From the Guidelines
Staphylococcus epidermidis on blood culture should be treated if it represents a true infection rather than contamination, with treatment warranted when there are multiple positive blood cultures, clinical signs of infection, presence of prosthetic devices or implants, or in immunocompromised patients. The decision to treat should be based on clinical correlation, as S. epidermidis is a common skin commensal and frequently contaminates blood cultures 1.
Treatment Approach
- The typical treatment regimen includes vancomycin 15-20 mg/kg IV every 8-12 hours (adjusted based on levels and renal function) for 10-14 days for uncomplicated bacteremia, or 4-6 weeks for endocarditis or device-related infections.
- Alternative options include daptomycin 6-8 mg/kg IV daily or linezolid 600 mg IV/oral twice daily.
- For methicillin-sensitive strains, nafcillin or oxacillin 2 g IV every 4 hours can be used.
Device Management
- Device removal should be considered when feasible, especially for infected catheters or temporary implants.
- Antibiotic lock therapy may be used in conjunction with systemic antibiotic therapy for catheter-related bloodstream infections, with the goal of sterilizing the catheter lumen 1.
Key Considerations
- Clinical assessment to identify the source and extent of the infection, with elimination and/or debridement of other sites of infection, is crucial.
- Echocardiography is recommended for all adult patients with bacteremia to rule out endocarditis 1.
- The organism often forms biofilms on medical devices and frequently carries methicillin resistance, making treatment challenging in device-associated infections. Some key points to consider when treating S. epidermidis infections include:
- The use of antibiotic lock therapy, which has been shown to be effective in sterilizing catheters and reducing the risk of recurrence 1.
- The importance of clinical correlation in determining the need for treatment, as S. epidermidis is a common contaminant of blood cultures 1.
- The need for individualized treatment approaches, taking into account the specific circumstances of each patient, including the presence of prosthetic devices or implants, and the patient's overall health status.
From the Research
Treatment of Staphylococcus epidermidis on Blood Culture
- Staphylococcus epidermidis is often regarded as a culture contaminant, but its importance as a pathogen has been recognized in recent years 2
- Staph. epidermidis is a common cause of infections involving indwelling foreign devices, surgical wound infections, and bacteremia in immunocompromised patients 2
- Treatment usually consists of antimicrobial therapy and removal of indwelling catheters or devices 2
Antimicrobial Therapy
- Penicillin G, semisynthetic penicillinase-resistant penicillins, and cephalosporins are effective for the treatment of methicillin-sensitive Staph. epidermidis infections 2
- Vancomycin is the drug of choice for infections caused by methicillin-resistant organisms 2, 3, 4
- Vancomycin, combined with rifampin or gentamicin, or both, is recommended for therapy of serious infections caused by methicillin-resistant strains 2
Resistance to Antimicrobial Agents
- Methicillin-resistant Staph. epidermidis isolates are frequently encountered, with 41% of isolates resistant to methicillin in one study 3
- Vancomycin-resistant Staph. epidermidis isolates have been reported, with decreased vancomycin susceptibility observed in some studies 5
- Resistance to gentamicin is also common, with 91% of isolates resistant in one study 4