STAPHYLOCOCCUS

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 Staphylococci

• Common inhabitant of then

skin and mucous
membranes
• Spherical cells
arranged in irregular
clusters
• Gram-positive
 STAPHYLOCOCCUS AUREUS
• S aureus distinguished from other species
by coagulase test

• Important causes of skin infections &

serious systemic diseases

• The widespread use of antibiotics

results in selective survival of resistant

strains
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CARRIAGE
• Anterior nares -35%

• Perineum -20%

• Axillae - 5-10%

• Toe webs – 5-10%

• In neonates- nose and umblical stump

• Intestinal carriage common in

hospitalized patients

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 TOXINS PRODUCED BY S AUREUS

• Panton-Valentine leukocidin

• Enterotoxin causing food poisoning

• Exfoliatin or Scalded Skin Syndrome toxin (SSST

• Toxic shock syndrome toxin (TSST)

 Enzymes produced by S aureus

• Coagulase – coagulates plasma and blood; diagnostic

• Hyaluronidase – digests connective tissue

• Staphylokinase – digests blood clots

• DNAase – digests DNA

• Lipases – digest oils; enhances colonization on skin

 Staphylococcus aureus: Pyogenic Diseases
• Skin and soft tissue infections
• Septicaemia
• Osteomyelitis
• Endocarditis
• Post surgical wound infections
• Pneumonia
• Conjunctivitis
 Staphylococcus aureus: Pyogenic Diseases
Skin and soft tissue infections are very common
• Impetigo
• Furuncles
• Carbuncles
• Cellulitis
• Folliculitis
• Severe necrotizing skin and soft tissue infections are caused
by MRSA strains that produce P-V leukocidin
Type of Infection Description of Lesion Layer of Skin Appearance of Lesion
Involved
and Common
Pathogens
Folliculitis Localized, inflamed Hair follicle
papules containing a S. aureus
small amount of pus

Skin abscess Raised, tender, inflamed Deep dermis

(also known as a nodule with central S. aureus
boil, furuncle, region of purulence; the
carbuncle) area of pus initially is
firm but then progresses
to fluctuance (becomes
movable)

Necrotizing soft Very painful area of Fascia and

tissue infections inflammation with rapid muscle; local
(necrotizing progression to necrosis, blood vessels
fasciitis) bullae, purpura, and nerves
anesthesia, and systemic also involved
toxicity S. pyogenes
 Type of Description of Lesion Layer of Skin Appearance of Lesion
Infection Involved and
Common Pathogens

Impetigo Vesicles with honey- Epidermis

colored crust, often on Staphylococcus
the face of a child aureus,
Streptococcus
pyogenes

Erysipelas Erythematous, very Superficial dermis

painful lesion with S. pyogenes
sharply demarcated,
raised, regular border

Cellulitis Erythematous diffuse, Deep dermis

flat lesion with irregular S. pyogenes, S.
border aureus
 Staphylococcus aureus: Toxin-Mediated Diseases
(1) Food poisoning (gastroenteritis) is caused by ingestion of
enterotoxin, which is preformed in foods and hence has a
short incubation period (1–8 hours), vomiting is typically more
prominent than diarrhea
(2) Toxic shock syndrome is characterized by fever; hypotension; a
diffuse, macular, sunburn-like rash that goes on to desquamate
and multiple organ failure
(3) Scalded-skin syndrome is characterized by fever, large bullae,
and an erythematous rash
Staphylococcal scalded skin syndrome
• This syndrome occurs most often in young
children
• The initial event is usually a localized staph
infection
• A few days later fever, irritability and skin
tenderness
• A widespread erythematous eruption follows
• Large areas of skin slough, serous fluid
exudes, and electrolyte imbalance can occur
• Recovery usually occurs within 7–10 days
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Laboratory Diagnosis
Specimens: Purulent material from the lesion, Depends on the
type of infection
Microscopy: Smears from Staphylococcal lesions reveal gram-
positive cocci in grapelike clusters
Culture: On Blood agar typically yield golden-yellow colonies that
are usually β-hemolytic
S aureus is coagulase positive and ferments mannitol. These
tests differentiate S aureus from other species of Staphylococcus
There are no serologic or skin tests used for the diagnosis of any
acute staphylococcal infection
 GRAM STAINING OF
GOLDEN
STAPHYLOCOCCUS AUREUS IN
YELLOW BETA HEMOLYTIC COLONIES OF
PUS
STAPHYLOCOCCUS AUREUS ON
BLOODAGAR
 MRSA
• 90% or more of S. aureus strains are resistant to penicillin G
• Most of these strains produce a-lactamase
• Such organisms can be treated with β-lactamase–resistant penicillins (e.g
nafcillin or cloxacillin), some cephalosporins, or vancomycin
• Approximately 20% of S. aureus strains are methicillin resistant by virtue
of altered penicillin binding proteins
• These resistant strains of S. aureus are often abbreviated MRSA
• Such organisms can produce sizable outbreaks of disease, especially in
hospitals
• The drug of choice for these staphylococci is vancomycin
 TREATMENT FOR S AUREUS
Topical treatment
• Bacitracin, polymyxin B, neomycin, mupirocin, 2%sodium
fusidate are useful for superficial skin infections. They
should be applied 3 to 4 times a day

Systemic treatment
• Penicillin is the drug of choice
• S. aureus strains resistant to penicillin G. can be treated with β-
lactamase–resistant penicillins (e.g., nafcillin or cloxacillin
• MRSA: The drug of choice for these staphylococci is
vancomycin, Linezolid, Daptomycin is also useful
 MRSA infections
• Vancomycin

• Linezolid

• Quinipristine/dalfopristin

• Daptomycin

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Supression of carriage
• Indications: where Staphylococcal dispersal is a

significant hazard to others (operating theater and

neonatal nursery staff)
• Mupirocin is very effective as a topical antibiotic in skin

infections and has also been used to reduce nasal carriage of

the organism in hospital personnel and in patients with
recurrent staphylococcal infections
THANK
YOU