Do I need to treat Staphylococcus hominis infections?

Treatment of Staphylococcus hominis Infections

Staphylococcus hominis infections should be treated with appropriate antibiotics when they cause invasive disease, are associated with prosthetic material, or occur in immunocompromised patients. 1, 2

When to Treat S. hominis Infections

Treatment decisions for S. hominis should be based on:

1. Clinical presentation and severity:

   • Treat if causing invasive infections (bacteremia, endocarditis, discitis) 1
   • Treat if associated with prosthetic material or foreign bodies 2
   • Treat if causing purulent skin and soft tissue infections 3

2. Patient factors:

   • Immunocompromised status
   • Presence of comorbidities
   • Extremes of age

Treatment Approach

For Skin and Soft Tissue Infections (SSTIs):

• For purulent SSTIs (abscesses):

  • Primary treatment: Incision and drainage 3
  • Antibiotic therapy if:
    • Severe/extensive disease or rapid progression with cellulitis
    • Signs of systemic illness
    • Comorbidities or immunosuppression
    • Extremes of age
    • Difficult-to-drain locations (face, hand, genitalia)
    • Associated septic phlebitis
    • No response to drainage alone 3

• For purulent cellulitis:

  • Empiric therapy for CA-MRSA pending culture results
  • Duration: 5-10 days based on clinical response 3

• For non-purulent cellulitis:

  • Empiric therapy for β-hemolytic streptococci
  • Add CA-MRSA coverage if no response to β-lactam therapy or if systemic toxicity present 3

Antibiotic Options:

• Outpatient oral options:

  • Clindamycin (A-II)
  • Trimethoprim-sulfamethoxazole (TMP-SMX) (A-II)
  • Tetracyclines (doxycycline or minocycline) (A-II)
  • Linezolid (A-II) 3

• For hospitalized patients with complicated SSTIs:

  • IV vancomycin (A-I)
  • Oral/IV linezolid 600 mg twice daily (A-I)
  • Daptomycin 4 mg/kg/dose IV once daily (A-I)
  • Telavancin 10 mg/kg/dose IV once daily (A-I)
  • Clindamycin 600 mg IV/PO three times daily (A-III) 3

Special Considerations:

• For prosthetic material-associated infections:

  • Consider removal of foreign material when possible 2
  • Longer duration of therapy may be needed

• For invasive infections (bacteremia, endocarditis):

  • IV antibiotics based on susceptibility testing
  • Consider surgical intervention for source control 1

• For pediatric patients:

  • Mupirocin 2% topical ointment for minor skin infections (A-III)
  • Avoid tetracyclines in children <8 years (A-II)
  • For hospitalized children with complicated SSTIs:
    • Vancomycin (A-II)
    • Clindamycin if resistance rates are low (A-II)
    • Linezolid for children >12 years: 600 mg PO/IV twice daily
    • Linezolid for children <12 years: 10 mg/kg/dose PO/IV every 8 hours 3

Important Considerations

• Obtain cultures from abscesses and purulent SSTIs in patients:

  • Receiving antibiotic therapy
  • With severe local infection or systemic illness
  • Who have not responded to initial treatment
  • When concerned about a cluster or outbreak 3

• Antimicrobial resistance:

  • S. hominis strains may be multidrug-resistant 4
  • Many strains carry the mecA gene (methicillin resistance) 4
  • All strains in recent studies remained sensitive to vancomycin, though some showed reduced sensitivity 4

• Duration of therapy:

  • 5-10 days for uncomplicated SSTIs
  • 7-14 days for complicated SSTIs
  • Longer duration may be needed for invasive infections 3

Prevention of Recurrent Infections

For patients with recurrent infections:

• Maintain good personal hygiene
• Keep draining wounds covered
• Avoid sharing personal items
• Consider decolonization strategies in selected cases 3