Staphylococcus aureus
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Introduction
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
- Staphylococcus aureus serology
- Staphylococcus aureus nucleic acid
- MRSA nucleic acid (also see MRSA)
- Staphylococcus aureus toxin 1 identified in isolate
- antibiotic-resistant Staphylococcus aureus identified in isolate
- see ARUP consult[9]
Diagnostic procedures
- 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
- consult infectious disease for sepsis[17]
- 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]
- switch to oral antibiotics after 14 days in low-risk patients
- complicated S. aureus bacteremia (positive follow-up cultures, persistent fever, endocarditis, or metastatic infection) IV antibiotics for 28-42 days[19]
- antibiotics
- MSSA
- nafcillin, methicillin, oxacillin*, dicloxacillin
- alternative agents:
- cefazolin may be better tolerated than nafcillin[6]
- clindamycin (84% susceptibility)[13]
- 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
- MRSA
- vancomycin, daptomycin or linezolid
- alternatives:
- trimethoprim/sulfamethoxazole (high susceptibility)
- clindamycin (91% susceptibility)[13]
- no overall benefit for added rifampicin[18]
- MSSA
- low-dose aspirin use prior to onset of Staphylococcus aureus sepsis reduces mortality (no so for E coli sepsis)[12]
- 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]
More general terms
More specific terms
- methicillin-resistant Staphylococcus aureus (MRSA)
- methicillin-sensitive Staphylococcus aureus (MSSA)
Additional terms
- chronic nasal colonization with Staphylococcus aureus
- ecthyma
- impetigo
- Staphylococcal pneumonia
- Staphylococcal scalded skin syndrome
References
- ↑ Manual of Medical Therapeutics, 28th edition, Ewald & McKenzie (eds) Little, Brown & Co, 1995, pg 301
- ↑ 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 - ↑ Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 796
- ↑ Harrison's Principles of Internal Medicine, 13th ed. Isselbacher et al (eds), McGraw-Hill Inc. NY, 1994, pg 615
- ↑ 5.0 5.1 Geriatrics Review Syllabus, American Geriatrics Society, 5th edition, 2002-2004
- ↑ 6.0 6.1 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: https://www.ncbi.nlm.nih.gov/pubmed/21825299
- ↑ 7.0 7.1 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: https://www.ncbi.nlm.nih.gov/pubmed/22198793
- ↑ 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: https://www.ncbi.nlm.nih.gov/pubmed/22760291
- ↑ 9.0 9.1 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 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23599360 <Internet> http://jac.oxfordjournals.org/content/early/2013/04/18/jac.dkt108
- ↑ ARUP Consult: Staphylococcal Disease deprecated reference
- ↑ 11.0 11.1 11.2 11.3 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: https://www.ncbi.nlm.nih.gov/pubmed/26536114
Hardt WD Antibiotics: Homed to the hideout. Nature. 2015 Nov 19;527(7578):309-10 PMID: https://www.ncbi.nlm.nih.gov/pubmed/26536107 - ↑ 12.0 12.1 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: https://www.ncbi.nlm.nih.gov/pubmed/26741577
- ↑ 13.0 13.1 13.2 13.3 Kaplan SL Staphylococcus aureus Infections in Children: The Implications of Changing Trends. Pediatrics Apr 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26933210 <Internet> http://pediatrics.aappublications.org/content/early/recent
- ↑ 14.0 14.1 Yahav D et al. Risk factors for long-term mortality of Staphylococcus aureus bacteremia. Eur J Clin Microbiol Infect Dis 2016 Feb 12 PMID: https://www.ncbi.nlm.nih.gov/pubmed/26873381
- ↑ 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: https://www.ncbi.nlm.nih.gov/pubmed/21371655
- ↑ 16.0 16.1 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 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27379577 <Internet> http://annals.org/article.aspx?articleid=2531780
- ↑ 17.0 17.1 17.2 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 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28873140 <Internet> http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2652832
- ↑ 18.0 18.1 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]. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29249276 Free Article <Internet> 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 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29249277 Free Article <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)33294-4/fulltext - ↑ 19.0 19.1 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: https://www.ncbi.nlm.nih.gov/pubmed/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: https://www.ncbi.nlm.nih.gov/pubmed/30264099 https://jamanetwork.com/journals/jama/fullarticle/2703302 - ↑ 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: https://www.ncbi.nlm.nih.gov/pubmed/26016486 Free PMC Article
- ↑ 21.0 21.1 21.2 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: https://www.ncbi.nlm.nih.gov/pubmed/32015029 https://aac.asm.org/content/early/2020/01/28/AAC.02345-19