Batterjee Medical College

Batterjee Medical College Staphylococcus aureus

Staphylococci
Dr. Manal El Said
Head of Microbiology Department

Batterjee Medical College -lactamase

Staphylococcus aureus
Diseases
Toxic shock syndrome

Abscesses of many organs

Endocarditis Gastroenteritis (food poisoning) Hospital-acquired pneumonia Surgical wound infections

Sepsis.

Batterjee Medical College

-lactamase.

Staphylococcus aureus
Characteristics

Gram-positive cocci in clusters.

Coagulase-positive.
Catalase-positive. Most isolates produce -lactamase

Habitat and Transmission

Main habitat is human nose & skin. Transmission is via the hands.

Batterjee Medical College

Staphylococcus aureus
Pathogenesis
Three exotoxins: 1-Toxic shock syndrome toxin - Superantigen helper T cells release of lymphokines ( IL-2). 2- Enterotoxin - Superantigen - Food poisoning (has a short incubation period because it is preformed in food). 3-Scalded skin syndrome toxin: - Protease cleaves desmoglein in tight junctions in skin. - Protein A binds to heavy chain of IgG & prevents activation of complement.

Batterjee Medical College

Staphylococcus aureus
Pathogenesis
Abscess containing pus is the most common lesion.

Predisposing factors to infection

- Breaks in the skin - Foreign bodies such as sutures

- Neutrophil levels below 500/ml

- Intravenous drug use - Tampon use right-sided endocarditis toxic shock syndrome

Batterjee Medical College

Staphylococcus aureus
Laboratory Diagnosis
Gram-stained smear and culture. Yellow or gold colonies on blood agar. Coagulase-positive

Batterjee Medical College

Staphylococcus aureus
Laboratory Diagnosis

Batterjee Medical College ;

Staphylococcus aureus
Treatment
Penicillin G for sensitive isolates Nafcillin (-lactamaseresistant penicillins) for resistant

isolates
Vancomycin for isolates resistant to nafcillin (changes in binding proteins). About 85% are resistant to penicillin G (tolerant to penicillin) Plasmid-encoded -lactamase mediates most resistance.

Batterjee Medical College

S. aureus methicillin-resistant (MRSA)

Treatment

S. aureus methicillin-resistant (MRSA) is due to altered penicillin-binding proteins.

MRSA can produce outbreaks of disease, especially in

hospitals. The drug of choice is vancomycin, to which gentamicin is

sometimes added.
Daptomycin is also useful.

Batterjee Medical College

S. aureus methicillin-resistant (MRSA)

Treatment

Trimethoprim-sulfamethoxazole or clindamycin can be used to treat nonlife-threatening infections caused by these organisms. MRSA strains are resistant to all -lactam drugs, including both penicillins & cephalosporins.

Batterjee Medical College

S. aureus with intermediate resistance to vancomycin

Treatment

Strains of S. aureus with intermediate resistance to vancomycin (VISA) & with complete resistance to

vancomycin (VRSA) isolated from patients.

These strains are methicillin-resistant as well, which makes them very difficult to treat. Daptomycin can be used to treat these infections Quinupristin-dalfopristin is another useful choice.

Batterjee Medical College ;

Staphylococcus aureus
Prevention
Cefazolin is used to prevent surgical wound infections. No vaccine is available.

Handwashing reduces spread.

Batterjee Medical College

Staphylococcus epidermidis
Diseases
Endocarditis on prosthetic heart valves Prosthetic hip infection Intravascular catheter infection Cerebrospinal fluid shunt infection Neonatal sepsis.

Characteristics
Gram-positive cocci in clusters. Coagulase-negative.

Catalase-positive.

Batterjee Medical College

Staphylococcus epidermidis
Habitat and Transmission
Normal flora of human skin & mucous membranes. Patient's own strains cause infection

Transmission from person to person via hands.

Pathogenesis
Glycocalyx-producing strains adhere well to foreign bodies such as prosthetic implants & catheters. It is low-virulence organism that causes disease: - Immunocompromised patients - Those with implants. It is a major cause of hospital-acquired infections.

Batterjee Medical College

Staphylococcus epidermidis Laboratory Diagnosis

Gram-stained smear and culture. Whitish, nonhemolytic colonies on blood agar. Coagulase-negative. It is sensitive to novobiocin (S. saprophyticus, is resistant).

Batterjee Medical College

Staphylococcus epidermidis Laboratory Diagnosis

Batterjee Medical College

Staphylococcus epidermidis
Treatment
Vancomycin plus either rifampin or aminoglycoside.
It . produces -lactamases & is resistant to many antibiotics

Prevention
There is no drug or vaccine.

Batterjee Medical College

Staphylococcus saprophyticus
Gram-positive cocci in clusters. Coagulase-negative. Resistant to novobiocin (S. epidermidis is sensitive). Community-acquired urinary tract infections in young women.