From the Guidelines
The treatment for Staphylococcus epidermidis diskitis typically involves a prolonged course of antibiotics, often lasting 6-12 weeks, with initial empiric therapy including vancomycin or daptomycin to cover methicillin-resistant strains, as recommended by the 2015 IDSA clinical practice guidelines 1. When treating Staphylococcus epidermidis diskitis, it is crucial to identify the offending pathogen through image-guided percutaneous needle aspiration biopsy, which is a relatively safe and inexpensive diagnostic tool 1.
- The decision to perform an image-guided biopsy or a percutaneous biopsy depends on the yield of an image-guided biopsy in a particular center and its availability.
- Empiric antimicrobial therapy is dependent on the host, the clinical situation, and the epidemiologic risk, as well as the local historical in vitro susceptibility data.
- Initial empiric therapy should include vancomycin (15-20 mg/kg IV every 8-12 hours) or daptomycin (6-8 mg/kg IV daily) to cover methicillin-resistant strains, as S. epidermidis frequently carries methicillin resistance.
- Once susceptibilities are available, therapy can be narrowed to more specific agents, such as nafcillin or oxacillin (2 g IV every 4 hours) for methicillin-sensitive strains.
- Some patients may be transitioned to oral antibiotics like linezolid (600 mg twice daily) or trimethoprim-sulfamethoxazole (1-2 double-strength tablets twice daily) after initial IV therapy and clinical improvement.
- Pain management is essential and may require opioid analgesics initially, transitioning to non-opioid options as pain improves.
- Bracing may be recommended to provide spinal stability during healing.
- Surgical intervention is generally reserved for cases with neurological deficits, spinal instability, significant abscess formation, or failure of conservative management.
- Blood cultures should be obtained before starting antibiotics, and inflammatory markers (ESR, CRP) should be monitored to assess treatment response.
From the Research
Treatment for Staphylococcus epidermidis (Staph epi) Diskitis
- The treatment for Staph epi diskitis typically involves antimicrobial therapy, with the choice of antibiotic depending on the susceptibility of the isolate 2.
- For methicillin-sensitive Staph epi infections, penicillin G, semisynthetic penicillinase-resistant penicillins, and cephalosporins are effective treatment options 2.
- However, for methicillin-resistant Staph epi infections, vancomycin is the drug of choice 2, 3, 4.
- Vancomycin can be used alone or in combination with other antibiotics, such as rifampin or gentamicin, for the treatment of serious infections caused by methicillin-resistant Staph epi 2, 5.
- In the case of diskitis, vancomycin has been shown to be effective in reducing bacterial loads, although the efficacy of other antibiotics, such as linezolid, may vary 6.
- The treatment of Staph epi diskitis may also involve the removal of any indwelling foreign devices or catheters, as these can serve as a source of infection 2.
Antibiotic Options
- Vancomycin: a bactericidal antibiotic that is effective against methicillin-resistant Staph epi 2, 3, 4.
- Rifampin: an antibiotic that can be used in combination with vancomycin for the treatment of serious Staph epi infections 2, 5.
- Linezolid: an antibiotic that has been approved for the treatment of MRSA infections, but its efficacy in treating diskitis is still being studied 6.
- Penicillin G: a beta-lactam antibiotic that is effective against methicillin-sensitive Staph epi infections 2.
- Cephalosporins: a class of beta-lactam antibiotics that are effective against methicillin-sensitive Staph epi infections 2.