Treatment of infections due to coagulase-negative staphylococci
- JoAnn M Tufariello, MD, PhD
JoAnn M Tufariello, MD, PhD
- Albert Einstein College of Medicine
- Franklin D Lowy, MD
Franklin D Lowy, MD
- Professor of Medicine and Pathology
- Columbia University, College of Physicians and Surgeons
- Section Editors
- Daniel J Sexton, MD
Daniel J Sexton, MD
- Editor-in-Chief — Infectious Diseases
- Section Editor — Bacterial Infections
- Professor of Medicine
- Duke University Medical Center
- Sheldon L Kaplan, MD
Sheldon L Kaplan, MD
- Editor-in-Chief — Pediatrics
- Section Editor — Pediatric Infectious Diseases
- Professor and Vice Chairman for Clinical Affairs
- Baylor College of Medicine
Coagulase-negative staphylococci (CoNS) are part of the normal flora of human skin . These organisms have relatively low virulence but are increasingly recognized as agents of clinically significant infection of the bloodstream and other sites.
Risk factors for CoNS infection include the presence of foreign devices (such as intravascular catheters) and immune compromise. Treatment of CoNS infections can be challenging given the frequency with which antimicrobial resistance is encountered and the frequent presence of foreign material.
Issues related to antimicrobial resistance and treatment of CoNS infections will be reviewed here. The epidemiology, microbiology, pathogenesis, and clinical manifestations of CoNS are discussed separately. (See "Epidemiology, microbiology, and pathogenesis of coagulase-negative staphylococci" and "Clinical manifestations of infection due to coagulase-negative staphylococci".)
Microbiology — Resistance to penicillin among the coagulase-negative staphylococci (CoNS) approaches 90 to 95 percent. Resistance to methicillin and semisynthetic penicillins has been observed in more than 80 percent of CoNS isolates ; these isolates are often resistant to multiple classes of antibiotics in addition to beta-lactams. An important exception is Staphylococcus lugdunensis, which is unique among the CoNS by virtue of its susceptibility to a wide range of antimicrobials. (See "Staphylococcus lugdunensis".)
The genes responsible for resistance are often found on plasmids, facilitating horizontal exchange of resistance genes among strains. The mecA gene encoding a low-affinity penicillin-binding protein (PBP 2a) is responsible for mediating methicillin or oxacillin resistance in CoNS, as in Staphylococcus aureus . It is part of a mobile genetic element called SCCmec (staphylococcal cassette chromosome). This resistance is usually heterotypic, since only a minority of the bacterial population (as few as one in 103 or 106 organisms) expresses the resistant phenotype; this makes detection of resistance especially challenging . (See "Microbiology of methicillin-resistant Staphylococcus aureus".)
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