Therapeutic considerations for infections caused by Staphylococcus epidermidis.

Most institutions are experiencing increased numbers of methicillin-resistant S. epidermidis infections. Currently, vancomycin is the only antibiotic that provides reliable bactericidal activity against this microorganism, including methicillin-resistant strains. Vancomycin is the treatment of choice for infections caused by methicillin-resistant staphylococci and for serious gram-positive infections in penicillin-allergic patients. With the emergence of more numerous and more serious gram-positive infections, this agent either alone or in combination with other antibiotics will clearly assume greater importance in the management of gram-positive infections, independent of host allergy or bacterial resistance. It is assuming a pivotal role in the treatment of gram-positive infections of central nervous system or dialysis shunts, endocarditis, meningitis, and septicemia. Except in patients with confirmed allergy to a beta-lactam antibiotic, vancomycin is not indicated for routine surgical prophylaxis. The current upsurge in methicillin-resistant staphylococcal infections as a complication of implant surgery may necessitate its use as a prophylactic agent, however.