combination of antibiotics may be effective in treating the wound infection caused by Staphylococcus aureus and Pantoae agglomerans. The choice of antibiotic should be guided by the susceptibility results and the severity of the infection. It is essential to consult with a healthcare professional to determine the best course of treatment.