:* '''Bacteremia''': most often due to IV lines, vascular grafts, cardiac valves (30-40% of all coagulase-negative staphylococcus infections)
:* 1. '''Methicillin-susceptible strain'''<ref>{{cite book | last = Abramowicz | first = Mark | title = Handbook of antimicrobial therapy : selected articles from Treatment guidelines with updates from The medical letter | publisher = The Medical Letter | location = New Rochelle, N.Y | year = 2011 | isbn = 978-0981527826 }}</ref><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 {{and}} [[Vancomycin]] {{and}} [[Rifampin]] 300 mg q8h IV/PO for prosthetic valve IE.
::* Preferred regimen (1): [[Nafcillin]] 1–2 g IV q4-6h (maximum 12 g/day)
::* 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]].
::* Preferred regimen (3): [[Cefazolin]] 0.5–2 g IV q6-8h
::: 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.
::* Alternative regimen (1): [[TMP-SMX]] 4–5 mg/kg IV q6–12h
::* Alternative regimen (2): [[Doxycycline]] 100–200 mg IV q12-24h
::* 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.
::* Preferred regimen: [[Vancomycin]] 15–20 mg/kg IV q8–12h
::* 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]].
::* Preferred regimen (1): [[Daptomycin]] 4–6 mg/kg IV q24h
::: 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.
::* 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 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
::* 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 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 consider valve replacement and antibiotics for 6 wks.
:* '''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]].
:* '''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 for vascular graft is to remove graft, antibiotics for 6 wks.
:* '''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]].
:* '''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: Only assume [[Methicillin]] susceptible if multiple isolates are so identified
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.
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.
↑Abramowicz, Mark (2011). Handbook of antimicrobial therapy : selected articles from Treatment guidelines with updates from The medical letter. New Rochelle, N.Y: The Medical Letter. ISBN978-0981527826.
↑Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN978-1930808843.
