Staph epidermidis

Staph epidermidis

Background:
>Staphylococcus Coagulase-negative species:
     1] Staph epidermidis Led
     2] Staph. haemolyticus
     3] Staph lugdunensis
     4] Staph saprophyticus
     5] Staph hominis
     6] Staph capitis

Staph epidermidis:

  • (nonmotile, Gram-positive cocci (forms clusters). 
  • Coagulase-negative,  facultative anaerobe.  + urease production, oxidase negative).
  • -Normal part of human skin flora (also found in the mucous membranes).
  • -Common contaminent and likely the most common species found in laboratory tests.
  • -Usually not pathogenic (greater risk in incompromised pts).
  • -Major concern for patients with plastic devices such as catheters or other surgical implants (colonization, formation of biofilm).
  • -Strains are often resistant to antibiotics, including penicillin, amoxicillin, and methicillin.

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Therapy:
Important considerations:  The choice of an agent should be based on local antimicrobial sensitivities, site of infection, cost, and comorbid conditions.   Generally, the most common agents/regimens are listed first. Listed dosages may need to be adjusted for renal dysfunction.  

Methicillin susceptible:

  1. Nafcillin  or Oxacillin 1-2 grams IVPB q4-6 hours
  2. Cefazolin 1 to 2 g IV every eight hours
  3. Ciprofloxacin  400mg IV q12h (Severe/complicated: 400mg IV q8h)  PLUS  [Rifampin 300-450 mg  orally/IV q12h  or 600mg orally/IV once daily]
  4. Bactrim  Mild-moderate infection:  5 to 10 mg/kg/day (based on trimethoprim component) IV/oral divided in 2-4 doses.    Severe infection: 15 to 20 mg/kg/day (based on trimethoprim component)  IV, given in equally divided doses every 6 to 8 hours. PLUS  [Rifampin 300-450 mg  orally/IV q12h  or 600mg orally/IV once daily]

Methicillin resistant:

  1. Vancomycin – (patient-specific regimen – trough goal 15-20 mcg/ml)  +/- Gentamicin
  2. Vancomycin – (patient-specific regimen – trough goal 15-20 mcg/ml)  +/-  [Rifampin 300-450 mg  orally/IV q12h  or 600mg orally/IV once daily]
  3. Linezolid 600 mg orally or IV q12h  (+/- Rifampin 300-450 mg  orally/IV q12h  or 600mg orally/IV once daily)
  4. Daptomycin 4 – 6 mg/kg IV once daily.    – NOT FOR PNEUMONIA     (+/- Rifampin 300-450 mg  orally/IV q12h  or 600mg orally/IV once daily)
  5. Telavancin 10 mg/kg IV every 24hours
Staph epidermidis