eMedicine Specialties > Infectious Diseases > Bacterial Infections

Staphylococcal Infections

Author: Thomas Herchline, MD, Professor of Medicine, Wright State University Boonshoft School of Medicine; Medical Director, Public Health, Dayton and Montgomery County, Ohio
Contributor Information and Disclosures

Updated: Aug 20, 2008

Introduction

Background

Staphylococcal infections are usually caused by the organism Staphylococcus aureus. However, the incidence of infections due to Staphylococcus epidermidis and other coagulase-negative staphylococci has been steadily increasing in recent years. This article focuses on S aureus but also discusses infections caused by coagulase-negative staphylococci when important differences exist.

Pathophysiology

S aureus is a gram-positive coccus that is both catalase- and coagulase-positive. Colonies are golden and strongly hemolytic on blood agar. They produce a range of toxins, including alpha-toxin, beta-toxin, gamma-toxin, delta-toxin, exfoliatin, enterotoxins, Panton-Valentine leukocidin (PVL), and toxic shock syndrome toxin–1 (TSST-1). The enterotoxins and TSST-1 are associated with toxic shock syndrome. PVL is associated with necrotic skin and lung infections but is not the major virulence factor.1 Coagulase-negative staphylococci, particularly S epidermidis, produce an exopolysaccharide (slime) that promotes foreign-body adherence and resistance to phagocytosis.

Frequency

United States

Up to 80% of people are eventually colonized with S aureus. Most are colonized only intermittently; 20-30% are persistently colonized. Colonization rates in health care workers, persons with diabetes, and patients on dialysis are higher than in the general population. The anterior nares are the predominant site of colonization in adults; other potential sites of colonization include the axilla, rectum, and perineum.

International

S aureus infection occurs worldwide. Pyomyositis due to S aureus is more prevalent in the tropics.

Mortality/Morbidity

Mortality due to staphylococcal infections varies widely. Untreated S aureus bacteremia carries a mortality rate that exceeds 80%. The mortality rate of staphylococcal toxic shock syndrome is 3-5%. Infections due to coagulase-negative staphylococci usually carry a very low mortality rate. Because these infections are commonly associated with prosthetic devices, the most serious complication is the need to remove the involved prosthesis, although prosthetic valve endocarditis may lead to death.

Race

Staphylococcal infections have no reported racial predilection.

Sex

The vaginal carriage rate of staphylococcal species is approximately 10% in premenopausal women. The rate is even higher during menses.

Age

  • Staphylococcal species colonize many neonates on the skin, perineum, umbilical stump, and GI tract. The staphylococcal colonization rate in adults is approximately 40% at any given time.
  • The mortality rate of S aureus bacteremia in elderly persons is markedly increased.2

Clinical

History

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
  • Purpura fulminans3
  • Endocarditis
  • Osteomyelitis
  • Pneumonia
  • Food poisoning
  • Infections related to prosthetic devices
    • Commonly associated with coagulase-negative staphylococci
    • Includes prosthetic joints and heart valves and vascular shunts, grafts, and catheters
  • Urinary tract infection

Physical

  • 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 (see Images 1-2)
    • Fever

Causes

Predisposing factors for staphylococcal infections include the following:

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

Colonization with S aureus is common. Skin-to-skin and skin-to-fomite contact are common routes of acquisition.4 Isolates can be spread by coughing or sneezing.5 Evidence has also shown that S aureus can be spread during male homosexual sex.6 Pets can also serve as household reservoirs.7

More on Staphylococcal Infections

Overview: Staphylococcal Infections
Differential Diagnoses & Workup: Staphylococcal Infections
Treatment & Medication: Staphylococcal Infections
Follow-up: Staphylococcal Infections
Multimedia: Staphylococcal Infections
References
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References

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Further Reading

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Keywords

staphylococcal infections, staph infection, MRSA, Staphylococcus aureus, S aureus, methicillin-resistant S aureus, methicillin-resistant Staphylococcus aureus, staphylococci, gram-positive cocci, S aureus bacteremia, staphylococcal toxic shock syndrome, Staphylococcus epidermis, S epidermis, staphylococcal skin infections, staphylococcal folliculitis, staphylococcal furuncles, staphylococcal bullous impetigo, staphylococcal wound infections, staphylococcal scalded skin syndrome, staphylococcal soft-tissue infections, staphylococcal pyomyositis, staphylococcal septic bursitis, staphylococcal septic arthritis, staphylococcal toxic shock syndrome, TSS, staphylococcal endocarditis, staphylococcal osteomyelitis, staphylococcal pneumonia, staphylococcal food poisoning, staphylococcal prosthetic infections, coagulase-negative staphylococci, staphylococcal urinary tract infection, UTI

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Contributor Information and Disclosures

Author

Thomas Herchline, MD, Professor of Medicine, Wright State University Boonshoft School of Medicine; Medical Director, Public Health, Dayton and Montgomery County, Ohio
Thomas Herchline, MD is a member of the following medical societies: American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Medical Editor

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 Society for Artificial Internal Organs, American Thoracic Society, Physicians for Social Responsibility, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

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 and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

 
 
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