What is the treatment for Staphylococcus capitis infection near a central venous catheter (CVC)?

From the Guidelines

Treatment of Staphylococcus capitis infection near a central venous catheter (CVC) should prioritize catheter removal and antimicrobial therapy, with vancomycin as a first-line option, as recommended by the most recent guidelines 1.

Key Considerations

• The decision to remove the catheter should be based on clinical judgment, considering the severity of the infection and the patient's overall condition.
• Antimicrobial therapy should be tailored to the specific pathogen and its susceptibilities, with vancomycin being a common choice for Staphylococcus capitis infections.
• Antibiotic lock therapy may be considered as an adjunctive treatment, but its effectiveness is limited, and catheter removal is often necessary for successful treatment.
• Blood cultures should be obtained before starting antibiotics to confirm the pathogen and its susceptibilities.

Treatment Options

• Vancomycin: 15-20 mg/kg IV every 8-12 hours for adults, with duration ranging from 7-14 days depending on infection severity.
• Alternative antibiotics: daptomycin (6-8 mg/kg IV daily) or linezolid (600 mg IV/oral twice daily).
• Oral options: trimethoprim-sulfamethoxazole (1-2 double-strength tablets twice daily) for mild cases.

Important Notes

• S. capitis is a coagulase-negative staphylococcus that commonly colonizes human skin but can cause serious infections in the presence of foreign bodies like catheters, particularly in immunocompromised patients or neonates.
• The length of antimicrobial therapy after catheter removal is often 7–14 days but varies with the pathogen and the degree of illness, as recommended by recent guidelines 1.

From the FDA Drug Label

Vancomycin Hydrochloride for Injection, USP is indicated for the treatment of serious or severe infections caused by susceptible strains of methicillin-resistant (β-lactam-resistant) staphylococci Vancomycin Hydrochloride for Injection, USP is effective in the treatment of staphylococcal endocarditis Its effectiveness has been documented in other infections due to staphylococci, including septicemia, bone infections, lower respiratory tract infections, skin and skin structure infections. When staphylococcal infections are localized and purulent, antibiotics are used as adjuncts to appropriate surgical measures

The treatment for Staphylococcus capitis infection near a central venous catheter (CVC) may involve vancomycin as it is effective against methicillin-resistant staphylococci. However, the specific treatment should be guided by susceptibility data and may require surgical measures in addition to antibiotic therapy 2.

• The treatment should be adjusted according to susceptibility data.
• Vancomycin may be used as an adjunct to surgical measures for localized and purulent infections.

From the Research

Treatment for Staphylococcus capitis Infection

• The treatment for Staphylococcus capitis infection near a central venous catheter (CVC) is primarily focused on antibiotic therapy, as the bacteria are often resistant to multiple antibiotics 3.
• The study by 3 recommends empiric therapy for S. capitis infection in NICU with ampicillin/sulbactam, as all isolates were susceptible to this combination.
• Vancomycin and teicoplanin are also effective against S. capitis, as all isolates were susceptible to these antibiotics 3.
• Removal of the central venous catheter is not always necessary, as there is no statistical significance between S. capitis infection and the duration of CVC placement 3.
• However, other studies suggest that removal of the catheter may be necessary in some cases, especially if the infection is severe or if the patient remains febrile for more than 72 hours 4.

Antibiotic Resistance

• S. capitis isolates often exhibit high levels of antibiotic resistance, with 94% of isolates being resistant to multiple antibiotics 3.
• The most effective antibiotics against S. capitis are ampicillin/sulbactam, vancomycin, and teicoplanin 3.
• Other antibiotics, such as oxacillin, erythromycin, and clindamycin, are often ineffective against S. capitis 3.

Antimicrobial Lock Therapy

• Antimicrobial lock solutions (ALSs) may be effective in treating intravascular catheter-related infections caused by S. aureus, including S. capitis 5.
• The most effective ALSs against S. aureus biofilms are daptomycin, tigecycline, rifampin, ethanol, and Taurolock 5.
• These findings suggest that ALSs may be a useful adjunct to antibiotic therapy in the treatment of S. capitis infections near a CVC.