Treatment of Gram-Positive Cocci in Blood and Coagulase-Negative Staphylococcus in Urine

Initial Empiric Therapy

• The Infectious Diseases Society of America recommends starting with vancomycin plus cefazolin while awaiting full culture and susceptibility results for patients with gram-positive cocci in the blood and coagulase-negative Staphylococcus in the urine 1, 2, 3

Treatment Approach

• For methicillin-susceptible staphylococci, the American College of Clinical Pharmacy recommends de-escalating to cefazolin alone as the preferred agent 1, 3
• For methicillin-resistant staphylococci, the Infectious Diseases Society of America recommends continuing vancomycin alone 1, 3, 4
• For mixed infections, consider continuing both agents if both methicillin-resistant and methicillin-susceptible organisms are present in different sites 3, 5

Dosing Recommendations

• For hemodialysis patients, the National Kidney Foundation recommends a 20 mg/kg loading dose of vancomycin followed by 500 mg during subsequent dialysis sessions, and 20 mg/kg IV of cefazolin after each dialysis session 1, 3

Clinical Considerations

• The Society for Healthcare Epidemiology of America recommends considering antibiotic lock therapy in addition to systemic antibiotics if the infection is catheter-related 4, 6
• For catheter lock solutions, the Infectious Diseases Society of America recommends cefazolin (5.0 mg/mL) for methicillin-susceptible staphylococci and vancomycin (5.0 mg/mL) for methicillin-resistant staphylococci 4, 7

Special Populations

• The American Geriatrics Society recommends using caution with dosing in elderly patients as both drugs are excreted by the kidney, and renal function monitoring is essential, although no specific citation is provided, the general guideline is to follow specific dosing recommendations for dialysis patients 1, 3