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p
 is a group of bacteria that can cause a multitude of diseases as a result of infection of various tissues
of the body. p
 is more familiarly known as Staph (pronounced "staff"). Staph-related illness can range
from mild and requiring no treatment to severe and potentially fatal.

The name p
 comes from the Greek


, meaning a bunch of grapes, and  , meaning berry,
and that is what Staph look like under the microscope, like a bunch of grapes or little round berries. (In technical
terms, these are gram-positive, facultative anaerobic, usually unencapsulated cocci.)

Over 30 different types of Staphylococci can infect humans, but most infections are caused by p
 


 . Staphylococci can be found normally in the nose and on the skin (and less commonly in other locations) of
25%-30% of healthy adults. In the majority of cases, the bacteria do not cause disease. However, damage to the skin
or other injury may allow the bacteria to overcome the natural protective mechanisms of the body, leading to
infection.

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nyone can develop a Staph infection, although certain groups of people are at greater risk, including newborn
infants, breastfeeding women, and people with chronic conditions such as diabetes, cancer, vascular disease, and
lung disease. Injecting drug users, those with skin injuries or disorders, intravenous catheters, surgical incisions, and
those with a weakened immune system all have an increased risk of developing Staph infections.

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Staphylococcal disease of the skin usually results in a localized collection of pus, known as an abscess, boil, or
furuncle. The affected area may be red, swollen, and painful. Drainage or pus is common. When Staph is in the
blood (bacteremia or sepsis) it can cause high fevers, chills, and low blood pressure.

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Skin infections (see above) are the most common type of disease produced by

p
 . Staph infections of the skin can progress to impetigo (a crusting of the skin) or cellulitis
(inflammation of the connective tissue under the skin, leading to swelling and redness of the area). In rare cases, a
serious complication known as scalded skin syndrome (see below) can develop. In breastfeeding women, Staph can
result in mastitis (inflammation of the breast) or in abscess of the breast. Staphylococcal breast abscesses can release
bacteria into the mother's milk.

When the bacteria enter the bloodstream and spread to other organs, a number of serious infections can occur.
Spread of the organisms to the bloodstream is known as bacteremia or sepsis. Staphylococcal pneumonia
predominantly affects people with underlying lung disease and can lead to abscess formation within the lungs.
Infection of the heart valves (endocarditis) can lead to heart failure. Spread of Staphylococci to the bones can result
in severe inflammation of the bones known as osteomyelitis. When Staph bacteria are present in the blood, a
condition known as Staphylococcal sepsis (widespread infection of the bloodstream) or Staphylococcal bacteremia
exists. Staphylococcal sepsis is a leading cause of shock and circulatory collapse, leading to death, in people with
severe burns over large areas of the body. When untreated, Staph aureus sepsis carries a mortality (death) rate of
over 80%. lthough not common, Staph aureus has been reported as a cause of chorioamnionitis and neonatal sepsis
in pregnancy, but group B streptococci are the most common bacterial cause of this life-threatening condition for the
fetus.
Staphylococcal infections should be contagious and can be transmitted from person to person. Pus from infected
wounds may contain the bacteria, proper hygiene and handwashing is required when caring for Staph-infected
wounds.

Staphylococcal food poisoning is an illness of the bowels that causes nausea, vomiting, diarrhea, and dehydration. It
is caused by eating foods contaminated with toxins produced by p
 

 . Symptoms usually develop
within one to six hours after eating contaminated food. The illness usually lasts for one to three days and resolves on
its own. Patients with this illness are not contagious, since toxins are not transmitted from one person to another.

Toxic shock syndrome is an illness caused by toxins secreted by p



 bacteria growing under conditions in
which there is little or no oxygen. Toxic shock syndrome is characterized by the sudden onset of high fever,
vomiting, diarrhea, and muscle aches, followed by low blood pressure (hypotension), which can lead to shock and
death. There may be a rash resembling sunburn, with peeling of skin. Toxic shock syndrome was originally
described and still occurs especially in menstruating women using tampons.

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In cases of minor skin infections, Staphylococcal infections are commonly diagnosed by their appearance without
the need for laboratory testing. More serious staphylococcal infections such as infection of the bloodstream,
pneumonia, and endocarditis require culturing of samples of blood or infected fluids. The laboratory establishes the
diagnosis and performs special tests to determine which antibiotics are effective against the bacteria.

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Minor skin infections are usually treated with an antibiotic ointment such as a nonprescription triple-antibiotic
mixture. In some cases, oral antibiotics may be given for skin infections. dditionally, if abscesses are present, they
are surgically drained. More serious and life-threatening infections are treated with intravenous antibiotics. The
choice of antibiotic depends on the susceptibility of the particular staphylococcal strain as determined by culture
results in the laboratory. Some Staph strains, such as MRS (see next section), are resistant to many antibiotics.

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Methicillin-resistant p
 

 , known as MRS, is a type of p
 

 that is resistant to
the antibiotic methicillin and other drugs in the same class, including penicillin, amoxicillin, and oxacillin. MRS is
one example of a so-called "superbug," an informal term used to describe a strain of bacteria that has become
resistant to the antibiotics usually used to treat it. MRS first appeared in patients in hospitals and other health
facilities, especially among the elderly, the very sick, and those with an open wound (such as a bedsore) or catheter
in the body. In these settings, MRS is referred to as health-care-associated MRS (H-MRS).

MRS has since been found to cause illness in the community outside of hospitals and other health facilities and is
known as community-associated MRS (C-MRS) in this setting. MRS in the community is associated with
recent antibiotic use, sharing contaminated items, having active skin diseases or injuries, poor hygiene, and living in
crowded settings. The U.S. Centers for Disease Control and Prevention (CDC) estimates that about 12% of MRS
infections are now community-associated, but this percentage can vary by community and patient population.

MRS infections are usually mild superficial infections of the skin that can be treated successfully with proper skin
care and antibiotics. MRS, however, can be difficult to treat and can progress to life-threatening blood or bone
infections because there are fewer effective antibiotics available for treatment.

The transmission of MRS is largely from people with active MRS skin infections. MRS is almost always
spread by direct physical contact and not through the air. Spread may also occur through indirect contact by
touching objects (such as towels, sheets, wound dressings, clothes, workout areas, sports equipment) contaminated
by the infected skin of a person with MRS. Just as p

 can be carried on the skin or in the nose without
causing any disease, MRS can be carried in this way also. In contrast to the relatively high (25%-30%) percentage
of adults who are colonized by p


 on the skin (have Staph bacteria present that do not cause illness), only
about 1% of people carry MRS.

More recently, strains of p



 have been identified that are resistant to the antibiotic vancomycin, which is
normally effective in treating Staph infections. These bacteria are referred to as vancomycin-intermediate resistance
p

 (VIS) and vancomycin-resistant p


 (VRS).

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Scalded skin syndrome is a potentially serious side effect of infection with Staph bacteria that produce a specific
protein which loosens the "cement" holding the various layers of the skin together. This allows blister formation and
sloughing of the top layer of skin. If it occurs over large body regions, it can be deadly, similar to a large surface
area of the body having been burned. It is necessary to treat scalded skin syndrome with intravenous antibiotics and
to protect the skin from allowing dehydration to occur if large areas peel off. The disease occurs predominantly in
children but can occur in anyone. It is known formally as Staphylococcal scalded skin syndrome.



 
 

No vaccine is available against p
 


 . Since the bacteria are so widespread and cause so many
different diseases, prevention of Staph infections requires attention to the risk factors that may increase the
likelihood of getting a particular type of Staph infection. For example, it is possible for menstruating women reduce
the risk of toxic shock syndrome by frequently changing tampons (at least every four to eight hours), using low-
absorbency tampons, and alternating sanitary pad and tampon use. Careful attention to food-handling and food-
preparation practices can decrease the risk of Staphylococcal food poisoning. Prevention of Staph infections can be
aided by proper hygiene when caring for skin wounds. Careful hand washing, avoiding close skin contact with
possible infected individuals, and proper hygienic care of skin scrapes, cuts, and wounds can all reduce the
likelihood of skin infections due to Staph, including community-acquired MRS.

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