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Staphylococcal Infections Clinical Presentation

  • Author: Thomas E Herchline, MD; Chief Editor: Mark R Wallace, MD, FACP, FIDSA  more...
Updated: Apr 25, 2016


Common manifestations of staphylococcal infections include the following types of infections. The history obtained usually depends on the type of infection the organism causes.

  • Skin infections (Many individuals who present with community-acquired skin infections are initially misdiagnosed with spider bites. These infections are often due to methicillin-resistant S aureus [MRSA].)
  • Soft-tissue infections (pyomyositis, septic bursitis, septic arthritis)
  • Toxic shock syndrome
  • Endocarditis
  • Osteomyelitis
  • Staphylococcal infections of prosthetic devices, including prosthetic joints and heart valves and vascular shunts, grafts, and catheters (these are increasing in incidence, mostly likely because of the increase in staphylococcal line-related bacteremias[15, 16] )
  • Urinary tract infection


See the list below:

  • Skin and soft-tissue infections
    • Erythema
    • Warmth
    • Draining sinus tracts
    • Superficial abscesses
    • Bullous impetigo
  • Toxic shock syndrome
    • Fever greater than 38.9°C
    • Diffuse erythroderma - Deep, red, "sunburned" appearance
    • Hypotension
    • Desquamation - Occurs 7-14 days after onset of illness, usually involves palms and soles
  • Endocarditis
    • Regurgitant murmur
    • Petechiae or other cutaneous lesions
      Embolic lesions in patient with Staphylococcus aurEmbolic lesions in patient with Staphylococcus aureus endocarditis.
      Close-up view of embolic lesions in patient with SClose-up view of embolic lesions in patient with Staphylococcus aureus endocarditis.
    • Fever


Predisposing factors for staphylococcal infections include the following:

  • Neutropenia or neutrophil dysfunction
  • Diabetes
  • Intravenous drug abuse
  • Foreign bodies, including intravascular catheters

Colonization with S aureus is common. Skin-to-skin and skin-to-fomite contact are common routes of acquisition.[17] Isolates can be spread by coughing or sneezing.[18] Evidence has also shown that S aureus can be spread during male homosexual sex.[19] Pets can also serve as household reservoirs.[20]

Contributor Information and Disclosures

Thomas E Herchline, MD Professor of Medicine, Wright State University, Boonshoft School of Medicine; Medical Director, Public Health, Dayton and Montgomery County, Ohio

Thomas E Herchline, MD is a member of the following medical societies: Alpha Omega Alpha, Infectious Diseases Society of Ohio, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

John L Brusch, MD, FACP Assistant Professor of Medicine, Harvard Medical School; Consulting Staff, Department of Medicine and Infectious Disease Service, Cambridge Health Alliance

John L Brusch, MD, FACP is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Mark R Wallace, MD, FACP, FIDSA Clinical Professor of Medicine, Florida State University College of Medicine; Clinical Professor of Medicine, University of Central Florida College of Medicine

Mark R Wallace, MD, FACP, FIDSA is a member of the following medical societies: American College of Physicians, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, International AIDS Society, Florida Infectious Diseases Society

Disclosure: Nothing to disclose.

Additional Contributors

Klaus-Dieter Lessnau, MD, FCCP Clinical Associate Professor of Medicine, New York University School of Medicine; Medical Director, Pulmonary Physiology Laboratory; Director of Research in Pulmonary Medicine, Department of Medicine, Section of Pulmonary Medicine, Lenox Hill Hospital

Klaus-Dieter Lessnau, MD, FCCP is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Medical Association, American Thoracic Society, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

  1. Schramm GE, Johnson JA, Doherty JA, et al. Methicillin-resistant Staphylococcus aureus sterile-site infection: The importance of appropriate initial antimicrobial treatment. Crit Care Med. 2006 Aug. 34(8):2069-74. [Medline].

  2. Mermel LA, Farr BM, Sherertz RJ, et al. Guidelines for the management of intravascular catheter-related infections. Clin Infect Dis. 2001 May 1. 32(9):1249-72. [Medline].

  3. Simor AE, Phillips E, McGeer A, et al. Randomized controlled trial of chlorhexidine gluconate for washing, intranasal mupirocin, and rifampin and doxycycline versus no treatment for the eradication of methicillin-resistant Staphylococcus aureus colonization. Clin Infect Dis. 2007 Jan 15. 44(2):178-85. [Medline].

  4. Yamasaki O, Kaneko J, Morizane S, et al. The Association between Staphylococcus aureus strains carrying panton-valentine leukocidin genes and the development of deep-seated follicular infection. Clin Infect Dis. 2005 Feb 1. 40(3):381-5. [Medline].

  5. Labandeira-Rey M, Couzon F, Boisset S, Brown EL, Bes M, Benito Y. Staphylococcus aureus Panton-Valentine leukocidin causes necrotizing pneumonia. Science. 2007 Feb 23. 315(5815):1130-3. [Medline].

  6. Cremieux AC, Dumitrescu O, Lina G, Vallee C, et al. Panton-valentine leukocidin enhances the severity of community-associated methicillin-resistant Staphylococcus aureus rabbit osteomyelitis. PLoS One. 2009 Sep 25. 4(9):e7204. [Medline]. [Full Text].

  7. Nienaber JJ, Sharma Kuinkel BK, Clarke-Pearson M, Lamlertthon S, Park L, Rude TH, et al. Methicillin-Susceptible Staphylococcus aureus Endocarditis Isolates Are Associated With Clonal Complex 30 Genotype and a Distinct Repertoire of Enterotoxins and Adhesins. J Infect Dis. 2011 Sep. 204(5):704-713. [Medline]. [Full Text].

  8. Kleiner E, Monk AB, Archer GL, Forbes BA. Clinical significance of Staphylococcus lugdunensis isolated from routine cultures. Clin Infect Dis. 2010 Oct 1. 51(7):801-3. [Medline].

  9. von Eiff C, Becker K, Machka K, et al. Nasal carriage as a source of Staphylococcus aureus bacteremia. Study Group. N Engl J Med. 2001 Jan 4. 344(1):11-6. [Medline].

  10. Mertz D, Frei R, Periat N, Zimmerli M, Battegay M, Flückiger U. Exclusive Staphylococcus aureus throat carriage: at-risk populations. Arch Intern Med. 2009 Jan 26. 169(2):172-8. [Medline].

  11. Gafter-Gvili A, Mansur N, Bivas A, et al. Thrombocytopenia in Staphylococcus aureus Bacteremia: Risk Factors and Prognostic Importance. Mayo Clin Proc. 2011 May. 86(5):389-96. [Medline]. [Full Text].

  12. Yilmaz M, Elaldi N, Balkan İİ, Arslan F, Batırel AA, Bakıcı MZ, et al. Mortality predictors of Staphylococcus aureus bacteremia: a prospective multicenter study. Ann Clin Microbiol Antimicrob. 2016 Feb 9. 15 (1):7. [Medline].

  13. McClelland RS, Fowler VG Jr, Sanders LL, et al. Staphylococcus aureus bacteremia among elderly vs younger adult patients: comparison of clinical features and mortality. Arch Intern Med. 1999 Jun 14. 159(11):1244-7. [Medline].

  14. Kravitz GR, Dries DJ, Peterson ML, et al. Purpura fulminans due to Staphylococcus aureus. Clin Infect Dis. 2005 Apr 1. 40(7):941-7. [Medline].

  15. Bor DH, Woolhandler S, Nardin R, Brusch J, Himmelstein DU. Infective endocarditis in the U.S., 1998-2009: a nationwide study. PLoS One. 2013. 8 (3):e60033. [Medline].

  16. Tande AJ, Palraj BR, Osmon DR, Berbari EF, Baddour LM, Lohse CM, et al. Clinical Presentation, Risk Factors, and Outcomes of Hematogenous Prosthetic Joint Infection in Patients with Staphylococcus aureus Bacteremia. Am J Med. 2016 Feb. 129 (2):221.e11-20. [Medline].

  17. Robicsek A, Beaumont JL, Paule SM, et al. Universal surveillance for methicillin-resistant Staphylococcus aureus in 3 affiliated hospitals. Ann Intern Med. 2008 Mar 18. 148(6):409-18. [Medline].

  18. Bischoff WE, Wallis ML, Tucker BK, et al. "Gesundheit!" sneezing, common colds, allergies, and Staphylococcus aureus dispersion. J Infect Dis. 2006 Oct 15. 194(8):1119-26. [Medline].

  19. Diep BA, Chambers HF, Graber CJ, et al. Emergence of multidrug-resistant, community-associated, methicillin-resistant Staphylococcus aureus clone USA300 in men who have sex with men. Ann Intern Med. 2008 Feb 19. 148(4):249-57. [Medline].

  20. Sing A, Tuschak C, Hörmansdorfer S. Methicillin-resistant Staphylococcus aureus in a family and its pet cat. N Engl J Med. 2008 Mar 13. 358(11):1200-1. [Medline].

  21. Deck MK, Anderson ES, Buckner RJ, Colasante G, Coull JM, Crystal B, et al. Multicenter Evaluation of the Staphylococcus QuickFISH Method for Simultaneous Identification of Staphylococcus aureus and Coagulase Negative Staphylococci Directly from Blood Culture Bottles in less than Thirty Minutes. J Clin Microbiol. 2012 Apr 4. [Medline].

  22. Sarikonda KV, Micek ST, Doherty JA, et al. Methicillin-resistant Staphylococcus aureus nasal colonization is a poor predictor of intensive care unit-acquired methicillin-resistant Staphylococcus aureus infections requiring antibiotic treatment. Crit Care Med. 2010 Oct. 38(10):1991-5. [Medline].

  23. Holland TL, Arnold C, Fowler VG Jr. Clinical management of Staphylococcus aureus bacteremia: a review. JAMA. 2014 Oct 1. 312 (13):1330-41. [Medline].

  24. Kaasch AJ, Fowler VG Jr, Rieg S, Peyerl-Hoffmann G, Birkholz H, Hellmich M, et al. Use of a simple criteria set for guiding echocardiography in nosocomial Staphylococcus aureus bacteremia. Clin Infect Dis. 2011 Jul 1. 53 (1):1-9. [Medline].

  25. Tubiana S, Duval X, Alla F, Selton-Suty C, Tattevin P, Delahaye F, et al. The VIRSTA score, a prediction score to estimate risk of infective endocarditis and determine priority for echocardiography in patients with Staphylococcus aureus bacteremia. J Infect. 2016 Feb 22. [Medline].

  26. Dumitrescu O, Boisset S, Badiou C, Bes M, Benito Y, Reverdy ME, et al. Effect of antibiotics on Staphylococcus aureus producing Panton-Valentine leukocidin. Antimicrob Agents Chemother. 2007 Apr. 51(4):1515-9. [Medline].

  27. Liu C, Bayer A, Cosgrove SE, Daum RS, Fridkin SK, Gorwitz RJ, et al. Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Clin Infect Dis. 2011 Feb. 52(3):e18-55. [Medline].

  28. Bai AD, Showler A, Burry L, Steinberg M, Ricciuto DR, Fernandes T, et al. Impact of Infectious Disease Consultation on Quality of Care, Mortality, and Length of Stay in Staphylococcus aureus Bacteremia: Results From a Large Multicenter Cohort Study. Clin Infect Dis. 2015 May 15. 60 (10):1451-61. [Medline].

  29. Proctor RA. Role of folate antagonists in the treatment of methicillin-resistant Staphylococcus aureus infection. Clin Infect Dis. Feb 15, 2008. 46(4):584-93. [Medline].

  30. Pillai SK, Wennersten C, Venkataraman L, Eliopoulos GM, Moellering RC, Karchmer AW. Development of reduced vancomycin susceptibility in methicillin-susceptible Staphylococcus aureus. Clin Infect Dis. 2009 Oct 15. 49(8):1169-74. [Medline].

  31. [Guideline] Rybak MJ, Lomaestro BM, Rotscahfer JC, Moellering RC, Craig WA, Billeter M, et al. Vancomycin therapeutic guidelines: a summary of consensus recommendations from the infectious diseases Society of America, the American Society of Health-System Pharmacists, and the Society of Infectious Diseases Pharmacists. Clin Infect Dis. 2009 Aug 1. 49(3):325-7. [Medline].

  32. Lubin AS, Snydman DR, Ruthazer R, Bide P, Golan Y. Predicting high vancomycin minimum inhibitory concentration in methicillin-resistant Staphylococcus aureus bloodstream infections. Clin Infect Dis. 2011 Apr 15. 52(8):997-1002. [Medline]. [Full Text].

  33. Jain R, Kralovic SM, Evans ME, et al. Veterans Affairs initiative to prevent methicillin-resistant Staphylococcus aureus infections. N Engl J Med. 2011 Apr 14. 364(15):1419-30. [Medline].

  34. Steed LL, Costello J, Lohia S, Jones T, Spannhake EW, Nguyen S. Reduction of nasal Staphylococcus aureus carriage in health care professionals by treatment with a nonantibiotic, alcohol-based nasal antiseptic. Am J Infect Control. 2014 Aug. 42(8):841-6. [Medline]. [Full Text].

  35. Archer GL. Staphylococcus aureus: a well-armed pathogen. Clin Infect Dis. 1998 May. 26(5):1179-81. [Medline].

  36. Baggett HC, Hennessy TW, Rudolph K, et al. Community-onset methicillin-resistant Staphylococcus aureus associated with antibiotic use and the cytotoxin Panton-Valentine leukocidin during a furunculosis outbreak in rural Alaska. J Infect Dis. 2004 May 1. 189(9):1565-73. [Medline].

  37. Begier EM, Frenette K, Barrett NL, et al. A high-morbidity outbreak of methicillin-resistant Staphylococcus aureus among players on a college football team, facilitated by cosmetic body shaving and turf burns. Clin Infect Dis. 2004 Nov 15. 39(10):1446-53. [Medline].

  38. Boggs W. Dicloxacillin for MSSA bacteremia tied to lower mortality than cefuroxime. Reuters Health Information. October 14, 2013. Available at Accessed: October 22, 2013.

  39. Bouza E. New therapeutic choices for infections caused by methicillin-resistant Staphylococcus aureus. Clin Microbiol Infect. 2009. 15:44-52.

  40. Campbell KM, Vaughn AF, Russell KL, et al. Risk factors for community-associated methicillin-resistant Staphylococcus aureus infections in an outbreak of disease among military trainees in San Diego, California, in 2002. J Clin Microbiol. 2004 Sep. 42(9):4050-3. [Medline].

  41. Chang FY, MacDonald BB, Peacock JE, et al. A prospective multicenter study of Staphylococcus aureus bacteremia: incidence of endocarditis, risk factors for mortality, and clinical impact of methicillin resistance. Medicine (Baltimore). 2003 Sep. 82(5):322-32. [Medline].

  42. Charlebois ED, Perdreau-Remington F, Kreiswirth B, et al. Origins of community strains of methicillin-resistant Staphylococcus aureus. Clin Infect Dis. 2004 Jul 1. 39(1):47-54. [Medline].

  43. Cosgrove SE, Sakoulas G, Perencevich EN, et al. Comparison of mortality associated with methicillin-resistant and methicillin-susceptible Staphylococcus aureus bacteremia: a meta-analysis. Clin Infect Dis. 2003 Jan 1. 36(1):53-9. [Medline].

  44. Cunha BA. Antimicrobial therapy of multidrug-resistant Streptococcus pneumoniae, vancomycin-resistant enterococci, and methicillin-resistant Staphylococcus aureus. Med Clin North Am. 2006 Nov. 90(6):1165-82. [Medline].

  45. Cunha BA. Methicillin-resistant Staphylococcus aureus: clinical manifestations and antimicrobial therapy. Clin Microbiol Infect. 2005 Jul. 11 Suppl 4:33-42. [Medline].

  46. Cunha BA. Oral antibiotic therapy of serious systemic infections. Med Clin North Am. 2006 Nov. 90(6):1197-222. [Medline].

  47. Cunha BA. Staphylococcus aureus nosocomial pneumonia: Clinical aspects. Infect Dis Pract. 2007. 31:557-60.

  48. Cunha BA, Eisenstein LE, Hamid NS. Pacemaker-induced Staphylococcus aureus mitral valve acute bacterial endocarditis complicated by persistent bacteremia from a coronary stent: Cure with prolonged/high-dose daptomycin without toxicity. Heart Lung. 2006 May-Jun. 35(3):207-11. [Medline].

  49. Cunha BA, Hamid N, Kessler H, Parchuri S. Daptomycin cure after cefazolin treatment failure of Methicillin-sensitive Staphylococcus aureus (MSSA) tricuspid valve acute bacterial endocarditis from a peripherally inserted central catheter (PICC) line. Heart Lung. 2005 Nov-Dec. 34(6):442-7. [Medline].

  50. Cunha BA, Mikail N, Eisenstein L. Persistent methicillin-resistant Staphylococcus aureus (MRSA) bacteremia due to a linezolid "tolerant" strain. Heart Lung. 2008 Sep-Oct. 37(5):398-400. [Medline].

  51. Cunha BA, Pherez FM. Daptomycin resistance and treatment failure following vancomycin for methicillin-resistant Staphylococcus aureus (MRSA) mitral valve acute bacterial endocarditis (ABE). Eur J Clin Microbiol Infect Dis. 2009 Jul. 28(7):831-3. [Medline].

  52. Czachor J, Herchline T. Bacteremic nonmenstrual staphylococcal toxic shock syndrome associated with enterotoxins A and C. Clin Infect Dis. 2001 Feb 1. 32(3):E53-6. [Medline].

  53. Daum RS, Ito T, Hiramatsu K, et al. A novel methicillin-resistance cassette in community-acquired methicillin-resistant Staphylococcus aureus isolates of diverse genetic backgrounds. J Infect Dis. 2002 Nov 1. 186(9):1344-7. [Medline].

  54. Deresinski S. Methicillin-resistant Staphylococcus aureus: an evolutionary, epidemiologic, and therapeutic odyssey. Clin Infect Dis. 2005 Feb 15. 40(4):562-73. [Medline].

  55. Fowler VG Jr, Sanders LL, Kong LK, et al. Infective endocarditis due to Staphylococcus aureus: 59 prospectively identified cases with follow-up. Clin Infect Dis. 1999 Jan. 28(1):106-14. [Medline].

  56. Fowler VG Jr, Sanders LL, Sexton DJ, et al. Outcome of Staphylococcus aureus bacteremia according to compliance with recommendations of infectious diseases specialists: experience with 244 patients. Clin Infect Dis. 1998 Sep. 27(3):478-86. [Medline].

  57. Francis JS, Doherty MC, Lopatin U, et al. Severe community-onset pneumonia in healthy adults caused by methicillin-resistant Staphylococcus aureus carrying the Panton-Valentine leukocidin genes. Clin Infect Dis. 2005 Jan 1. 40(1):100-7. [Medline].

  58. Fridkin SK, Hageman JC, Morrison M, et al. Methicillin-resistant Staphylococcus aureus disease in three communities. N Engl J Med. 2005 Apr 7. 352(14):1436-44. [Medline].

  59. Grundmann H, Aires-de-Sousa M, Boyce J, Tiemersma E. Emergence and resurgence of methicillin-resistant Staphylococcus aureus as a public-health threat. Lancet. 2006 Sep 2. 368(9538):874-85. [Medline].

  60. Harbarth S, Liassine N, Dharan S, et al. Risk factors for persistent carriage of methicillin-resistant Staphylococcus aureus. Clin Infect Dis. 2000 Dec. 31(6):1380-5. [Medline].

  61. Herchline TE, Ayers LW. Occurrence of Staphylococcus lugdunensis in consecutive clinical cultures and relationship of isolation to infection. J Clin Microbiol. 1991 Mar. 29(3):419-21. [Medline].

  62. Herchline TE, Barnishan J, Ayers LW, et al. Penicillinase production and in vitro susceptibilities of Staphylococcus lugdunensis. Antimicrob Agents Chemother. 1990 Dec. 34(12):2434-5. [Medline].

  63. Jensen AG, Wachmann CH, Espersen F, et al. Treatment and outcome of Staphylococcus aureus bacteremia: a prospective study of 278 cases. Arch Intern Med. 2002 Jan 14. 162(1):25-32. [Medline].

  64. Kazakova SV, Hageman JC, Matava M, et al. A clone of methicillin-resistant Staphylococcus aureus among professional football players. N Engl J Med. 2005 Feb 3. 352(5):468-75. [Medline].

  65. Kloos WE, Bannerman TL. Update on clinical significance of coagulase-negative staphylococci. Clin Microbiol Rev. 1994 Jan. 7(1):117-40. [Medline].

  66. Mekontso-Dessap A, Kirsch M, Brun-Buisson C, et al. Poststernotomy mediastinitis due to Staphylococcus aureus: comparison of methicillin-resistant and methicillin-susceptible cases. Clin Infect Dis. 2001 Mar 15. 32(6):877-83. [Medline].

  67. Miller LG, Diep BA. Clinical practice: colonization, fomites, and virulence: rethinking the pathogenesis of community-associated methicillin-resistant Staphylococcus aureus infection. Clin Infect Dis. 2008 Mar 1. 46(5):752-60. [Medline].

  68. Mohan SS, McDermott BP, Cunha BA. Methicillin-resistant Staphylococcus aureus prosthetic aortic valve endocarditis with paravalvular abscess treated with daptomycin. Heart Lung. 2005 Jan-Feb. 34(1):69-71. [Medline].

  69. Naimi TS, LeDell KH, Como-Sabetti K, et al. Comparison of community- and health care-associated methicillin-resistant Staphylococcus aureus infection. JAMA. 2003 Dec 10. 290(22):2976-84. [Medline].

  70. Nouwen JL, Ott A, Kluytmans-Vandenbergh MF, et al. Predicting the Staphylococcus aureus nasal carrier state: derivation and validation of a "culture rule". Clin Infect Dis. 2004 Sep 15. 39(6):806-11. [Medline].

  71. Polenakovik H, Herchline T, Bacheller C, et al. Staphylococcus lugdunensis endocarditis after angiography. Mayo Clin Proc. 2000 Jun. 75(6):656-7. [Medline].

  72. Rasmussen JB, Knudsen JD, Arpi M, Schønheyder HC, Benfield T, Ostergaard C. Relative efficacy of cefuroxime versus dicloxacillin as definitive antimicrobial therapy in methicillin-susceptible Staphylococcus aureus bacteraemia: a propensity-score adjusted retrospective cohort study. J Antimicrob Chemother. 2013 Oct 3. [Medline].

  73. Saiman L, O'Keefe M, Graham PL 3rd, et al. Hospital transmission of community-acquired methicillin-resistant Staphylococcus aureus among postpartum women. Clin Infect Dis. 2003 Nov 15. 37(10):1313-9. [Medline].

  74. Smith TL, Pearson ML, Wilcox KR, et al. Emergence of vancomycin resistance in Staphylococcus aureus. Glycopeptide-Intermediate Staphylococcus aureus Working Group. N Engl J Med. 1999 Feb 18. 340(7):493-501. [Medline].

  75. US Food and Drug Administration. FDA Drug Safety Communication: Serious CNS reactions possible when linezolid (Zyvox®) is given to patients taking certain psychiatric medications. Available at Accessed: July 27, 2011.

  76. Vandenesch F, Naimi T, Enright MC, et al. Community-acquired methicillin-resistant Staphylococcus aureus carrying Panton-Valentine leukocidin genes: worldwide emergence. Emerg Infect Dis. 2003 Aug. 9(8):978-84. [Medline].

Embolic lesions in patient with Staphylococcus aureus endocarditis.
Close-up view of embolic lesions in patient with Staphylococcus aureus endocarditis.
Fifty-six-year-old man with erythema, edema, and drainage from below his right eye.
Gram stain in a 70-year-old woman with rheumatoid arthritis.
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