Staphylococcus lugdenesis

Treatment

Antimicrobial therapy

• 1. Skin and soft tissue infections

• Preferred regimen: Oxacillin 1-2 g IV q4h for 1-2 weeks
• Note: Abscesses should be drained if possible.

• 2. Endocarditis

• 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

• 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.

• 4. Prosthetic devices,

• 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