Treatment of Staphylococcus epidermidis in Urine

Key Clinical Decision Points

The American Academy of Pediatrics and the Infectious Diseases Society of America recommend that asymptomatic bacteriuria with S. epidermidis should not be treated, even when isolated from properly collected urine specimens, as it typically represents contamination or asymptomatic bacteriuria that does not warrant antimicrobial therapy, with evidence suggesting that treatment increases antimicrobial resistance, costs, and adverse drug effects without improving outcomes 1, 2
Coagulase-negative staphylococci, including S. epidermidis, are not considered clinically relevant urine isolates for otherwise healthy individuals, and screening for and treating asymptomatic bacteriuria is harmful in most populations, with a strength of evidence that is clear and consistent across guidelines 1, 2

The Infectious Diseases Society of America recommends treatment for symptomatic UTI with confirmed S. epidermidis, with fever, dysuria, flank pain, or other UTI symptoms, and properly collected urine culture showing ≥50,000 CFU/mL of S. epidermidis as a single pathogen, using targeted antimicrobial therapy based on susceptibility testing, with a duration of 7 days for prompt symptom resolution, and 10-14 days for delayed response 2, 3
For patients with indwelling urinary catheters, the Infectious Diseases Society of America recommends replacing the catheter if it has been in place ≥2 weeks before starting antimicrobial therapy, as antibiotic therapy alone without catheter removal/replacement will likely fail due to biofilm formation, with a strength of evidence that is based on multiple studies 3, 4, 5, 6

The American Urological Association recommends screening for and treating asymptomatic bacteriuria, including S. epidermidis, only before endoscopic urologic procedures with mucosal trauma, such as TURP, ureteroscopy, or lithotripsy, using short-course therapy, with 1-2 doses of targeted antimicrobial, administered 30-60 minutes before the procedure, with a strength of evidence that is based on guidelines and expert opinion 1, 7

The Infectious Diseases Society of America recommends basing antimicrobial selection on local susceptibility patterns and adjusting according to culture results, with susceptibility testing obtained before finalizing antimicrobial choice, and considering the use of ciprofloxacin for UTIs caused by methicillin-susceptible S. epidermidis, with a strength of evidence that is based on guidelines and expert opinion 3