eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease
Staphylococcus Aureus Infection: Treatment & Medication
Updated: Jan 23, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
Treatment
Medical Care
Because community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) causes more than one half of all staphylococcal infections in most communities, empiric therapy with penicillins or cephalosporins is inadequate. Some experts recommend combination therapy with a penicillinase-resistant penicillin or cephalosporin (in case the organism is methicillin-sensitive S aureus [MSSA]) and clindamycin or a quinolone. Others suggest use of clindamycin, trimethoprim-sulfamethoxazole (TMP-SMX), rifampin, or a quinolone. Finally, because of concerns about induction of resistance, some recommend using TMP-SMX and rifampin in combination, rather than singly.
- Impetigo, folliculitis, furuncle, carbuncle: Impetigo and other minor skin infections (ie, superficial or localized infections) may be treated with a topical agent such as mupirocin or retapamulin. However, most CA-MRSA strains are or readily become resistant to mupirocin. More extensive or serious skin disease and bullous impetigo are treated with oral antistaphylococcal agents, as noted above.
- Scalded skin syndrome (Ritter disease): As with any S aureus toxin–mediated disease, treatment should aim to eradicate the focus of infection and end toxin production. Administer large doses of intravenous antistaphylococcal agents, such as oxacillin (150 mg/kg/d), or a first-generation cephalosporin, such as cefazolin (100 mg/kg/d). In vitro, clindamycin has been shown to inhibit the synthesis of TSST-1 and is extremely effective in combination with one of the agents mentioned above. Children with denuded skin should be touched as little as possible. Topical antimicrobial agents have little use, because skin damage is self-limited once systemic antibiotics are administered.
- Osteomyelitis: Empirically, initiating a semisynthetic penicillin (eg, oxacillin [150 mg/kg/d]) and clindamycin (30-40 mg/kg/d) is a good choice for most cases of community-acquired osteomyelitis. In patients with allergy to penicillin, a first-generation cephalosporin and clindamycin (30-40 mg/kg/d) are an excellent alternative. Use vancomycin or linezolid when the other drugs mentioned are absolutely not tolerated or when resistance or the clinical course dictates. The duration of therapy is a controversial topic in the literature, but the consensus among multiple authors is that the minimum effective treatment time is 4-6 weeks. A switch to oral therapy is acceptable if the child is able to take oral antibiotics, is afebrile, and if he or she has demonstrated a good clinical response to parenteral antibiotics.
- Septic arthritis: As in osteomyelitis, initiate an appropriate antistaphylococcal drug (eg, oxacillin, which is penicillinase resistant; clindamycin; cefazolin) parenterally. These antibiotics readily reach joint fluid, and the concentration in the joint fluid is 30% of the serum value. Therapy usually continues for at least 4 weeks. Duration of parenteral therapy is often debated. Some authors have demonstrated efficacy with 1 week of parenteral therapy followed with 3 weeks of oral therapy. Consider a switch to oral therapy based on the considerations mentioned above. Joint fluid that reaccumulates should be removed, and a sample should be cultured to assess the efficacy of therapy and to make the patient more comfortable.
- Endocarditis
- Duration of therapy for endocarditis, which is a life-threatening infection, is at least 4 weeks.
- The combination of a beta-lactam and an aminoglycoside is advocated, because it increases bacterial killing in vitro and in animal models of endocarditis. In patients with MRSA, combinations of vancomycin with aminoglycosides should be used.
- Rifampin, because of its lipid solubility, is another potent agent when used in combination with nafcillin and gentamicin or vancomycin and gentamicin, especially in patients with prosthetic valve endocarditis. Rifampin should never be used alone because resistance can develop.
- The response to therapy is usually slow, and patients may continue to have bacteremia, fever, and leukocytosis for at least a week after therapy is initiated.
- Some authors recommend obtaining blood cultures after the end of therapy.
- Treatment with antibiotics is specific to the etiologic agent and its characteristics. For more information, see Endocarditis, Bacterial.
Surgical Care
- Osteomyelitis: Surgery is usually indicated to drain purulent material from the subperiosteal space or if infected foreign material is present.
- Septic arthritis: In an infant, septic arthritis of the hip and shoulder is a surgical emergency; these joints should be drained as soon as possible to prevent bony destruction. In addition, if a large amount of fibrin, tissue debris, or loculation is present, preventing adequate drainage with needle aspiration, the joint should be surgically drained.
- Endocarditis: If endocarditis occurs in the presence of an intracardiac foreign body, it may require removal.
- Toxic shock syndrome (TSS): All potential foci of infection should be explored and surgically drained.
- Thrombophlebitis: Remove the infected intravenous line in patients who are immunocompromised or severely ill or when infection is impossible to eradicate medically.
Medication
The major antibiotics active against the staphylococcal organism are presented here.
Antistaphylococcal antibiotics
Serious staphylococcal infections require treatment with parenteral penicillinase-resistant penicillin (eg, nafcillin, oxacillin) or first-generation or second-generation cephalosporins (eg, cephalexin, cefuroxime) plus clindamycin. Vancomycin is reserved for staphylococcal strains that are resistant to penicillinase-resistant penicillins (ie, MRSA) and clindamycin, or for when the patient has potentially life-threatening infection or intoxication. Mupirocin or retapamulin may be used for superficial localized infections (ie, impetigo).
Dicloxacillin
Binds to one or more penicillin-binding proteins, which, in turn, inhibits synthesis of bacterial cell walls. For treatment of infections caused by penicillinase-producing staphylococci. May be used to initiate therapy when staphylococcal infection is suspected.
Adult
125-500 mg PO q6h
Pediatric
<40 kilograms: 12.5-50 mg/kg/d PO divided q6h; doses up to 50-100 mg/kg/d have been used for PO therapy for osteomyelitis
>40 kilograms: Administer as in adults
Decreases efficacy of PO contraceptives; may decrease effects of anticoagulants; probenecid and disulfiram may increase penicillin levels
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Prolonged elimination in neonates; toxicity may increase with renal dysfunction
Oxacillin
Bactericidal antibiotic that inhibits cell wall synthesis. Used in the treatment of infections caused by penicillinase-producing staphylococci.
Adult
0.25-1 g IV q6h
Pediatric
150 mg/kg/d IV divided qid
Oxacillin decreases effects of contraceptives and tetracycline; when administered concomitantly with disulfiram and probenecid, may increase oxacillin levels; increases anticoagulant effect with large IV doses
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Decreased elimination in neonates; can cause elevations in levels of transaminases with prolonged use
Nafcillin
Initial therapy for suspected penicillin G–resistant staphylococcal infections. Use parenteral therapy initially in severe infections. Change to PO therapy as condition warrants.
Adult
0.5-1 g IV/IM q4-6h
Pediatric
Neonates:
<1200 grams or <7 days and 1200-2000 grams: 50 mg/kg/d IV divided q12h
<7 days and >2000 grams or >7 days and 1200-2000 grams: 75 mg/kg/d IV divided q8h
>7 days and >2000 grams: 100 mg/kg/d IV divided q6h
Children:
100-200 mg/kg/d IV divided qid; not to exceed 12 g/d
Reduce dose by 50% in renal or hepatic impairment
CYP450 3A4 inducer; probenecid may decrease elimination of nafcillin; nafcillin may decrease half-life of warfarin and may decrease cyclosporine serum concentrations or interfere with the cyclosporine assay
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Elimination decreased in neonates; avoid during first 2 wk of life; monitor CBC count with prolonged use; may cause thrombophlebitis
Cephalexin (Keflex)
First-generation cephalosporin that arrests bacterial growth by inhibiting bacterial cell wall synthesis. Bactericidal activity against rapidly growing organisms. Primary activity against skin flora.
Adult
250-500 mg PO q6h; not to exceed 4 g/d
Pediatric
25-100 mg/kg/d PO divided q6h; not to exceed 4 g/d
Probenecid may increase and prolong cephalosporin plasma levels by competitively inhibiting renal tubular secretion; coadministration with aminoglycosides theoretically increases risk of nephrotoxicity
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Adjust dose in severe renal insufficiency (high doses may cause CNS toxicity); superinfections and promotion of nonsusceptible organisms may occur with prolonged use or repeated therapy
Cefuroxime (Ceftin oral, Kefurox injection)
Broad-spectrum cephalosporin most closely resembling the second-generation cephalosporins. Cefuroxime is stable against beta-lactamase–producing organisms.
Adult
250-500 mg PO bid; alternatively, 1 g IV q8h
Pediatric
Serious infections: 150 mg/kg/d IV divided q8h
Impetigo:
250-mg tab PO q12h
30 mg/kg/d PO susp divided bid; not to exceed 1 g/d
Probenecid may increase and prolong cephalosporin plasma levels by competitively inhibiting renal tubular secretion; aminoglycosides may increase nephrotoxicity
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Periodically monitor renal function and CBC count; adjust dose or frequency with renal insufficiency (high doses may cause CNS toxicity); bacterial or fungal overgrowth of nonsusceptible organisms may occur with prolonged or repeated therapy
Cefazolin
First-generation semisynthetic cephalosporin that arrests bacterial cell wall synthesis, inhibiting bacterial growth. Primarily active against skin flora, including S aureus. Typically used alone for skin and skin structure coverage.
Adult
0.5-2 g IV q6-8h; not to exceed 12 g/d
Pediatric
50-100 mg/kg/d IV divided q8h; not to exceed 6 g/d
Probenecid prolongs effect of cefazolin; coadministration with aminoglycosides may increase renal toxicity; may yield false-positive urine-dip test results for glucose
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Monitor renal function parameters when used with other nephrotoxic drugs; monitor CBC count with prolonged use; dosing in renal impairment: administer q24h if CrCl <10 mL/min, administer q12h if CrCl 10-30 mL/min
Amoxicillin and clavulanate (Augmentin)
Drug combination treats bacteria resistant to beta-lactam antibiotics. For children >3 mo, base dosage regimen on amoxicillin content. Because of different amoxicillin/clavulanic acid ratios in 250-mg tab (ie, 250/125) versus 250-mg chewable tab (ie, 250/62.5), do not use 250-mg tab until child is >40 kg.
Adult
250-500 mg PO q8h; not to exceed 2 g/d
Pediatric
<3 months: 30 mg (based on amoxicillin component) per kg/d PO divided q12h
Use 125 mg/5 mL PO susp
>3 months and <40 kilograms: 45 mg (based on amoxicillin component) per kg/d PO divided bid/tid
>40 kilograms: Administer as in adults
Increased risk of amoxicillin rash with concurrent allopurinol; probenecid and disulfiram may increase penicillin levels
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Increased risk of maculopapular rash with concurrent EBV infection, CMV infection, or acute lymphocytic leukemia
Vancomycin (Lyphocin, Vancocin, Vancoled)
Potent antibiotic directed against gram-positive organisms and active against Enterococcus species. Useful in the treatment of septicemia and skin structure infections. Indicated in patients who are unable to receive or who have not responded to penicillins and cephalosporins or for infections with resistant staphylococci. Use CrCl to adjust dose in patients diagnosed with renal impairment.
Adult
0.5 g IV q6h or 1 g IV q24h
Pediatric
Neonates:
<7 days and >2000 grams: 30 mg/kg/d IV divided q12h
>7 days and >2000 grams: 45 mg/kg/d IV divided q8h
<1 month and <1200 grams: 15 mg/kg/d IV q24h
<1 month and 1200-2000 grams: 20-30 mg/kg/d IV divided q12-18h
Infants >1 month and children: 40 mg/kg/d IV divided q8h
Seriously ill cancer patients and patients with suspected CNS infection: 60 mg/kg/d IV divided q6h
The necessity of monitoring drug levels is debated; to achieve an adequate therapeutic level in severe infections, the upper range of the peak (40 mcg/mL) should be reached
Erythema, histaminelike flushing, and anaphylactic reactions may occur when administered with anesthetic agents; when taken concurrently with aminoglycosides, risk of nephrotoxicity may increase above that with aminoglycoside monotherapy; effects in neuromuscular blockade may be enhanced when coadministered with nondepolarizing muscle relaxants
Documented hypersensitivity; avoid using with prior hearing loss
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Use with caution in patients with renal impairment or on other nephrotoxic or ototoxic drugs; may cause facial flushing due to histamine release (ie, red man syndrome); flushing usually resolves by slowing IV infusion to administration over 2 h and by administering antihistamines; adjust daily dosing frequency in renal impairment (ie, monitor serum levels and CrCl)
Clindamycin (Cleocin)
Lincosamide for treatment of serious skin and soft tissue staphylococcal infections. Also effective against aerobic and anaerobic streptococci (except enterococci). Inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, arresting RNA-dependent protein synthesis.
Adult
150-450 mg PO q6h
1.2-1.8 g/d IV divided bid/qid; may increase dose, not to exceed 4.8 g/d
Pediatric
10-30 mg/kg/d PO divided q6-8h
25-40 mg/kg/d IV divided q6-8h; not to exceed 4.8 g/d
Increases duration of neuromuscular blockade induced by tubocurarine and pancuronium; erythromycin may antagonize effects of clindamycin; antidiarrheals may delay absorption of clindamycin
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Adjust dose in severe hepatic dysfunction; no adjustment necessary in renal insufficiency; associated with severe and possibly fatal colitis through allowing overgrowth of Clostridium difficile (inform patient to report severe diarrhea immediately)
Daptomycin (Cubicin)
First of new antibiotic class termed cyclic lipopeptides. Binds to bacterial membranes and causes rapid membrane potential depolarization, thereby inhibiting protein, DNA, and RNA synthesis, and, ultimately, causing cell death. Indicated to treat complicated skin and skin structure infections caused by S aureus (including methicillin-resistant strains), S pyogenes, S agalactiae, S dysgalactiae, and E faecalis (vancomycin-susceptible strains only). Indicated for skin and skin structure infections.
Adult
CrCl >30 mL/min: 4 mg/kg IV q24h infused over 30 min
CrCl <30 mL/min: 4 mg/kg IV q48h (including hemodialysis or CAPD)
Pediatric
<18 years: Not established
>18 years: Administer as in adults
Coadministration with tobramycin slightly increase daptomycin Cmax and AUC and decreases tobramycin Cmax and AUC; may experience additive effects with other drugs causing myopathy (eg, HMG CoA reductase inhibitors)
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Decrease dose with renal function <30 mL/min; pseudomembranous colitis may occur; may cause muscle pain or weakness; monitor CPK levels and discontinue daptomycin upon elevated CPK and unexplained myopathy or marked CPK elevation (10X upper limit of reference range); not indicated for pneumonia (higher death rate in daptomycin-treated patients during phase III trials); not compatible with dextrose-containing solutions
Linezolid (Zyvox)
Prevents formation of functional 70S initiation complex, which is essential for bacterial translation process. Bacteriostatic against staphylococci.
Adult
400-600 mg PO/IV q12h
Pediatric
Preterm neonate <7 days: 10 mg/kg PO/IV q12h
Term neonates-12 years: 10 mg/kg PO/IV q8h
>12 years: Administer as in adults
May cause hypertension when used concomitantly with adrenergic agents including pseudoephedrine, sympathomimetic agents, vasopressor or dopaminergic agents (reduce dose of dopamine or epinephrine if concurrent use required); serotonin syndrome may occur if used concomitantly with serotonergic agents including tricyclic antidepressants, meperidine, dextromethorphan, trazodone, venlafaxine, and SSRIs; may cause myelosuppression or pseudomembranous colitis inhibitors
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Has mild MAOI properties and may have the same interactions as other MAOIs; caution in uncontrolled hypertension, pheochromocytoma, carcinoid syndrome, or untreated hyperthyroidism; caution in patients who are at increased risk of bleeding, have preexisting thrombocytopenia, receive concomitant medications that may decrease platelet count or function, or who may require >2 wk of therapy (monitor platelet counts); unnecessary use may lead to development of drug resistance; may cause peripheral or optic neuropathy
Rifampin (Rifadin injection/oral, Rimactane oral)
Inhibits RNA synthesis in bacteria by binding to beta subunit of DNA-dependent RNA polymerase, which, in turn, blocks RNA transcription.
Adult
S aureus: 600 mg/d PO/IV with other antibiotics
Pediatric
S aureus: 15 mg/kg/d PO/IV divided q12h with other antibiotics
Induces microsomal enzymes, which may decrease effects of acetaminophen, PO anticoagulants, barbiturates, benzodiazepines, beta-blockers, chloramphenicol, PO contraceptives, corticosteroids, mexiletine, cyclosporine, digitoxin, digoxin, disopyramide, estrogens, hydantoins, methadone, clofibrate, quinidine, dapsone, tazobactam, sulfonylureas, theophyllines, or tocainide; blood pressure may increase with coadministration of enalapril; coadministration with isoniazid or pyrazinamide may result in higher rate of hepatotoxicity than with either agent alone (discontinue one or both agents if alterations in LFT results occur); additive hepatotoxic effect with halothane
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Monitor liver function periodically; stains body fluids orange; soft contact lenses may be permanently stained; obtain CBC counts and baseline clinical chemistries prior to and throughout therapy; in liver disease, weigh benefits against risk of further liver damage; interruption of therapy and high-dose intermittent therapy are associated with thrombocytopenia that is reversible if therapy is discontinued as soon as purpura occurs; if treatment is continued or resumed after appearance of purpura, cerebral hemorrhage or death may occur
Sulfamethoxazole and trimethoprim (Bactrim, Septra)
Inhibits bacterial growth by inhibiting synthesis of dihydrofolic acid.
Adult
160/800 mg PO q12h
Pediatric
<2 years: Do not administer
>2 years: 6-12 mg of trimethoprim/kg/d in 2 doses
May increase PT when used with warfarin (perform coagulation tests and adjust dose accordingly); coadministration with dapsone may increase blood levels of both drugs; coadministration of diuretics increases incidence of thrombocytopenia purpura in elderly patients; phenytoin levels may increase with coadministration; may potentiate effects of methotrexate in bone marrow depression; hypoglycemic response to sulfonylureas may increase with coadministration; may increase levels of zidovudine
Documented hypersensitivity; megaloblastic anemia due to folate deficiency; age <2 mo
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Do not use during last trimester of pregnancy because of potential toxicity to newborn (eg, jaundice, hemolytic anemia, kernicterus)
Dosage adjustments (adult adjustments)
CrCl (mL/min) 80-50: Recommended IV dose q18h
CrCl 50-10: Recommended IV dose q24h
CrCl <10: Not recommended
HD: 4-5 mg/kg after HD
During peritoneal dialysis: 0.16-0.8 g q48h
Discontinue at first appearance of skin rash or sign of adverse reaction; obtain CBC count frequently; discontinue therapy if significant hematologic changes occur; goiter, diuresis, and hypoglycemia may occur with sulfonamides; prolonged IV infusions or high doses may cause bone marrow depression (if signs occur, give 5-15 mg/d leucovorin); caution in folate deficiency (eg, those who have chronic alcoholism, who are elderly, who are receiving anticonvulsant therapy, or who have malabsorption syndrome); hemolysis may occur in individuals deficient in G-6-PD; patients with AIDS may not tolerate or respond to TMP-SMZ; caution in renal or hepatic impairment (perform urinalyses and renal function tests during therapy); give fluids to prevent crystalluria and stone formation
Mupirocin (Bactroban)
For elimination of S aureus. Inhibits bacterial growth by inhibiting RNA and protein synthesis.
Adult
Apply small amount topically to affected area 2-5 times per d for 5-14 d
Apply intranasal ointment 2-4 times per d and topical cream or ointment 3-5 times per d
Pediatric
Apply as in adults
Concurrent intranasal administration of other medication not studied
Documented hypersensitivity; hypersensitivity to polyethylene glycol
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
For topical use only; avoid contact with eyes; patients with burns or open wounds can absorb toxic levels of polyethylene glycol; may irritate mucous membranes; overgrowth of nonsusceptible organisms can result with prolonged use
Retapamulin (Altabax)
Topical antibiotic available as a 1% ointment. First of new antibiotic class called pleuromutilins. Inhibits protein synthesis by binding to 50S subunit on ribosome. Indicated for impetigo caused by Staphylococcus aureus or Streptococcus pyogenes.
Adult
Apply topically to affected site bid for 5 d
Pediatric
<9 months: Not established
>9 months: Apply as in adults
None known
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
May cause irritation at application site (1.4%); avoid application to eye area; keep out of reach of children
Blood products
These agents stimulate an immune response and offer transient protection while the host immune system develops antibodies.
Immune globulin, intravenous (Carimune, Gamunex, Polygam S/D)
Actions include neutralizing circulating myelin antibodies through anti-idiotypic antibodies, down-regulating proinflammatory cytokines (including interferon gamma), blocking Fc receptors on macrophages, suppressing inducer T and B cells, and augmenting suppressor T cells. Also blocks the complement cascade and promotes remyelination. May increase CSF IgG (10%).
IVIG has been shown to have high concentration of TSST-1 and the staphylococcal enterotoxins implicated in the pathogenesis of TSS. These antibodies may interfere with the binding of toxins that cause TSS.
Adult
400 mg/kg IV as single dose infused over several hours
Pediatric
Administer as in adults
Globulin preparation may interfere with immune response to live virus vaccine (MMR) and reduce efficacy (do not administer within 3 months of vaccine)
Documented hypersensitivity; IgA deficiency
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Check serum IgA before IVIG (use an IgA-depleted product if deficient, eg, Gammagard S/D); infusions may increase serum viscosity and thromboembolic events; infusions may increase risk of migraine attacks, aseptic meningitis (10%), urticaria, pruritus, or petechiae (2-30 d postinfusion)
Increases risk of renal tubular necrosis in elderly patients and in patients with diabetes, volume depletion, and preexisting kidney disease; lab result changes associated with infusions include elevated antiviral or antibacterial antibody titers for 1 mo, 6-fold increase in ESR for 2-3 wk, and apparent hyponatremia
More on Staphylococcus Aureus Infection |
| Overview: Staphylococcus Aureus Infection |
| Differential Diagnoses & Workup: Staphylococcus Aureus Infection |
 Treatment & Medication: Staphylococcus Aureus Infection |
| Follow-up: Staphylococcus Aureus Infection |
| References |
| « Previous Page | Next Page » |
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Further Reading
Keywords
Staphylococcus aureus, abscess, bacteremia, carbuncle, cellulitis, community-acquired methicillin-resistant S aureus, community-associated methicillin-resistant S aureus, CA-MRSA, conjunctivitis, empyema, endocarditis, folliculitis, furuncle, impetigo, methicillin-resistant S aureus, MRSA, methicillin-sensitive S aureus, MSSA, osteomyelitis, pneumonia, Ritter disease, scalded skin syndrome, septic arthritis, S aureus, Staphylococcus aureus infection, thrombophlebitis, toxic shock syndrome, TSS, staphylococcal toxic shock syndrome, wound infection
