Rapid risk assessment: Multidrug-resistant Staphylococcus epidermidis

Risk assessment
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 European Centre for Disease Prevention and Control. Multidrug-resistant Staphylococcus epidermidis – 8 November 2018. Stockholm: ECDC; 2018. 

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This rapid risk assessment addresses the public health risk associated with a previously unrecognised international spread of near pandrug-resistant strains of S. epidermidis as a cause of infection in several countries including EU Member States.

Executive summary

Several endemic multidrug-resistant S. epidermidis strains predominate across healthcare systems globally. Increases in the rate and breadth of resistance to multiple antimicrobial agents among these strains is a concerning trend that may limit treatment options for indwelling and prosthetic device infections that are already difficult to treat. Although there are a number of alternative antimicrobial agents that are active against staphylococci, clinical experience with these antimicrobial agents is still limited. Consequently, the precise significance for the therapeutic outcome in patients who have foreign devices (e.g. central vascular catheters, orthopaedic prosthetic devices and cerebrospinal fluid shunts) and surgical site infections of evolving resistance mechanisms that have been recently described in S. epidermidis is not yet fully characterised.

Further epidemiological studies of the geographical prevalence of multidrug-resistant S. epidermidis strains as a cause of invasive infection in susceptible patient populations as well as prospective in vitro, in vivo and clinical outcome correlation studies are needed to clarify their clinical impact on therapeutic outcomes of foreign-body infections However in the majority of cases of S. epidermidis infections, removal or replacement of the contaminated medical device is already required in addition to antimicrobial therapy.

Irrespective of the findings of further studies, the increasing resistance of S. epidermidis to multiple antimicrobial agents that are currently considered as first-line agents for the treatment of S. epidermidis infections highlights the need for prudent use of them and therefore the importance of antimicrobial stewardship. Treatment options should be guided by local epidemiological surveillance data and individual antimicrobial susceptibility test results for each patient’s isolates. Ensuring consistent application of proper infection prevention and control practices, particularly during the insertion and use of medical devices, is crucial for prevention of infections by S. epidermidis. More information on antimicrobial susceptibility testing against newer antimicrobial agents with activity against S.
 epidermidis
, as well as better evaluation of their effectiveness, is necessary for the optimal management of S. epidermidis infections. 

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