Staphylococcus epidermidis: Difference between revisions

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===Antimicrobial therapy===
===Antimicrobial therapy===


* Staphylococcus epidermidis <ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
* Staphylococcus epidermidis
:* '''Bacteremia''': most often due to IV lines, vascular grafts, cardiac valves (30-40% of all coagulase-negative staphylococcus infections)
:* '''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.
::* 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.
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:* '''CSF shunt''': meningitis
:* '''CSF shunt''': meningitis
::* 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.
::* 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 IV/PO q8h 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 resistent Staphylococcus epidermidis) (1): [[Linezolid]] 600 mg IV/PO bd {{or}} [[Daptomycin]] IV 6 mg/kg/day with or without [[Rifampin]] 300 mg IV/PO q8h.
::* 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]].
::* 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: 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 is recommended.  
::: Note: 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 is recommended.


:* '''Peritoneal dialysis catheter''': peritonitis
:* '''Peritoneal dialysis catheter''': peritonitis
::* 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.
::* 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 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]].  
::* 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 to keep dialysis 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.
::: Note: Site sepcific recommendation is to keep dialysis 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.


:* '''Prosthetic joint''': septic arthritis
:* '''Prosthetic joint''': septic arthritis
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::* 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 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]].
::* 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 : Only assume [[Methicillin]] susceptible if multiple isolates are so identified.
::: Note: Only assume [[Methicillin]] susceptible if multiple isolates are so identified





Revision as of 17:53, 25 June 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
  • Bacteremia: most often due to IV lines, vascular grafts, cardiac valves (30-40% of all coagulase-negative staphylococcus infections)
Note: Site sepcific recommendation for peripheral line is to remove line, antibiotics for 5-7 days and for central line may often keep line and systemic antibiotics for 2 wks with antibiotics lock.
  • CSF shunt: meningitis
Note: 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 is recommended.
  • Peritoneal dialysis catheter: peritonitis
Note: Site sepcific recommendation is to keep dialysis 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.
  • Prosthetic joint: septic arthritis
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
Note: Site sepcific recommendation is consider valve replacement and antibiotics for 6 wks.
  • Post-sternotomy: osteomyelitis
  • Implants (breast, penile, pacemaker) and other prosthetic devices: local infection
Note: Site sepcific recommendation for vascular graft is to remove graft, antibiotics for 6 wks.
  • Post-ocular surgery: endophthalmitis
  • Surgical site infections
Note: Only assume Methicillin susceptible if multiple isolates are so identified






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

Reference