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Staphylococcus aureus

Gram positive cocci in clusters. Epidemiology: - occurs in the nasal passages of 20-40% of normal individuals Pathology: - bacteremia, septicemia, endocarditis, osteomyelitis - pneumonia - abscesses - skin infections - postinfectious glomerulonephritis - S. aureus may have an intracellular phase that protects it from antibiotics [11] Genetics: - familial clustering of S aureus bacteremia - greatest relative risk in individuals exposed to siblings with a history of S aureus bacteremia [16] Laboratory: - blood cultures for bacteremia, sepsis - repeat every 2-4 days until negative - median time to clearance of MRSA is 7-9 days - Staphylococcus aureus serology - serology for Staphylococcus aureus enterotoxin - Staphylococcus aureus nucleic acid - Staphylococcus aureus DNA - Staphylococcus aureus rRNA - MRSA nucleic acid (also see MRSA) - Staphylococcus aureus toxin 1 identified in isolate - antibiotic-resistant Staphylococcus aureus identified in isolate - see ARUP consult [9] Special laboratory: - Staphylococcus aureus septicemia (catheter-related): [5,17] - transesophageal echocardiography (TEE) (rule out endocarditis) Complications: - endocarditis - osteomyelitis, esp vertebral osteomyelitis - high mortality associated with S aureus bacteremia - 20-40% 30 day mortality - 62% 1 year mortality - 72% 5 year mortality [14] Management: 1) consult infectious disease for sepsis [17] 2) if TEE negative & follow-up blood culture negative, IV antibiotics for 14 days (2-6 weeks) [21] - switch to oral antibiotics after 14 days in low-risk patients - no Staphylococcal bacteremia in > 72 hours - no evidence of deep infectio - no involvement of retained bioprosthetic material [21] 3) complicated S. aureus bacteremia (positive follow-up cultures, persistent fever, endocarditis, or metastatic infection) IV antibiotics for 28-42 days [19] 4) antibiotics a) MSSA 1] nafcillin, methicillin, oxacillin*, dicloxacillin 2] alternative agents: a] cefazolin may be better tolerated than nafcillin [6] b] clindamycin (84% susceptibility) [13] 3] if penicillin sensitive, treatment of Staphylococcal sepsis with penicillin or dicloxacillin is associated with 2.7-3.3 fold lower 30 day mortality than treatment with cefuroxime b) MRSA 1] vancomycin, daptomycin or linezolid 2] alternatives: - trimethoprim/sulfamethoxazole (high susceptibility) - clindamycin (91% susceptibility) [13] c) no overall benefit for added rifampicin [18] 5) low-dose aspirin use prior to onset of Staphylococcus aureus sepsis reduces mortality (no so for E coli sepsis) [12] 6) decolonization of household contacts with chlorhexidine & mupirocin reduces recurrence of S aureus skin infections [7] * overall susceptibility to oxacillin 68% (2014) [13] Comparative biology: - a single injection of a rifampicin-derived antibiotic attached to an antibody that binds to the surface carbohydrates of S. aureus is more successful than treatment with vancomycin, daptomycin, or linezolid in reducing bacterial burden following experimental S. aureus infection [11] - when bacteria coated with this antibody-antibiotic conjugate are ingested by cells, the antibiotic is activated & kills the intracellular S. aureus [11]

Related

chronic nasal colonization with Staphylococcus aureus ecthyma impetigo Staphylococcal pneumonia Staphylococcal scalded skin syndrome Staphylococcus aureus + MRSA nucleic acid (DNA or RNA) Staphylococcus aureus capsular polysaccharide enzyme gene Staphylococcus aureus enterotoxin A gene Staphylococcus aureus enterotoxin B gene Staphylococcus aureus enterotoxin C gene Staphylococcus aureus enterotoxin D gene Staphylococcus aureus enterotoxin E gene Staphylococcus aureus exfoliative toxin A gene Staphylococcus aureus exfoliative toxin B gene Staphylococcus aureus nucleic acid (DNA or RNA) Staphylococcus aureus Panton-Valentine leukocidin gene Staphylococcus aureus sau3AI gene Staphylococcus aureus toxic shock syndrome toxin gene

Specific

methicillin-resistant Staphylococcus aureus (MRSA) methicillin-sensitive Staphylococcus aureus (MSSA)

General

Staphylococcus

Properties

KINGDOM: monera DIVISION: SCHIZOMYCETES

References

  1. Manual of Medical Therapeutics, 28th edition, Ewald & McKenzie (eds) Little, Brown & Co, 1995, pg 301
  2. Medical Knowledge Self Assessment Program (MKSAP) 11, 15, 17. American College of Physicians, Philadelphia 1998, 2009, 2015 - Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
  3. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 796
  4. Harrison's Principles of Internal Medicine, 13th ed. Isselbacher et al (eds), McGraw-Hill Inc. NY, 1994, pg 615
  5. Geriatrics Review Syllabus, American Geriatrics Society, 5th edition, 2002-2004
  6. Lee S et al. Is cefazolin inferior to nafcillin for treatment of methicillin-susceptible Staphylococcus aureus bacteremia? Antimicrob Agents Chemother 2011 Nov; 55:5122. PMID: 21825299
  7. Fritz SA et al. Household versus individual approaches to eradication of community-associated Staphylococcus aureus in children: A randomized trial. Clin Infect Dis 2012 Mar 15; 54:743. PMID: 22198793
  8. Landrum ML et al. Epidemiology of Staphylococcus aureus blood and skin and soft tissue infections in the US Military Health System, 2005-2010. JAMA 2012 Jul 4; 308:50 PMID: 22760291
  9. Nissen JL et al. Effectiveness of penicillin, dicloxacillin and cefuroxime for penicillinsusceptible Staphylococcus aureus bacteraemia: A retrospective, propensity-score-adjusted case-control and cohort analysis. J Antimicrob Chemother 2013 PMID: 23599360 http://jac.oxfordjournals.org/content/early/2013/04/18/jac.dkt108
  10. ARUP Consult: Staphylococcal Disease deprecated reference
  11. Lehar SM, Pillow T, Xu M et al Novel antibody-antibiotic conjugate eliminates intracellular S. aureus. Nature. 2015 Nov 19;527(7578):323-8. PMID: 26536114 - Hardt WD Antibiotics: Homed to the hideout. Nature. 2015 Nov 19;527(7578):309-10 PMID: 26536107
  12. Osthoff M et al. Low-dose acetylsalicylic acid treatment and impact on short- term mortality in Staphylococcus aureus bloodstream infection: A propensity score-matched cohort study. Crit Care Med 2016 Jan 6 PMID: 26741577
  13. Kaplan SL Staphylococcus aureus Infections in Children: The Implications of Changing Trends. Pediatrics Apr 2016 PMID: 26933210 http://pediatrics.aappublications.org/content/early/recent
  14. Yahav D et al. Risk factors for long-term mortality of Staphylococcus aureus bacteremia. Eur J Clin Microbiol Infect Dis 2016 Feb 12 PMID: 26873381
  15. Thwaites GE, Edgeworth JD, Gkrania-Klotsas E et al Clinical management of Staphylococcus aureus bacteraemia. Lancet Infect Dis. 2011 Mar;11(3):208-22. Review. PMID: 21371655
  16. Oestergaard LB et al Familial Clustering of Staphylococcus aureus Bacteremia in First-Degree Relatives: A Danish Nationwide Cohort Study. Ann Intern Med. Published online 5 July 2016 PMID: 27379577 http://annals.org/article.aspx?articleid=2531780
  17. Goto M, Schweizer ML, Vaughan-Sarrazin MS et al. Association of evidence-based care processes with mortality in Staphylococcus aureus bacteremia at Veterans Health Administration hospitals, 2003-2004 JAMA Intern Med 2017 Sep 05 PMID: 28873140 http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2652832
  18. Thwaites GE, Scarborough M, Szubert A et al. Adjunctive rifampicin for Staphylococcus aureus bacteraemia (ARREST): A multicentre, randomised, double-blind, placebo- controlled trial. Lancet 2017 Dec 14; [e-pub]. PMID: 29249276 Free Article http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32456-X/fulltext - Holland TL, Fowler VG Jr. Rifampicin for Staphylococcus aureus bacteraemia: Give it ARREST. Lancet 2017 Dec 14 PMID: 29249277 Free Article http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)33294-4/fulltext
  19. Holland TL, Raad I, Boucher HW et al. Effect of algorithm-based therapy vs usual care on clinical success and serious adverse events in patients with staphylococcal bacteremia: A randomized clinical trial. JAMA 2018 Sep 25; 320:1249. PMID: 30264119 https://jamanetwork.com/journals/jama/fullarticle/2703352 - Perencevich EN. Malani PN. Treatment algorithms for staphylococcal bacteremia: Improving clinical care and enhancing antimicrobial stewardship. JAMA 2018 Sep 25; 320:1243. PMID: 30264099 https://jamanetwork.com/journals/jama/fullarticle/2703302
  20. Tong SY, Davis JS, Eichenberger E et al Staphylococcus aureus infections: epidemiology, pathophysiology, clinical manifestations, and management. Clin Microbiol Rev. 2015 Jul;28(3):603-61. Review. PMID: 26016486 Free PMC Article
  21. Bupha-Intr O, Blackmore T, Bloomfield M. Efficacy of early oral switch with beta-lactams for low-risk Staphylococcus aureus bacteremia. Antimicrob Agents Chemother 2020 Feb 3; PMID: 32015029 https://aac.asm.org/content/early/2020/01/28/AAC.02345-19