Staphylococcus lugdenesis

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Treatment

Antimicrobial therapy

  • 1. Skin and soft tissue infections[1]
  • Preferred regimen: Oxacillin 1-2 g IV q4h for 1-2 weeks
  • Note: Abscesses should be drained if possible.
  • 2. Endocarditis[2]
  • 2.1 Native valve infectious endocarditis
  • Preferred regimen (1): Vancomycin 15 mg/kg IV q12h (target trough concentration, 10-15 mcg/mL)
  • Preferred regimen (for most patients with normal renal function) (2): Vancomycin 15-20 mg/kg (actual body weight) IV q8-12h -for trough concentration of 15-20 mcg/mL (minimum inhibitory concentration, 1 mcg/mL or less)
  • Note: should consist of 6 weeks of parenteral beta-lactam therapy or Vancomycin (depending on susceptibility testing and beta-lactam hypersensitivity).
  • 2.2 Prosthetic valve infective endocarditis
  • Preferred regimen: Combination therapy including a beta-lactam (or Vancomycin) with an Aminoglycoside- Gentamicin 3 mg/kg/day in 1-3 divided doses and Rifampin 300 mg PO/IV q8h for at least 6 weeks
  • Note (1): Combine with Vancomycin for the entire duration of therapy and Gentamicin for the first 2 weeks.
  • Note (2): The Gentamicin should be administered for the first 2 weeks of therapy; the beta-lactam (or Vancomycin) and Rifampin should be continued for 6 weeks.
  • Note (3): Surgery must be considered given the frequency of valvular compromise in the setting of Staphylococcus lugdunensis infective endocarditis.
  • Note (4): The treatment of Staphylococcus lugdunensis pacemaker endocarditis includes antibiotic therapy as well as removal of the pacer system
  • 3. Bacteremia[3]
  • Preferred regimen: Oxacillin 1-2 g IV q4h for 1-2 weeks
  • Note (1): Bacteremia without endocarditis (often related to an intravascular catheter) appears to have a good prognosis.
  • Note (2): For intravascular catheter-related Staphylococcus lugdunensis bacteremia, the catheter should be removed, followed by 14 days of antibiotics, provided that all of the following are applicable
  • 2.1 The patient is not diabetic or immunosuppressed.
  • 2.2 There is no prosthetic material, thrombophlebitis, infective endocarditis, evidence of metastatic infection.
  • 2.3 The patient’s fever and bacteremia resolve within 72 hours after initiation of appropriate antibiotic therapy.
  • Preferred regimen (1): Vancomycin 15 mg/kg IV q12h (target trough concentration, 10-15 mcg/mL)
  • Preferred regimen (for most patients with normal renal function) (2): Vancomycin 15-20 mg/kg (actual body weight) IV q8-12h -for trough concentration of 15 to 20 mcg/mL (minimum inhibitory concentration, 1 mcg/mL or less)
  • Preferred regimen (3): Daptomycin 6 mg/kg IV qd for 3-4 weeks
  • Preferred regimen (4): Linezolid 600 mg IV q12h
  • 5. Vertebral osteomyelitis, discitis
  • Preferred regimen: Vancomycin 15-20 mg/kg IV q8-12h, not to exceed 2 g per dose
  • 6. Septic arthritis in adults
  • Preferred regimen: Vancomycin 15 mg/kg IV bd, not to exceed 2 g per 24 hours (unless cncentrations in serum are inappropriately low) for 4 weeks
  1. Tashima Y, Hasegawa M (1975). "Specific inhibition of ouabain sensitive and K+-dependent p-nitrophenylphosphatase by polyamines". Biochem Biophys Res Commun. 66 (4): 1344–8. PMID 172078.
  2. Anguera I, Del Río A, Miró JM, Matínez-Lacasa X, Marco F, Gumá JR; et al. (2005). "Staphylococcus lugdunensis infective endocarditis: description of 10 cases and analysis of native valve, prosthetic valve, and pacemaker lead endocarditis clinical profiles". Heart. 91 (2): e10. doi:10.1136/hrt.2004.040659. PMC 1768720. PMID 15657200.
  3. 3.0 3.1 Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, O'Grady NP; et al. (2009). "Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America". Clin Infect Dis. 49 (1): 1–45. doi:10.1086/599376. PMC 4039170. PMID 19489710.
  4. Liu C, Bayer A, Cosgrove SE, Daum RS, Fridkin SK, Gorwitz RJ; et al. (2011). "Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children". Clin Infect Dis. 52 (3): e18–55. doi:10.1093/cid/ciq146. PMID 21208910.