Linezolid is an alternative, however it is only recommended for up to 4 weeks treatment due to risk of hematological side effects. We have successfully used prolonged treatment with linezolid and rifampicin in a patient suffering from a complicated prosthetic joint infection caused by a vancomycin resistant Staphyloccous epidermidis strain.
Full Answer
Can teicoplanin and vancomycin be used as alternative treatments for Staphylococcus epidermidis infections?
Conclusions In conclusion, as all the S. epidermidis strains isolated from patients in Riyadh region were susceptible to teicoplanin and vancomycin, these antibacterial agents could be used as alternative treatments for S. epidermidis infections.
What is the empiric therapy for Staphylococcus epidermidis?
The choice of empiric therapy for staphylococcus epidermidis infection would be IV vancomycin, as methicillin resistance should be assumed. If the pathogen is methicillin-susceptible, then treatment can be narrowed to beta-lactam antibiotics such as nafcillin and oxacillin.
Is Staphylococcus epidermidis a cause of nosocomial infection?
[2] The belief is that Staphylococcus epidermidis is one of the most common causes of nosocomial infection, with infection rates as high as those of Staphylococcus aureus. [3] Etiology Staphylococcus epidermidisis usually a symbiont that is harmless in its natural environment.[4]
Is Staphylococcus epidermidis antibiotic resistant?
Antibiotic-resistant Staphylococcus epidermidis is an opportunistic pathogen frequently isolated from patients and healthy individuals. This study aimed to examine the antibiotic resistance of S. epidermidis isolated from patients, healthy students and compare the results with antibiotic-resistant bacteria isolated from pasteurized milk.
What antibiotic treats Staphylococcus epidermidis?
Virtually all Staph. epidermidis isolates are susceptible in vitro to vancomycin and rifampin. Penicillin G, semisynthetic penicillinase-resistant penicillins, and cephalosporins are effective for the treatment of methicillin-sensitive Staph.
Is Staphylococcus epidermidis resistant to vancomycin?
The antimicrobial agent of choice for most infections caused by S. epidermidis is vancomycin. Strains with decreased susceptibility or with resistance to vancomycin and the presence of subpopulations resistant to vancomycin (heteroresistance) have been commonly reported [10–12].
Can you use daptomycin if allergic to vancomycin?
Daptomycin is indicated for: treatment of resistant gram-positive infection (e.g., MRSA or VRE) in patients who are allergic to vancomycin (Vancocin, Lilly) or linezolid (Zyvox, Pfizer). treatment of resistant gram-positive infection (e.g., MRSA or VRE) that is resistant to vancomycin and linezolid.
Does Cipro treat staph epidermidis?
Ciprofloxacin has limited usefulness against MR Staphylococcus aureus but can be still used to treat Staphylococcus epidermidis infections.
Does cefazolin Cover Staph epidermidis?
S. epidermidis strains harbored the highest prevalence of resistance against penicillin, tetracycline, erythromycin, cefazolin, and trimethoprim-sulfamethoxazole antibiotic agents.
Does cefepime Cover Staph epidermidis?
Cefepime is an injectable cephalosporin with a broad spectrum of activity against many bacterial species, including staphylococci. Husson et al. noted that cefepime reduced the minimum killing time for vancomycin against methicillin-resistant staphylococci in vitro.
Does daptomycin treat staph?
Conclusion. In our practice, daptomycin combined with suitable surgical intervention had a high success rate in treating resistant staphylococcal PJI. Daptomycin could be a treatment option for patients with these infections, especially in those with chronic kidney disease or intolerance to glycopeptide antibiotics.
What is tigecycline used for?
Tigecycline injection used to treat certain serious infections including community acquired pneumonia (a lung infection that developed in a person who was not in the hospital), skin infections, and infections of the abdomen (area between the chest and the waist).
At what ck do you stop daptomycin?
Daptomycin should be discontinued in patients with symptoms of muscle pain or weakness whose CPK levels exceed 1000 U/L (~ 5x ULN), or in patients without symptoms whose CPK exceeds 10x ULN.
How is Staph epidermidis treated?
Treatment / Management [19] The choice of empiric therapy for staphylococcus epidermidis infection would be IV vancomycin, as methicillin resistance should be assumed. If the pathogen is methicillin-susceptible, then treatment can be narrowed to beta-lactam antibiotics such as nafcillin and oxacillin.
Does doxycycline treat staph epidermidis?
To conclude, as the majority of the S. epidermidis isolates were susceptible to doxycycline, this antimicrobial agent may provide a potential alternative for combination therapy together with rifampicin.
Is Staph epidermidis sensitive to Bactrim?
Oral antibiotics such as Bactrim® (sulfamethoxazole and trimethoprim) or levofloxacin are often used in conjunction with rifampin. In 2005 at SBH-G, S. aureus was 64% susceptible, S. epidermidis was 71% susceptible, and S.
What is the potential for staphylococci with reduced susceptibility to vancomycin?
This case illustrates the potential for staphylococci with reduced susceptibility to vancomycin to be overlooked in the clinical microbiology laboratory. While primary testing of 4 strains of S. epidermidis recovered from this patient indicated increased resistance to vancomycin, subsequent testing of subcultures of these isolates failed to confirm the initial findings. This suggests that either the susceptibility results of the primary cultures were in error or the expression of intermediate-level resistance by these isolates was lost or diluted upon subculture. Although both explanations have merit, a number of findings in this case support the latter conclusion. First, the results of the E-test and disk diffusion testing of the first of this patient's isolates and the results of subsequent testing of colonies selected on vancomycin screening agar all corroborate the MIC of vancomycin obtained by use of VITEK for all primary isolates. Secondly, the patient's risk factors (i.e., diabetes, CAPD, chronic infections with MRSA or methicillin-resistant CONS, indwelling catheter, and multiple courses of antimicrobial therapy that included vancomycin) closely parallel those of a number of reported cases of infection caused by strains of S. aureus with intermediate resistance to glycopeptides [ 8, 9–12, 14] and CONS [ 2, 4, 5, 7 ].
How to select for stable vancomycin-intermediate subpopulations?
To select for stable vancomycin-intermediate subpopulations, we cultured each isolate on vancomycin screening agar with an aztreonam disk for induction of resistance [ 8 ]. We recovered 8 colonies that had MICs of vancomycin that ranged from 6 to 12 µg/mL, as determined by means of the E-test. The frequency of isolation of the vancomycin-intermediate subpopulations ranged from 8 × 10 −6 to 4 × 10 −7 cfu/mL; that low frequency could be easily missed using the recommended National Committee for Clinical Laboratory Standards inoculum density of 5 × 10 5 cfu/mL. The Michigan Department of Community Health Bacteriology Laboratory confirmed the identity of the initial isolate as VISE ( S. epidermidis with an MIC of vancomycin of 6 µg/mL). A subculture of the isolate was forwarded to the Centers for Disease Control and Prevention (Atlanta) where the MIC of vancomycin was determined to be 4 µg/mL by use of standard microbroth dilution testing. The patient was subsequently readmitted to the hospital in July 2000 with abdominal pain and cloudy peritoneal fluid. Her catheter was removed following repeated isolation of S. epidermidis that had susceptibility patterns identical to those of the initial isolate. Her abdominal symptoms subsequently resolved.
What is the MIC of vancomycin?
Because of skepticism regarding the MIC of vancomycin, an E-test was performed. Results indicated a MIC of 12 µg/mL, which indicates intermediate resistance, and a disk-diffusion zone of inhibition 13 mm in diameter (i.e., no susceptibility). A biochemical profile of the isolate performed with use of the VITEK system allowed us to tentatively identify it as S. epidermidis, and the isolate was forwarded to the Michigan Department of Community Health Bacteriology Laboratory (Lansing, Michigan) for assessment. Analysis of 3 subsequent peritoneal dialysate samples with use of the VITEK system was also positive for vancomycin-intermediate S. epidermidis (VISE). At first isolation, these isolates had the same antibiogram and MIC of vancomycin as did the initial isolate (i.e., 16 µg/mL); a second morphotype of CONS was susceptible to vancomycin (MIC, 2 µg/mL). However, subculture and testing by use of VITEK, E-test, disk diffusion, and microbroth dilution (MicroScan; Dade Behring) revealed that all 4 VISE isolates were susceptible to vancomycin (MIC <4 µg/mL; zone of inhibition, >17 mm diameter); there was no change in interpretation for the other antimicrobial agents. Subsequent testing also showed that each isolate of VISE was susceptible to linezolid, quinupristin/dalfopristin, teicoplanin, chloramphenicol, and doxycycline.
Is vancomycin a mixed inocula?
Until recently, all instances of falsely elevated MICs of vancomycin among staphylococci at Henry Ford Hospital could be ascribed to mixed inocula or unreproducible results. However, the following case report illustrates a potential dilemma for clinical microbiologists when the vancomycin resistance of a strain of S. epidermidis can neither be substantiated nor dismissed.
Is Staphylococcus aureus resistant to glycopeptides?
The recent and trou bling isolation of Staphylococcus aureus and coagulase-negative staphylococci that have increased resistance to glycopeptide antibiotics has prompted the use of aggressive surveillance measures in the clinical microbiology laboratory to aid in the recognition of these strains. Despite increasing awareness, the confirmation of glycopeptide resistance among staphylococci can be problematic; we present a case of catheter-associated peritonitis caused by Staphylococcus epidermidis to illustrate the dilemma.
Can vancomycin be detected in 2 strains of CONS?
Del'Alamo et al. [ 1] noted the inconsistency of different susceptibility methods to detect increasing vancomycin resistance in 2 strains of CONS, quite possibly due to the inability of any one method to detect low-frequency heteroresistance. Whatever the explanation, the unsuspecting laboratorian in this circumstance would likely retest the isolate and (if they did not know the pertinent patient history) would conclude that the MIC of vancomycin measured initially was in error and would report the subsequent interpretation that the isolate was susceptible. It seems reasonable, therefore, to approach the interpretation of an elevated MIC of glycopeptide for staphylococci with caution rather than skepticism, especially in light of clinical risk factors such as those that were present in the patient we describe. The use of an induction method such as the one described by Wong et al. [ 8 ]—one that has an increased inoculum density to permit the detection of a low-frequency event—might be the only way to confirm whether there is increased glycopeptide resistance among certain strains of staphylococci.