What is Staphylococcus Epidermidis
Coagulase-negative staphylococci (CNS) are an essential part of the commensal flora of the human and other warm-blooded animals skin and mucous membranes. He is also to be found on foods and settled on polymeric surfaces. Bacteria forms white colonies 1-2 millimeter in diameter after 24 hour incubation and it grows best in aerobic conditions. They do people are classic opportunists, only possess a low pathogenic potential for immune-competent individuals. Staphylococcus epidermidis is responsible for 70-80% of infections caused by CNS.
Staphylococcus Epidermidis syndromes
S. epidermidis is a common cause of infections of implanted foreign bodies (intravascular catheters, catheters for continuous ambulatory peritoneal dialysis [CAPD], Liquorshunts, prostheses, artificial heart valves and joints, pacemakers, etc.).
Bring the tribes, the foreign body-associated infections usually come from the endogenous flora of patients. But there are also exogenous nosocomial infections. About the pathogenicity is known that S. epidermidis strains have the ability to bind to polymer surfaces and there by train and increase mucus production (glycocalyx) biofilms. This process is in the presence of matrix proteins (eg fibrinogen, fibronectin), which cover the foreign body in the macro-organism, become stronger. Biofilms are sources of infection from which bacteria are flushed into the bloodstream and cause sepsis-like illness images.
Staphylococcus Epidermidis diagnosis
The current Miq Directive (quality standard for microbiological and infectious diseases diagnostics of the German Society for Hygiene and Microbiology) for blood culture diagnostics determines that it is questionable in the detection of bacteria of the normal skin flora such as S. epidermidis, the findings if these pathogens from one of multiple blood cultures are grown. On the other hand, it is recognized that S. epidermidis can cause particularly in immunocompromised and hematology-oncology patients serious infections. With regard to the detection of oxacillin resistance testing (methicillin) is resistant strains (MRSE) is important, since these strains can not be treated with beta-lactam antibiotics. Currently, the proportion of MRSE based on all S. epidermidis strains in Germany about 70%.
Staphylococcus Epidermidis therapy
Generally, the treatment depends on the antibiogram. See www.ndrugs.com for medications. In cases of suspected prosthetic endocarditis by S. epidermidis was due to the high proportion of MRSE the primary therapy but with a glycopeptide (eg vancomycin, VANCO, etc.) in combination with rifampicin (RIFA, etc.) and / or an aminoglycoside (eg as gentamicin, including Refobacin done).
Foreign body-associated infections often have a chronic course, because they're in the depths of biofilms, bacterial cells present largely protected from the effects of antibiotics and the immune system. In general, the removal of infected foreign material is necessary.
A thrombophlebitis in venous catheters infected by S. epidermidis must always be treated with antibiotics (eg, cefazolin (ELZOGRAM etc.) or cefuroxime (cefuroxime, etc.)). A particular problem is the infection of a permanent access (Hickman, Port, etc.) dar. port infections can be treated in the system by instillation of antibiotics.
For the therapy of MRSE infections glycopeptides are the drugs of choice. Alternatively, is a therapy with linezolid (Zyvox) and quinupristin / dalfopristin (Synercid) into consideration. Rifampicin should be used because of the rapid development of resistance only in combination with another MRSE-effective antibiotic.