From the Guidelines
The recommended treatment for a wound infected with Staphylococcus aureus and Bacteroides pyogenes typically involves a combination of antibiotics that cover both organisms, with first-line therapy including intravenous vancomycin or daptomycin to target the S. aureus, combined with metronidazole or clindamycin to cover the anaerobic Bacteroides.
Key Considerations
- The choice of antibiotic regimen should be as targeted to likely pathogens and as narrow spectrum as possible, considering the culture and sensitivity results when available 1.
- Initial antibiotic therapy is usually empirical, and the regimen should include activity against Staphylococcus aureus and aerobic streptococci, with consideration of agents active against methicillin-resistant S. aureus for patients with risk factors for this pathogen or if the local prevalence is high 1.
- For less severe infections, oral options might include trimethoprim-sulfamethoxazole or doxycycline for S. aureus plus metronidazole for Bacteroides, typically for 7-14 days depending on infection severity.
Wound Care and Adjunctive Treatments
- Wound care is equally important, including regular cleaning, debridement of necrotic tissue if present, and appropriate dressing changes.
- Surgical drainage may be necessary for abscesses, and surgical procedures may be performed by any appropriately skilled healthcare provider to remove any necrotic soft tissue or accessible dead bone 1.
- The choice of a dressing should be based mainly on whether the wound is exudative or dry, with no convincing evidence supporting the use of topical antimicrobials for infected or uninfected diabetic foot wounds 1.
Duration of Therapy
- The duration of antibiotic therapy can likely be based on the extent of residual soft tissue or bone infection and dead bone, after any surgical procedure, with a suggested initial antibiotic course for a soft tissue infection of about 1–2 weeks for mild infections and 2–3 weeks for moderate to severe infections 1.
Adjusting Treatment
- Treatment should be adjusted based on culture and sensitivity results when available, and patients should complete the full course of antibiotics even if symptoms improve quickly to prevent recurrence or resistance development.
From the Research
Treatment Options for Staphylococcus aureus and Bacteroides pyogenes Infection
- The recommended treatment for a wound infected with Staphylococcus aureus and Bacteroides pyogenes depends on the severity of the infection and the susceptibility of the organisms to antibiotics 2, 3.
- For Staphylococcus aureus, methicillin-susceptible strains can be treated with penicillinase-resistant penicillins, first-generation cephalosporins, clindamycin, lincomycin, or erythromycin 2.
- For methicillin-resistant Staphylococcus aureus (MRSA), treatment options include vancomycin, daptomycin, or ceftobiprole 4.
- Bacteroides pyogenes is typically treated with antibiotics that are effective against anaerobic bacteria, such as metronidazole, clindamycin, or cefoxitin 2.
- The choice of antibiotic should be guided by the results of susceptibility testing and the severity of the infection 3, 4.
Antibiotic Resistance and Treatment Considerations
- Staphylococcus aureus is often resistant to penicillin, and methicillin-resistant strains are common in hospitals and are emerging in the community 2, 4.
- The use of antibiotics such as rifampicin and fusidic acid should be reserved for cases where other treatments have failed or are not tolerated 2.
- The development of antibiotic resistance is a concern, and treatment should be guided by susceptibility testing and local resistance patterns 3, 4.
Local Delivery of Antibiotics
- Local delivery of antibiotics, such as moxifloxacin, may be effective in treating Staphylococcus aureus-infected wounds, especially in cases where systemic antibiotic therapy is not effective or is contraindicated 5.
- The use of hydrogels or other topical formulations may enhance the delivery of antibiotics to the wound site and improve treatment outcomes 5.