You are on page 1of 13

WEBVTT

1
00:00:00.403 --> 00:00:04.006
In this video, we'll be combining
two Staphylococcus species.

2
00:00:04.254 --> 00:00:08.088
These are Staph epidermidis
and Staph saprophyticus.

3
00:00:08.553 --> 00:00:10.788
We're gonna call the scene,
"Beauty and the Plumber."

4
00:00:11.176 --> 00:00:14.311
Without further ado, let's get to
drawing out the backdrop of the scene.

5
00:00:18.606 --> 00:00:21.110
You'll notice, we're using
a lot of violet color.

6
00:00:21.149 --> 00:00:23.149
This is to signify gram-positive

7
00:00:23.227 --> 00:00:27.605
because gram-positive organisms
take up a lot of crystal violet stain.

8
00:00:27.987 --> 00:00:29.330
Our structure for this segment

9
00:00:29.368 --> 00:00:32.601
will be to discuss unique features
of epidermidis first.

10
00:00:32.887 --> 00:00:34.687
Then there's the saprophyticus.

11
00:00:34.794 --> 00:00:37.770
And finally, we'll talk about their
shared features at the end.

12
00:00:38.577 --> 00:00:41.967
We'll be illustrating all of the unique
characteristics of Staph epidermidis
13
00:00:42.018 --> 00:00:43.553
around this plumber right here.

14
00:00:44.499 --> 00:00:46.965
So first, you should know
that Staph epidermidis

15
00:00:47.016 --> 00:00:49.295
is the enemy of orthopedic surgeons.

16
00:00:49.631 --> 00:00:52.928
It often infects artificial joins
and other implanted hardware.

17
00:00:53.306 --> 00:00:55.306
So we've drawn a bunch of hardware
down here

18
00:00:55.368 --> 00:00:57.709
that the plumber is working on
to remind you of that.

19
00:00:58.360 --> 00:01:00.856
Now, we'll draw some tubing
down here under the sink

20
00:01:00.919 --> 00:01:02.516
that look like catheter tubes.

21
00:01:03.074 --> 00:01:05.074
This is because indwelling catheters

22
00:01:05.105 --> 00:01:08.426
are also important sources of infection
of Staph epidermidis.

23
00:01:08.918 --> 00:01:11.215
Staph epidermidis is everywhere.

24
00:01:11.337 --> 00:01:13.990
It's given a name because
it covers all of our skin

25
00:01:14.174 --> 00:01:15.939
so when you penetrate the skin
with a line,
26
00:01:15.988 --> 00:01:17.769
it makes sense that Staph epidermidis

27
00:01:17.802 --> 00:01:19.802
will be the culprit of these infections.

28
00:01:20.081 --> 00:01:23.099
Finally, the third major area
of infection for epidermidis

29
00:01:23.120 --> 00:01:24.588
is really the same as the first.

30
00:01:24.919 --> 00:01:27.665
It's an infection of an implant
but it's slightly special.

31
00:01:28.020 --> 00:01:31.354
You have to know that it's the most
common cause of endocarditis

32
00:01:31.400 --> 00:01:33.943
affecting artificially implanted
heart valves.

33
00:01:34.361 --> 00:01:36.127
So we'll draw some valves over here

34
00:01:36.315 --> 00:01:38.144
and one of them will be shaped
like a heart.

35
00:01:38.888 --> 00:01:42.840
And this is our symbol for endocarditis
of artificial heart valves.

36
00:01:43.462 --> 00:01:46.894
One reason epidermidis is so good
at infecting prosthesis,

37
00:01:46.950 --> 00:01:48.950
implanted heart valves, and catheters

38
00:01:49.260 --> 00:01:53.064
is because it has found a way to stick
to sleek metal and plastic surfaces.

39
00:01:53.291 --> 00:01:55.808
It produces copious adherent biofilms

40
00:01:55.983 --> 00:01:57.890
which is a massive polysaccharides

41
00:01:57.914 --> 00:02:00.145
and not only help it stick to surfaces

42
00:02:00.298 --> 00:02:02.251
but it also acts as a coating that

43
00:02:02.309 --> 00:02:05.343
protects it from exposure to antibiotics
and immune cells.

44
00:02:05.836 --> 00:02:07.836
So to help you remember these biofilms,

45
00:02:07.929 --> 00:02:09.859
we'll draw a bunch of gunk
under the sink

46
00:02:09.906 --> 00:02:12.220
coating all of the pipes
and tubes and valves.

47
00:02:12.500 --> 00:02:14.140
I think that's pretty intuitive.

48
00:02:14.512 --> 00:02:17.290
Because epidermidis is able to
produce these biofilms,

49
00:02:17.515 --> 00:02:19.760
it's resistant to many antibiotics.

50
00:02:20.040 --> 00:02:21.923
So you have to really bring out
the big guns.

51
00:02:22.262 --> 00:02:24.262
Current guidelines state
that you should treat
52
00:02:24.311 --> 00:02:26.758
suspected Staph epidermidis endocarditis

53
00:02:26.920 --> 00:02:28.184
with Vancomycin.

54
00:02:28.627 --> 00:02:31.477
We'll draw the vancomycin van
outside of the kitchen window.

55
00:02:32.106 --> 00:02:34.690
Remember, we used a caravan
in Staph aureus

56
00:02:34.735 --> 00:02:37.281
but that's only because after
doing extensive research

57
00:02:37.341 --> 00:02:40.340
we found out that vans didn't exist
in Moses' time.

58
00:02:40.891 --> 00:02:43.977
So we'll continue to use this van symbol
in future drawings.

59
00:02:44.324 --> 00:02:47.025
Also, you should know if any
implanted joint is infected

60
00:02:47.081 --> 00:02:49.175
it's more than likely that
you have to replace it.

61
00:02:49.303 --> 00:02:51.303
Staph epidermidis is a nasty
little bugger.

62
00:02:51.792 --> 00:02:53.452
If you were to draw blood cultures
on me,

63
00:02:53.580 --> 00:02:56.288
there's a really decent chance
that Staph epi would grow
64
00:02:56.361 --> 00:02:58.466
even though I'm not really
infected with it.

65
00:02:58.599 --> 00:02:59.656
Really I hope I'm not.

66
00:03:00.277 --> 00:03:02.202
But this is because as I
mentioned earlier,

67
00:03:02.235 --> 00:03:03.539
it's normal skin flora

68
00:03:03.603 --> 00:03:06.127
so it's everywhere and can easily
contaminate cultures

69
00:03:06.160 --> 00:03:07.160
when blood is drawn

70
00:03:07.602 --> 00:03:10.438
So to remember this, we're gonna put
some dirt on our plumber's hand

71
00:03:10.476 --> 00:03:13.774
representing that it's covering the skin
and part of his normal flora.

72
00:03:14.176 --> 00:03:16.408
And then we'll draw this
drip pan over here

73
00:03:16.479 --> 00:03:19.138
which looks a lot like
a blood culture petri dish.

74
00:03:19.470 --> 00:03:22.051
We're showing dirty liquid
dripping into the culture

75
00:03:22.460 --> 00:03:24.460
which altogether is representing

76
00:03:24.530 --> 00:03:26.530
contamination of blood cultures.
77
00:03:27.964 --> 00:03:30.440
Alright, we're almost done with
the Staph epidermidis

78
00:03:30.488 --> 00:03:32.488
but there is another thing that
you should be aware of.

79
00:03:32.756 --> 00:03:34.604
One of the attributes that distinguishes

80
00:03:34.640 --> 00:03:36.828
Staph epi from Staph saprophyticus

81
00:03:36.955 --> 00:03:39.878
is that Staph epi
is Novobiocin-sensitive.

82
00:03:40.564 --> 00:03:42.559
This can be a tough one
for instance, remember?

83
00:03:42.585 --> 00:03:43.693
Or at least it was for me.

84
00:03:44.125 --> 00:03:47.498
But I think we've figured out
a great way to eliminate confusion.

85
00:03:48.806 --> 00:03:50.922
Novo, kind of sounds like navel.

86
00:03:51.470 --> 00:03:53.188
Navel as in belly button.

87
00:03:53.272 --> 00:03:56.071
So we're going to expose
the plumber's navel here

88
00:03:56.239 --> 00:03:58.601
to help you remember
Novobiocin-sensitive.

89
00:03:58.822 --> 00:04:01.243
Yes, his stomach is hanging out
but he's a plumber.

90
00:04:01.451 --> 00:04:03.697
He could lose a little weight, he knows.
He knows.

91
00:04:03.742 --> 00:04:04.778
He's working on it.

92
00:04:04.856 --> 00:04:05.672
He's sensitive.

93
00:04:05.796 --> 00:04:07.112
His navel is sensitive.

94
00:04:07.870 --> 00:04:09.929
Since that's all for Staph epidermidis,

95
00:04:09.975 --> 00:04:12.641
let's move on to cover
Staph saprophyticus.

96
00:04:12.942 --> 00:04:15.958
She'll be represented by this young lady
sitting on the counter.

97
00:04:16.271 --> 00:04:19.054
Really quickly, notice that her navel
is not exposed.

98
00:04:19.133 --> 00:04:20.936
She's Novobiocin-resistant.

99
00:04:21.167 --> 00:04:22.130
Sensitive.

100
00:04:22.254 --> 00:04:23.165
Resistant.

101
00:04:23.462 --> 00:04:24.498
Sensitive.

102
00:04:24.693 --> 00:04:25.455
Resistant.

103
00:04:25.877 --> 00:04:26.878
Never forget it.

104
00:04:27.760 --> 00:04:31.593
Truthfully, you probably won't get too
many questions on Staph saprophyticus.

105
00:04:31.835 --> 00:04:34.477
But there are few things you should
know about it just in case.

106
00:04:35.373 --> 00:04:39.312
Staph saprophyticus is the common cause
of urinary tract infections

107
00:04:39.529 --> 00:04:42.887
specifically in sexually active females.

108
00:04:43.429 --> 00:04:45.803
This is why we made our
saprophyticus girl

109
00:04:45.884 --> 00:04:47.884
looks as sexy as a cartoon can.

110
00:04:48.187 --> 00:04:49.688
Twirling her hair and all.

111
00:04:49.942 --> 00:04:53.080
This should help you remember
saprophyticus' association

112
00:04:53.139 --> 00:04:55.517
with sexually active females.

113
00:04:56.017 --> 00:04:59.299
To help you remember that
Staph saprophyticus causes UTIs,

114
00:04:59.486 --> 00:05:01.368
we're gonna give her our UTI symbol

115
00:05:01.403 --> 00:05:03.861
which is a yellow drink that is
shaped like a bladder

116
00:05:03.997 --> 00:05:07.079
and has these two straws coming
out of it that look like ureters.

117
00:05:07.396 --> 00:05:08.216
Pretty cool.

118
00:05:08.685 --> 00:05:11.370
Again, this is the symbol you'll see
in future drawings.

119
00:05:12.118 --> 00:05:15.438
Now we're going to illustrate all
the attributes these two have in common.

120
00:05:15.820 --> 00:05:19.490
First, both of these microbes
are catalase-positive.

121
00:05:19.626 --> 00:05:22.378
To remember this, we'll have
our catalase-positive cat

122
00:05:22.617 --> 00:05:24.255
sitting over here on the counter.

123
00:05:24.676 --> 00:05:27.280
And all of the Staphylococci
are catalase-positive.

124
00:05:27.468 --> 00:05:29.468
So this is one way you can tell Staph

125
00:05:29.631 --> 00:05:30.389
from Strep.

126
00:05:31.620 --> 00:05:33.959
This next fact is kind of random
and not really important

127
00:05:34.005 --> 00:05:35.320
for these two microbes.

128
00:05:35.516 --> 00:05:38.010
But both are actually urease-positive.

129
00:05:38.506 --> 00:05:40.788
It's more important for proteus
and klebsiella

130
00:05:40.995 --> 00:05:43.465
which we'll see in future videos
but I'll explain it here.

131
00:05:43.636 --> 00:05:46.407
Urease converts urea into ammonia.

132
00:05:46.731 --> 00:05:50.284
So our symbol for urease-positive
is this ammonia spray bottle.

133
00:05:50.573 --> 00:05:51.842
A household cleaner.

134
00:05:52.398 --> 00:05:56.187
You'll see it every time we're dealing
with a urease-positive organism.

135
00:05:57.253 --> 00:06:00.484
Last, and most important
of the shared characteristics

136
00:06:00.640 --> 00:06:04.395
is that you should know that both of these
microbes are coagulase-negative.

137
00:06:04.943 --> 00:06:08.153
This is in contrast to Staph aureus
which is coagulase-positive.

138
00:06:08.493 --> 00:06:10.891
In fact, you often just hear
of Staph epidermidis

139
00:06:10.913 --> 00:06:13.357
referred to as a coag-negative Staph.

140
00:06:13.717 --> 00:06:15.075
And they won't even mention the name.

141
00:06:15.589 --> 00:06:18.564
So to remember this, we'll have
a bowl of jello here on the counter.
142
00:06:18.800 --> 00:06:22.550
The jello is untouched with a
nice, smooth and liquidy surface

143
00:06:22.654 --> 00:06:24.654
It doesn't look coagulated at all.

144
00:06:24.992 --> 00:06:28.089
Remember how in Staph aureus
the red sea was coagulated?

145
00:06:28.262 --> 00:06:31.395
To make sure you get the comparison
between the coag-negative here

146
00:06:31.438 --> 00:06:33.241
and coag-positive Staph aureus,

147
00:06:33.392 --> 00:06:35.287
we've added this little subtlety.

148
00:06:36.103 --> 00:06:39.020
Notice the jello brand is Moses' GELL-O.

149
00:06:39.420 --> 00:06:41.044
This will help you make the connection

150
00:06:41.082 --> 00:06:43.799
that coag-negative separates it
from Staph aureus.

151
00:06:44.061 --> 00:06:45.603
We also made the hyphen red

152
00:06:45.770 --> 00:06:47.326
so it looks like a negative symbol.

153
00:06:48.562 --> 00:06:49.189
And that's it.

154
00:06:49.303 --> 00:06:52.354
We knocked out two microbes
in one cohesive sketch.

155
00:06:52.567 --> 00:06:53.599
I hope you enjoyed it.