What is the recommended treatment for Streptococcus capitis infections?

Streptococcus capitis Treatment

For Streptococcus capitis infections, ampicillin/sulbactam is the recommended empiric therapy, as all isolates demonstrate susceptibility to this agent despite widespread resistance to other antibiotics. 1

Antibiotic Selection

First-Line Therapy

• Ampicillin/sulbactam is the preferred empiric treatment for S. capitis infections, particularly in neonatal intensive care settings where this organism is most commonly encountered 1
• This recommendation is based on 100% susceptibility rates, even in the context of multidrug-resistant strains 1

Alternative Agents for Resistant Strains

• Vancomycin remains universally effective against S. capitis and should be used when ampicillin/sulbactam is contraindicated or unavailable 1
• Teicoplanin demonstrates complete susceptibility and represents another glycopeptide option 1

Agents to Avoid

• Do NOT use oxacillin, nafcillin, or other anti-staphylococcal penicillins alone, as 94% of S. capitis isolates demonstrate resistance 1
• Avoid erythromycin and clindamycin due to universal resistance patterns in S. capitis 1
• Standard penicillin monotherapy is inadequate given the high resistance rates 1

Clinical Context and Risk Factors

High-Risk Populations

• S. capitis infections occur predominantly in very low birth weight premature infants in neonatal intensive care units 1
• Prolonged hospitalization (mean 52 days) is strongly associated with S. capitis infection 1
• Extended total parenteral nutrition (mean 46 days) significantly increases infection risk 1

Clinical Presentation

• Common manifestations include apnea, bradycardia, temperature instability, and poor activity 1
• Complications may include septic meningitis, though this is uncommon 1

Central Line Management

Routine removal of percutaneous central venous catheters is NOT recommended for S. capitis bacteremia, as there is no statistical correlation between catheter duration and infection risk 1

• Central line removal should be reserved for cases with proven catheter-related infection or persistent bacteremia despite appropriate antibiotics 1
• This differs from S. aureus bacteremia, where catheter removal is mandatory 2

Duration of Therapy

• Treatment duration should follow standard principles for coagulase-negative staphylococcal bacteremia
• Continue antibiotics until clinical stability is achieved with resolution of fever and normalization of vital signs 1
• All patients in the reported series survived with appropriate antibiotic therapy 1

Important Caveats

Resistance Patterns

• S. capitis demonstrates an exceptionally high rate of multidrug resistance (94%), making empiric therapy selection critical 1
• This organism should be considered in nosocomial outbreaks among very low birth weight infants 1

Microbiologic Confirmation

• Accurate species identification is essential to guide appropriate therapy, as S. capitis resistance patterns differ significantly from other coagulase-negative staphylococci 1
• Blood cultures should be obtained before initiating therapy when S. capitis is suspected 1