What is the recommended treatment for coagulase-negative staphylococci infections?

From the Guidelines

The recommended treatment for coagulase-negative staphylococci infections typically involves antibiotics for 5–7 days if the catheter is removed and for 10–14 days, in combination with antibiotic lock therapy, if the catheter is retained. This approach is based on the guidelines for the diagnosis and management of intravascular catheter-related infection, which suggest that for uncomplicated catheter-related bloodstream infections (CRBSI), treatment with antibiotics for 5–7 days is sufficient if the catheter is removed, while 10–14 days of treatment, including antibiotic lock therapy, is recommended if the catheter is retained 1.

Key Considerations

• The management of CRBSI due to coagulase-negative staphylococci should consider the complexity of the infection, with uncomplicated cases potentially being managed with shorter durations of antibiotic therapy and catheter removal.
• For patients with no intravascular or orthopedic hardware and whose catheter is removed, observation without antibiotics may be considered, provided additional blood cultures confirm the absence of bacteremia 1.
• The interpretation of blood cultures positive for coagulase-negative staphylococci can be challenging due to the commonality of these organisms as contaminants, but a high proportion of positive blood cultures from multiple sites can indicate true CRBSI 1.

Treatment Duration and Approach

• The duration of treatment varies based on the complexity of the infection and whether the catheter is removed or retained.
• For infections associated with tunneled central venous catheters (CVCs) or implantable devices, management strategies may include removal of the device and antibiotic therapy, with the duration of therapy dependent on the presence of complications such as septic thrombosis, endocarditis, or osteomyelitis 1.

Antibiotic Selection

• While specific antibiotic recommendations are not provided in the referenced guidelines, the choice of antibiotic should be guided by susceptibility patterns, with consideration for the high prevalence of methicillin resistance among coagulase-negative staphylococci.
• Vancomycin is often considered a first-line therapy for serious infections, but the final choice should be tailored to the specific organism's susceptibility profile and the patient's clinical condition.

Clinical Context

• The clinical context, including the presence of underlying conditions such as valvular heart disease or neutropenia, and the specific type of catheter or device involved, plays a crucial role in determining the management strategy for coagulase-negative staphylococcal infections.
• Close monitoring for signs of infection and consideration of a short course of antibiotics may be warranted in certain high-risk patients, even in the absence of definitive evidence of CRBSI 1.

From the FDA Drug Label

Vancomycin Injection is indicated in adults and pediatric patients for whom appropriate dosing with this formulation can be achieved [see Dosage and Administration (2) and Use in Specific Populations (8. 4)] for the treatment of septicemia due to: • Susceptible isolates of methicillin-resistant Staphylococcus aureus (MRSA) and coagulase negative staphylococci.

The recommended treatment for coagulase-negative staphylococci infections is Vancomycin Injection.

• Key points:
  • Vancomycin Injection is indicated for the treatment of septicemia, infective endocarditis, skin and skin structure infections, bone infections, and lower respiratory tract infections due to susceptible isolates of coagulase-negative staphylococci.
  • The dosage and administration of Vancomycin Injection should be based on the specific infection being treated and the patient's age, weight, and renal function.
  • Vancomycin Injection should be administered by intravenous infusion over 60 minutes or greater to reduce the risk of infusion-related adverse reactions 2.

From the Research

Treatment Options for Coagulase-Negative Staphylococci Infections

• Vancomycin is a useful bactericidal antibiotic for the treatment of serious staphylococcal infections, including coagulase-negative staphylococci, when penicillins and cephalosporins cannot be used 3.
• The susceptibility of coagulase-negative staphylococci to vancomycin, oxacillin, and other antibiotics can vary, with some species showing higher resistance rates 4, 5.
• Newer antibiotics such as telavancin, daptomycin, linezolid, and tigecycline have shown activity against coagulase-negative staphylococci, with daptomycin being particularly effective against methicillin-resistant strains 4, 6.
• Ceftaroline has also demonstrated potent in vitro activity against staphylococci with reduced susceptibility to linezolid, daptomycin, or vancomycin, and may be a valuable treatment option for infections caused by these multidrug-resistant staphylococci 7.

Antibiotic Resistance Patterns

• Coagulase-negative staphylococci have shown resistance to various antibiotics, including oxacillin, ciprofloxacin, and linezolid, with vancomycin resistance being a concern in some cases 4, 5, 6.
• The presence of the mecA gene can confer higher MICs for oxacillin, but does not influence MICs to all other antibiotics tested 4.
• Daptomycin has shown good activity against all coagulase-negative staphylococci isolates tested, with a susceptibility range between 0.032-1 mg/L and a modal value of 0.25 mg/L 6.

Clinical Implications

• The treatment of coagulase-negative staphylococci infections should be guided by antibiotic susceptibility testing, as resistance patterns can vary between species and isolates 4, 5, 6.
• Vancomycin and daptomycin may be useful treatment options for serious coagulase-negative staphylococci infections, particularly in cases where resistance to other antibiotics is a concern 3, 6.
• Ceftaroline may be a valuable treatment option for infections caused by multidrug-resistant staphylococci, including coagulase-negative staphylococci with reduced susceptibility to linezolid, daptomycin, or vancomycin 7.