Treatment of Staphylococcus Skin Infection Affecting the Kidney

Initial Assessment and Classification

• The Infectious Diseases Society of America recommends obtaining blood cultures 2-4 days after initial positive cultures to document clearance of bacteremia, and performing echocardiography for all adult patients with bacteremia to exclude endocarditis, and assessing for metastatic sites of infection including bone, joints, and other organs 1
• Determining if MRSA or MSSA through culture and susceptibility testing is crucial, though empiric MRSA coverage should be initiated immediately, as recommended by the Infectious Diseases Society of America 2, 3

Antibiotic Selection

• The Infectious Diseases Society of America recommends vancomycin as the primary agent for treating staphylococcal skin infections with kidney involvement, with a dosing of 30-60 mg/kg/day IV in 2-4 divided doses, and a loading dose of 25-30 mg/kg for seriously ill patients 1, 4, 5
• Daptomycin is an equally effective alternative, with a dosing of 6 mg/kg/dose IV once daily for bacteremia, as recommended by the Infectious Diseases Society of America 1

Treatment Duration

• The Infectious Diseases Society of America recommends a treatment duration of at least 2 weeks for uncomplicated bacteremia and 4-6 weeks for complicated bacteremia, with transition from parenteral to oral agents done cautiously and not recommended in complicated bacteremia 1, 4, 5

Management of the Skin Source

• The Infectious Diseases Society of America recommends incision and drainage for purulent skin lesions, such as abscesses, carbuncles, and large furuncles, and obtaining Gram stain and culture of pus 2, 3

Monitoring Requirements

• The Infectious Diseases Society of America recommends repeat blood cultures 2-4 days after initial positive cultures, and continuing blood cultures as needed until clearance documented, and monitoring for clinical improvement and assessing for complications 1

Common Pitfalls to Avoid

• The Infectious Diseases Society of America recommends never delaying antibiotics while awaiting culture results in bacteremia, and not using oral antibiotics alone for bacteremia, and not stopping antibiotics early even if skin lesions improve, and not forgetting source control, and not assuming MSSA 1, 2, 3, 4, 5, 6, 7, 8