Treatment of Staphylococcus hominis in Urine
For Staphylococcus hominis urinary tract infections, first-line treatment should include nitrofurantoin, trimethoprim-sulfamethoxazole (TMP-SMX), or fosfomycin, with the specific choice guided by local antibiogram data and susceptibility testing. 1
Antibiotic Selection Algorithm
Step 1: Obtain Culture and Susceptibility Testing
- Always obtain urine culture before starting antibiotics
- Ensure proper documentation of cultures during symptomatic periods
- Use susceptibility results to guide targeted therapy
Step 2: First-Line Empiric Treatment Options
- Nitrofurantoin (100mg twice daily for 5-7 days)
- Trimethoprim-sulfamethoxazole (160/800mg twice daily for 3-5 days)
- Fosfomycin (3g single dose)
Step 3: Second-Line Options (if resistance to first-line agents)
- Fluoroquinolones (e.g., ciprofloxacin 500mg twice daily for 3-5 days)
- Cephalosporins (e.g., cefazolin 20 mg/kg IV after each dialysis session for catheter-associated infections) 1
Step 4: For Resistant Strains
- For methicillin-resistant strains: Vancomycin (based on susceptibility)
- For multidrug-resistant strains: Consider parenteral antibiotics for as short a course as reasonable, generally no longer than seven days 1
Important Considerations
Duration of Therapy
- Treat for as short a duration as reasonable, generally no longer than 7 days 1
- Short-course therapy (3-5 days) is often sufficient for uncomplicated UTIs
- Longer courses may be needed for complicated infections
Special Situations
- For catheter-associated infections, consider antibiotic lock therapy with appropriate agents like vancomycin for gram-positive cocci 1
- In patients with recurrent UTIs, prophylactic antibiotics may be considered following discussion of risks and benefits 1
Cautions
- Avoid treating asymptomatic bacteriuria (ASB) as this leads to unnecessary antibiotic exposure and potential resistance 1
- Consider local resistance patterns when selecting empiric therapy
- Fluoroquinolones should be used judiciously due to concerns about collateral damage and resistance development
Monitoring
- Follow-up urine cultures are not necessary if symptoms resolve
- If symptoms persist despite appropriate antibiotic therapy, consider:
- Alternative diagnosis
- Structural abnormalities
- Resistant organisms requiring different antimicrobial therapy
Staphylococcus hominis is a coagulase-negative staphylococcus that may be part of normal skin flora but can cause opportunistic infections, particularly in healthcare settings. Treatment should follow the same principles as for other gram-positive urinary pathogens, with attention to local susceptibility patterns and patient-specific factors.