What is the treatment for a coagulase-negative (CoNS) Staphylococcus urinary tract infection (UTI)?

From the Guidelines

The treatment for a coagulase-negative Staphylococcus (CoNS) urinary tract infection typically involves antibiotics based on susceptibility testing, with a recommended duration of 7 days for patients with prompt resolution of symptoms, as per the guidelines from the Infectious Diseases Society of America 1.

Key Considerations

• First-line treatment often includes trimethoprim-sulfamethoxazole (TMP-SMX) at a dose of 160/800 mg twice daily for 5-7 days, or nitrofurantoin 100 mg four times daily for 5-7 days.
• For patients with allergies or in cases of resistance, fluoroquinolones like ciprofloxacin 250-500 mg twice daily for 3-5 days may be used.
• In complicated cases or those with systemic symptoms, vancomycin might be necessary, especially for methicillin-resistant strains.

Important Notes

• CoNS UTIs are often considered contaminants rather than true infections, so clinical correlation is essential before initiating treatment.
• These bacteria frequently show resistance to multiple antibiotics due to biofilm formation and acquired resistance mechanisms, making susceptibility testing crucial for effective management.
• Follow-up urine cultures may be necessary to confirm resolution, particularly in complicated cases or recurrent infections.
• A urine specimen for culture should be obtained prior to initiating antimicrobial therapy for presumed CA-UTI because of the wide spectrum of potential infecting organisms and the increased likelihood of antimicrobial resistance 1.
• If an indwelling catheter has been in place for 12 weeks at the onset of CA-UTI and is still indicated, the catheter should be replaced to hasten resolution of symptoms and to reduce the risk of subsequent CA-bacteriuria and CA-UTI 1.

From the Research

Treatment of Coagulase-Negative Staphylococcus Urinary Tract Infections

• The treatment of coagulase-negative Staphylococcus (CoNS) urinary tract infections (UTIs) depends on the antibiotic susceptibility of the isolate 2, 3, 4, 5, 6.
• Studies have shown that CoNS isolates from urinary tract infections are often resistant to multiple antibiotics, including penicillin, tetracycline, methicillin, and sulfonamide 2, 5, 6.
• However, some antibiotics such as vancomycin, cefotaxime, and ciprofloxacin have been shown to be effective against CoNS isolates 3, 4.
• Daptomycin has also been shown to be a promising antibacterial agent for the treatment of complicated UTIs caused by gram-positive uropathogens, including CoNS 3.
• The emergence of teicoplanin-non-susceptible CoNS strains with inducible resistance to vancomycin has been reported, highlighting the need for vigilant surveillance of nosocomial isolates of CoNS 6.

Antibiotic Susceptibility of CoNS

• CoNS isolates have been shown to be susceptible to vancomycin, cefotaxime, and ciprofloxacin 3, 4.
• However, resistance to penicillin, tetracycline, methicillin, and sulfonamide is common among CoNS isolates 2, 5, 6.
• Clavulanate potentiated amoxycillin has been shown to be highly active against penicillin, ampicillin, and amoxycillin resistant CoNS isolates 4.

Clinical Implications

• The treatment of CoNS UTIs should be guided by antibiotic susceptibility testing to ensure effective treatment 2, 3, 4, 5, 6.
• The emergence of antibiotic-resistant CoNS strains highlights the need for prudent use of antibiotics and vigilant surveillance of nosocomial isolates of CoNS 6.