Management of Staphylococcus epidermidis in Urine Culture

Key Clinical Decision Points

The Infectious Diseases Society of America recommends against treating asymptomatic bacteriuria with S. epidermidis in most populations, as treatment promotes antimicrobial resistance without clinical benefit 1
The Hospital Infection Control Practices Advisory Committee discourages treatment of single positive cultures when contamination is likely, a principle that extends to urine cultures where S. epidermidis is a common skin contaminant 2, 3

Treatment of S. epidermidis urinary tract infections is indicated when the patient has clear urinary symptoms and a positive culture, according to the Infectious Diseases Society of America and the American Academy of Pediatrics 1, 4
The Infectious Diseases Society of America recommends treating S. epidermidis urinary tract infections in patients undergoing endoscopic urologic procedures with anticipated mucosal trauma 1
The Infectious Diseases Society of America recommends treating asymptomatic bacteriuria in pregnant women, one of the few populations where asymptomatic bacteriuria requires treatment 1

Device removal is often necessary for device-related infections, as S. epidermidis produces extracellular slime forming biofilms on indwelling devices, requiring higher antibiotic concentrations to eradicate 5
The Centers for Disease Control and Prevention recommends against using vancomycin for routine prophylaxis of catheter-associated infections or for treating presumed infections when cultures are negative 2, 3
The American Academy of Pediatrics recognizes that while S. epidermidis can cause true UTIs in children with anatomic abnormalities, it should not be treated as a first-line pathogen without clear clinical indication 6, 7
Proper specimen collection technique is essential to minimize contamination, as S. epidermidis is normal skin flora, according to the Hospital Infection Control Practices Advisory Committee 2, 3