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 patients 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
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-  Anguera I, Del Rio A, Miro JM, Matinez-Lacasa X, Marco F, Guma 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.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link) CS1 maint: PMC format (link)
-  Jump up to: 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): 145. doi:10.1086/599376. PMC 4039170. PMID 19489710.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link) CS1 maint: PMC format (link)
-  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): e1855. doi:10.1093/cid/ciq146. PMID 21208910.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)