Staphylococcus epidermidis

Staphylococcus epidermidis

Description, Causes and Risk Factors:

Staphylococcus epidermidis (S. epidermidis) is a part of a normal skin flora, and it is often attached to the upper layer of the skin (epidermis) or mucosa, without causing any symptoms (staph epidermidis carrier state).

When the skin is injured (wounds, burns, intravenous drug addicts etc), Staphylococcus epidermidis may enter into deeper layers of the skin or even the blood and cause an infection.

Staphylococcus epidermidis is a gram-positive, coagulase negative hemolytic. It grows in aerobic conditions, but also in anaerobic conditions (without air). It forms white colonies on blood agar. The hosts for the Staphylococcus epidermidis are humans and other warm-blooded animals.

Staphylococcus epidermidis is spread by skin-to-skin contact. In hospitals, it can spread by medical instruments, stethoscopes, oxygen masks, bed lining, and so on.

Risk Factors:

  • Lowered immunity due to cancer, chemotherapy, AIDS, heavy disease (especially in old people), low birth weight (newborns) are at high risk.
  • Congenital heart or vascular disease.
  • Internal prosthetic devices: artificial heart valves, artificial hip, cerebrovascular shunts, and so on.
  • Vascular or urinary catheters, peritoneal dialysis.
  • Skin diseases, injuries, burns.
  • Injured gastrointestinal mucosa and those receiving oral antibiotics that kill normal gut bacteria and thus provide place for antibiotic resistant Staphylococcus epidermidis strains.

Symptoms:

Signs and Symptoms:

  • Symptoms of a Staphylococcus epidermidis infection do not differ much from symptoms of S. aureus infection; both may be mild or life threatening.
  • Staphylococcus epidermidis and rarely Staphylococcus saprophyiticus may sometimes cause staph skin infections.
  • Staphylococcus epidermidis may cause infection of conjunctiva (conjunctivitis), cornea (keratitis) or hair follicles on the edge of the eyelid (folliculitis, stye).
  • S.epidermidis and S. saprophyticus often causes hospital acquired urinary infections, mostly in old, catheterized patients with urinary tract complications.
  • Persons with artificial heart valves, hips, cerebrovascular shunts (meningitis), patients on peritoneal dialysis (peritonitis), operations of bones (osteomyelitis), eye operations (endophthalmitis) are all at greater risk to get Staphylococcus epidermidis infection.

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%.

Treatment:

Generally, the treatment depends on the antibiogram. 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.

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.

For best treatment options consult your physician.

NOTE: The above information is for the educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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