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Optimum treatment of staphylococcal infections
1Department of Microbiology, Monash Medical Centre, Clayton, Victoria, Australia.
Abstract:
Serious staphylococcal infections remain a significant clinical problem despite advances in antibacterial therapy. Resistance to penicillin is common and methicillin-resistant staphylococci have become troublesome nosocomial pathogens in many institutions. Penicillinase-resistant penicillins (e.g. flucloxacillin, cloxacillin and oxacillin) are the preferred drugs for all methicillin-susceptible staphylococcal infections, although first generation cephalosporins, beta-lactam/beta-lactamase inhibitor combinations, clindamycin, and occasionally erythromycin and cotrimoxazole (trimethoprim/sulfamethoxazole) are alternatives. Serious infections due to methicillin-resistant staphylococci should be treated with parenteral vancomycin. Teicoplanin, where available, is a suitable alternative. Rifampicin, fusidic acid and some fluoroquinolones may be useful oral alternatives, although resistance develops rapidly if they are used as single agents. Cotrimoxazole and minocycline have also proven useful when strains are susceptible. Staphylococcal toxic shock syndrome often requires aggressive resuscitation and anti-staphylococcal therapy for generally 10 to 14 days. Staphylococcus aureus bacteraemia remains a life-threatening condition which, in all but one-third of cases, is associated with an underlying septic focus such as endocarditis, osteomyelitis or occult abscess. Differentiating between complicated and uncomplicated bacteraemia is critical to define the appropriate treatment regimen. Serious staphylococcal sepsis such as endocarditis and acute osteomyelitis generally requires prolonged (4 to 6 weeks) antibiotic treatment. Coagulase-negative staphylococci are the commonest cause of prosthetic device infection, and generally require prolonged therapy with an agent to which they have proven to be sensitive, e.g. a penicillinase-resistant penicillin or vancomycin. Removal of infected foreign or prosthetic material, and drainage of deep collections remain a critical aspect of all therapy.
Insights
Serious staphylococcal infections, including those caused by methicillin-resistant strains, require specific antibiotic strategies. Treatment depends on susceptibility, with vancomycin often used for resistant infections and prolonged therapy for severe cases.
Area of Science:
- Infectious Diseases
- Microbiology
- Pharmacology
Background:
- Serious staphylococcal infections pose a significant clinical challenge due to widespread penicillin resistance and the emergence of methicillin-resistant staphylococci (MRSA) as nosocomial pathogens.
- Effective management necessitates understanding resistance patterns and selecting appropriate antimicrobial agents.
Purpose of the Study:
- To outline current therapeutic strategies for serious staphylococcal infections, addressing both methicillin-susceptible and methicillin-resistant strains.
- To highlight critical considerations for treating specific conditions like Staphylococcus aureus bacteremia and prosthetic device infections.
Main Methods:
- Review of established and alternative antibiotic treatments based on staphylococcal susceptibility profiles.
- Discussion of treatment durations and adjunctive therapies for severe staphylococcal infections.
Main Results:
- Penicillinase-resistant penicillins are preferred for methicillin-susceptible staphylococci; parenteral vancomycin is the primary treatment for MRSA infections.
- Oral alternatives like rifampicin and fluoroquinolones may be used cautiously, while cotrimoxazole and minocycline are options for susceptible strains.
- Prolonged antibiotic courses (4-6 weeks) are essential for severe sepsis like endocarditis and osteomyelitis, alongside removal of infected prosthetic material.
Conclusions:
- Tailoring antibiotic therapy to specific staphylococcal susceptibility is crucial for successful outcomes.
- Management of severe staphylococcal infections requires prolonged treatment and often surgical intervention, such as drainage or removal of infected devices.