Staphylococcus epidermidis: Difference between revisions

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===Antimicrobial therapy===
===Antimicrobial therapy===
:* '''Bacteremia''': most often due to IV lines, vascular grafts, cardiac valves (30-40% of all coagulase-negative staphylococcus infections)
::* Preferred regimen: [[Vancomycin]] 15 mg/kg IV q12h with or without [[Rifampin]] 300 mg q8h IV/PO {{or}} [[Gentamicin]] 3 mg/kg/day IV q8h {{and}} [[Vancomycin]] {{and}} [[Rifampin]] 300 mg q8h IV/PO for prosthetic valve IE.
::* Alternative regimen (methicillin resistent Staphylococcus epidermidis) (1): [[Linezolid]] 600 mg IV/PO bd {{or}} [[Daptomycin]] IV 6 mg/kg/day with or without [[Rifampin]] 300 mg q8h IV/PO.
::* Alternative regimen (methicillin-sensitive Staphylococcus epidermidis) (2): ([[Oxacillin]] 1.5-3 g IV q6h {{or}} [[Nafcillin]] 1.5-3 g IV q6h), {{or}} [[Cefazolin]] 1-2 g IV q8h {{or}} [[Ciprofloxacin]] 400 mg IV q12h {{or}} [[Clindamycin]] 600 mg IV q8h {{or}} [[Trimethoprim]]-[[Sulfamethoxazole]].
::: Note: site sepcific recommendation for  Peripheral line is to remove line, antibiotics for 5-7 days and for central line is to  may often keep line and systemic antibiotics for 2 wks with antibiotics lock.consider valve replacement and antibiotics for 6 wks.


:* '''CSF shunt''': meningitis
*Staphylococcus epidermidis<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
::* Preferred regimen: [[Vancomycin]] 15 mg/kg IV q12h with or without [[Rifampin]] 300 mg q8h IV/PO {{or}} [[Gentamicin]] 3 mg/kg/day IV q8h added to [[Vancomycin]] {{and}} [[Rifampin]] 300 mg q8h IV/PO for prosthetic valve IE.
:*1. '''Methicillin-sensitive Staphylococcus epidermidis'''
::* Alternative regimen (methicillin resistent Staphylococcus epidermidis) (1): [[Linezolid]] 600 mg IV/PO bd {{or}} [[Daptomycin]] IV 6 mg/kg/day with or without [[Rifampin]] 300 mg q8h IV/PO.
::*Preferred regimen (1): [[Oxacillin]] 1-2 g IV q4h
::* Alternative regimen (methicillin-sensitive Staphylococcus epidermidis) (2): ([[Oxacillin]] 1.5-3 g IV q6h {{or}} [[Nafcillin]] 1.5-3 g IV q6h), {{or}} [[Cefazolin]] 1-2 g IV q8h {{or}} [[Ciprofloxacin]] 400 mg IV q12h {{or}} [[Clindamycin]] 600 mg IV q8h {{or}} [[Trimethoprim]]-[[Sulfamethoxazole]].
::*Preferred regimen (2): [[Nafcillin]] 1-2 g IV q4h
::: Note: site sepcific recommendation is 
::*Preferred regimen (3): [[Cephalothin]]
::*Alternative regimen (1): [[Rifampin]] 600 mg/day PO qd {{and}} [[Trimethoprim]]-[[Sulfamethoxazole]]  


:* '''Peritoneal dialysis catheter''': peritonitis
::*Alternative regimen (2): [[Fluoroquinolones]] {{and}} [[Daptomycin]] 600 mg PO/IV q12h<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
::* Preferred regimen: [[Vancomycin]] 15 mg/kg IV q12h with or without [[Rifampin]] 300 mg q8h IV/PO {{or}} [[Gentamicin]] 3 mg/kg/day IV q8h added to [[Vancomycin]] {{and}} [[Rifampin]] 300 mg q8h IV/PO for prosthetic valve IE.
::*Note: 75% of the S. epidermidis are methicillin-resistant.
::* Alternative regimen (methicillin resistent Staphylococcus epidermidis) (1): [[Linezolid]] 600 mg IV/PO bd {{or}} [[Daptomycin]] IV 6 mg/kg/day with or without [[Rifampin]] 300 mg q8h IV/PO.
:*2. '''Methicillin-resistant Staphylococcus epidermidis'''
::* Alternative regimen (methicillin-sensitive Staphylococcus epidermidis) (2): ([[Oxacillin]] 1.5-3 g IV q6h {{or}} [[Nafcillin]] 1.5-3 g IV q6h), {{or}} [[Cefazolin]] 1-2 g IV q8h {{or}} [[Ciprofloxacin]] 400 mg IV q12h {{or}} [[Clindamycin]] 600 mg IV q8h {{or}} [[Trimethoprim]]-[[Sulfamethoxazole]].  
::*Preferred regimen: [[Vancomycin]] 1 g IV q12h with or without [[Rifampin]] 600 mg/day PO qd
:* '''Prosthetic joint''': septic arthritis
:*Note: For deep-seated infections consider adding [[Gentamicin]] with or without [[Rifampin]] 600 mg/day PO qd to the regimen<ref name="pmid15956145">{{cite journal| author=Baddour LM, Wilson WR, Bayer AS, Fowler VG, Bolger AF, Levison ME et al.| title=Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America. | journal=Circulation | year= 2005 | volume= 111 | issue= 23 | pages= e394-434 | pmid=15956145 | doi=10.1161/CIRCULATIONAHA.105.165564 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15956145  }} </ref>
::* Preferred regimen: [[Vancomycin]] 15 mg/kg IV q12h with or without [[Rifampin]] 300 mg q8h IV/PO {{or}} [[Gentamicin]] 3 mg/kg/day IV q8h added to [[Vancomycin]] {{and}} [[Rifampin]] 300 mg q8h IV/PO for prosthetic valve IE.
:*3. '''Prosthetic device infections'''
::* Alternative regimen (methicillin resistent Staphylococcus epidermidis) (1): [[Linezolid]] 600 mg IV/PO bd {{or}} [[Daptomycin]] IV 6 mg/kg/day with or without [[Rifampin]] 300 mg q8h IV/PO.
::* Preferred regimen (1): [[Oxacillin]] 1-2 g IV q4h {{and}} [[Rifampin]] 600 mg/day PO qd {{and}} [[Gentamicin]] 3 mg/kg/day IV/IM q8-24h
::* Alternative regimen (methicillin-sensitive Staphylococcus epidermidis) (2): ([[Oxacillin]] 1.5-3 g IV q6h {{or}} [[Nafcillin]] 1.5-3 g IV q6h), {{or}} [[Cefazolin]] 1-2 g IV q8h {{or}} [[Ciprofloxacin]] 400 mg IV q12h {{or}} [[Clindamycin]] 600 mg IV q8h {{or}} [[Trimethoprim]]-[[Sulfamethoxazole]].  
::* Preferred regimen (2): [[Vancomycin]] 1 g IV q12h {{and}} [[Rifampin]] 600 mg/day PO qd {{and}} [[Gentamicin]] 3 mg/kg/day IV/IM q8-24h.<ref name="pmid15956145">{{cite journal| author=Baddour LM, Wilson WR, Bayer AS, Fowler VG, Bolger AF, Levison ME et al.| title=Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America. | journal=Circulation | year= 2005 | volume= 111 | issue= 23 | pages= e394-434 | pmid=15956145 | doi=10.1161/CIRCULATIONAHA.105.165564 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15956145 }} </ref>
::: Note: site sepcific recommendation is typically remove joint (two stage more common than single stage replacement), antibiotics for 6 wks. If very early infection (less than 3 wks post-op, debridement and retention an option).
 
:* '''Prosthetic or natural cardiac valve''': endocarditis
::* Preferred regimen: [[Vancomycin]] 15 mg/kg IV q12h with or without [[Rifampin]] 300 mg q8h IV/PO {{or}} [[Gentamicin]] 3 mg/kg/day IV q8h added to [[Vancomycin]] {{and}} [[Rifampin]] 300 mg q8h IV/PO for prosthetic valve IE.
::* Alternative regimen (methicillin resistent Staphylococcus epidermidis) (1): [[Linezolid]] 600 mg IV/PO bd {{or}} [[Daptomycin]] IV 6 mg/kg/day with or without [[Rifampin]] 300 mg q8h IV/PO.
::* Alternative regimen (methicillin-sensitive Staphylococcus epidermidis) (2): ([[Oxacillin]] 1.5-3 g IV q6h {{or}} [[Nafcillin]] 1.5-3 g IV q6h), {{or}} [[Cefazolin]] 1-2 g IV q8h {{or}} [[Ciprofloxacin]] 400 mg IV q12h {{or}} [[Clindamycin]] 600 mg IV q8h {{or}} [[Trimethoprim]]-[[Sulfamethoxazole]].  
::: Note: site sepcific recommendation is
 
:* '''Post-sternotomy''': osteomyelitis
::* Preferred regimen: [[Vancomycin]] 15 mg/kg IV q12h with or without [[Rifampin]] 300 mg q8h IV/PO {{or}} [[Gentamicin]] 3 mg/kg/day IV q8h added to [[Vancomycin]] {{and}} [[Rifampin]] 300 mg q8h IV/PO for prosthetic valve IE.
::* Alternative regimen (methicillin resistent Staphylococcus epidermidis) (1): [[Linezolid]] 600 mg IV/PO bd {{or}} [[Daptomycin]] IV 6 mg/kg/day with or without [[Rifampin]] 300 mg q8h IV/PO.
::* Alternative regimen (methicillin-sensitive Staphylococcus epidermidis) (2): ([[Oxacillin]] 1.5-3 g IV q6h {{or}} [[Nafcillin]] 1.5-3 g IV q6h), {{or}} [[Cefazolin]] 1-2 g IV q8h {{or}} [[Ciprofloxacin]] 400 mg IV q12h {{or}} [[Clindamycin]] 600 mg IV q8h {{or}} [[Trimethoprim]]-[[Sulfamethoxazole]].
::: Note: site sepcific recommendation is
 
:* '''Implants (breast, penile, pacemaker) and other prosthetic devices''': local infection
::* Preferred regimen: [[Vancomycin]] 15 mg/kg IV q12h with or without [[Rifampin]] 300 mg q8h IV/PO {{or}} [[Gentamicin]] 3 mg/kg/day IV q8h added to [[Vancomycin]] {{and}} [[Rifampin]] 300 mg q8h IV/PO for prosthetic valve IE.
::* Alternative regimen (methicillin resistent Staphylococcus epidermidis) (1): [[Linezolid]] 600 mg IV/PO bd {{or}} [[Daptomycin]] IV 6 mg/kg/day with or without [[Rifampin]] 300 mg q8h IV/PO.
::* Alternative regimen (methicillin-sensitive Staphylococcus epidermidis) (2): ([[Oxacillin]] 1.5-3 g IV q6h {{or}} [[Nafcillin]] 1.5-3 g IV q6h), {{or}} [[Cefazolin]] 1-2 g IV q8h {{or}} [[Ciprofloxacin]] 400 mg IV q12h {{or}} [[Clindamycin]] 600 mg IV q8h {{or}} [[Trimethoprim]]-[[Sulfamethoxazole]].
::: Note: site sepcific recommendation is
 
:* '''Post-ocular surgery''': endophthalmitis
::* Preferred regimen: [[Vancomycin]] 15 mg/kg IV q12h with or without [[Rifampin]] 300 mg q8h IV/PO {{or}} [[Gentamicin]] 3 mg/kg/day IV q8h added to [[Vancomycin]] {{and}} [[Rifampin]] 300 mg q8h IV/PO for prosthetic valve IE.
::* Alternative regimen (methicillin resistent Staphylococcus epidermidis) (1): [[Linezolid]] 600 mg IV/PO bd {{or}} [[Daptomycin]] IV 6 mg/kg/day with or without [[Rifampin]] 300 mg q8h IV/PO.
::* Alternative regimen (methicillin-sensitive Staphylococcus epidermidis) (2): ([[Oxacillin]] 1.5-3 g IV q6h {{or}} [[Nafcillin]] 1.5-3 g IV q6h), {{or}} [[Cefazolin]] 1-2 g IV q8h {{or}} [[Ciprofloxacin]] 400 mg IV q12h {{or}} [[Clindamycin]] 600 mg IV q8h {{or}} [[Trimethoprim]]-[[Sulfamethoxazole]].
::: Note: site sepcific recommendation is
 
:* '''Surgical site infections'''
::* Preferred regimen: [[Vancomycin]] 15 mg/kg IV q12h with or without [[Rifampin]] 300 mg q8h IV/PO {{or}} [[Gentamicin]] 3 mg/kg/day IV q8h added to [[Vancomycin]] {{and}} [[Rifampin]] 300 mg q8h IV/PO for prosthetic valve IE.
::* Alternative regimen (methicillin resistent Staphylococcus epidermidis) (1): [[Linezolid]] 600 mg IV/PO bd {{or}} [[Daptomycin]] IV 6 mg/kg/day with or without [[Rifampin]] 300 mg q8h IV/PO.
::* Alternative regimen (methicillin-sensitive Staphylococcus epidermidis) (2): ([[Oxacillin]] 1.5-3 g IV q6h {{or}} [[Nafcillin]] 1.5-3 g IV q6h), {{or}} [[Cefazolin]] 1-2 g IV q8h {{or}} [[Ciprofloxacin]] 400 mg IV q12h {{or}} [[Clindamycin]] 600 mg IV q8h {{or}} [[Trimethoprim]]-[[Sulfamethoxazole]].
::: Note: site sepcific recommendation is
 
::: Note: only assume [[Methicillin]] susceptible if multiple isolates are so identified.
 
Peripheral line: remove line, antibiotics for 5-7 days.
Central line: may often keep line and systemic antibiotics for 2 wks with antibiotics lock.
Prosthetic joint: typically remove joint (two stage more common than single stage replacement), antibiotics for 6 wks. If very early infection (less than 3 wks post-op, debridement and retention an option).
Dialysis catheter: keep catheter (at least for first effort) and IV [[Vancomycin]] (usually 2 g IV/wk and redose when level <15 mcg/mL) with antibiotics lock for 10-14 days.
Vascular graft: remove graft, antibiotics for 6 wks.
CSF shunt: shunt removal usually recommended but variable. [[Vancomycin]] 22.5 mg/kg IV q12h and [[rifampin]] PO/IV and possible intraventricular antibiotics: [[Vancomycin]] 20 mg/day with or without [[Gentamicin]] 4-8 mg/day.
 
 
 
 
 
   


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[[Category:Staphylococcaceae]]
[[Category:Staphylococcaceae]]
==Reference==
{{reflist|2}}

Latest revision as of 14:10, 12 August 2015

Staphylococcus epidermidis/epidermis
Scanning electron image of S. epidermidis.
Scanning electron image of S. epidermidis.
Scientific classification
Kingdom: Bacteria
Phylum: Firmicutes
Class: Cocci
Order: Bacillales
Family: Staphylococcaceae
Genus: Staphylococcus
Species: S. epidermidis
Binomial name
Staphylococcus epidermidis
(Winslow & Winslow 1908)
Evans 1916

Staphylococcus epidermidis is a member of the bacterial genus Staphylococcus, consisting of Gram-positive cocci arranged in clusters. It is catalase-positive and coagulase-negative and occurs frequently on the skin of humans and animals and in mucous membranes.It is sensitive to the antibiotic Novobiocin; a feature that distinguishes it from the other common coagulase negative organism Staph. saprophyticus. Due to contamination, S. epidermidis is probably the most common species found in laboratory tests.

Although S. epidermidis is usually non-pathogenic, it is an important cause of infection in patients whose immune system is compromised, or who have indwelling catheters. Many strains produce a slime (biofilm) that allows them to adhere to the surfaces of medical prostheses.

S. epidermidis is often resistant to a wide variety of antibiotics, including penicillin and methicillin.

Colonies of S. epidermidis are typically small, white or beige, approximately 1-2 mm in diameter after overnight incubation. The organism is sensitive to desferrioxamine, and this test is used to distinguish it from almost all other staphylococci. Staphylococcus hominis, which is also sensitive, produces acid from trehalose, so it can usually be distinguished from S. epidermidis.

The normal practice of detecting S.epidermidis is by using the Baird Parker agar with egg yolk supplement. Colonies appeared in small, black colonies while confirmation can be done using coagulase test.

Treatment

Antimicrobial therapy

  • Staphylococcus epidermidis[1]
  • 1. Methicillin-sensitive Staphylococcus epidermidis
  • 2. Methicillin-resistant Staphylococcus epidermidis
  • Note: For deep-seated infections consider adding Gentamicin with or without Rifampin 600 mg/day PO qd to the regimen[3]
  • 3. Prosthetic device infections

de:Staphylococcus epidermidis nl:Staphylococcus epidermidis sr:Стафилококус епидермидис

Reference

  1. ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
  2. ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
  3. ↑ 3.0 3.1 Baddour LM, Wilson WR, Bayer AS, Fowler VG, Bolger AF, Levison ME; et al. (2005). "Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America". Circulation. 111 (23): e394–434. doi:10.1161/CIRCULATIONAHA.105.165564. PMID 15956145.
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