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])
- Folliculitis
- Furuncles
- Impetigo (bullous)
- Wound infections
- Scalded skin syndrome
Soft tissue infections (pyomyositis, septic bursitis, septic arthritis)
Toxic shock syndrome
Purpura fulminans^[21]
Endocarditis
Osteomyelitis
Pneumonia
Food poisoning
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 ^{[22, 23]})
Urinary tract infection

Physical

Physical findings include the following:

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 aureus endocarditis.
  View Media Gallery
  
  Close-up view of embolic lesions in patient with Staphylococcus aureus endocarditis.
  View Media Gallery
- 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.^{[24, 25]}Isolates can be spread by coughing or sneezing.^[26]Evidence has also shown that S aureus can be spread between men during sex with other men.^[27]Pets can also serve as household reservoirs.^[28]The rate of MRSA hand colonization among health care workers has been shown to exceed 4% (over 8% in North America).^[17]

Differential Diagnoses

Sanchini A. Recent Developments in Phenotypic and Molecular Diagnostic Methods for Antimicrobial Resistance Detection in Staphylococcus aureus: A Narrative Review. Diagnostics (Basel). 2022 Jan 15. 12 (1):[QxMD MEDLINE Link].
Rongisch R, Fabri M. [Soft tissue infections]. Hautarzt. 2022 Mar. 73 (3):223-233. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
[Guideline] 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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Komoto A, Maiguma T, Teshima D, Sugiyama T, Haruki Y. Effects of pharmacist intervention in Vancomycin treatment for patients with bacteremia due to Methicillin-resistant Staphylococcus aureus. PLoS One. 2018. 13 (9):e0203453. [QxMD MEDLINE Link]. [Full Text].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link]. [Full Text].
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. [QxMD MEDLINE Link]. [Full Text].
de Jong NWM, van Kessel KPM, van Strijp JAG. Immune Evasion by Staphylococcus aureus. Microbiol Spectr. 2019 Mar. 7 (2):[QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Montoya A, Schildhouse R, Goyal A, Mann JD, Snyder A, Chopra V, et al. How often are health care personnel hands colonized with multidrug- resistant organisms? A systematic review and meta-analysis. Am J Infect Control. 2019 Jun. 47 (6):693-703. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link]. [Full Text].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Kravitz GR, Dries DJ, Peterson ML, et al. Purpura fulminans due to Staphylococcus aureus. Clin Infect Dis. 2005 Apr 1. 40(7):941-7. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Holland TL, Arnold C, Fowler VG Jr. Clinical management of Staphylococcus aureus bacteremia: a review. JAMA. 2014 Oct 1. 312 (13):1330-41. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
[Guideline] 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. [QxMD MEDLINE Link].
Taupin D, Karchmer AW, Davis RB, LaSalvia MT. Uncomplicated Staphylococcus aureus Bacteremia Treatment Duration and Outcomes at an Academic Medical Center. Open Forum Infect Dis. 2020 Oct. 7 (10):ofaa457. [QxMD MEDLINE Link].
McNeil JC, Fritz SA. Prevention Strategies for Recurrent Community-Associated Staphylococcus aureus Skin and Soft Tissue Infections. Curr Infect Dis Rep. 2019 Mar 11. 21 (4):12. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Archer GL. Staphylococcus aureus: a well-armed pathogen. Clin Infect Dis. 1998 May. 26(5):1179-81. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Cunha BA. Methicillin-resistant Staphylococcus aureus: clinical manifestations and antimicrobial therapy. Clin Microbiol Infect. 2005 Jul. 11 Suppl 4:33-42. [QxMD MEDLINE Link].
Shi C, Xiao Y, Zhang Q, Li Q, Wang F, Wu J, et al. Efficacy and safety of cefazolin versus antistaphylococcal penicillins for the treatment of methicillin-susceptible Staphylococcus aureus bacteremia: a systematic review and meta-analysis. BMC Infect Dis. 2018 Oct 11. 18 (1):508. [QxMD MEDLINE Link].
Weis S, Kesselmeier M, Davis JS, Morris AM, Lee S, Scherag A, et al. Cefazolin versus anti-staphylococcal penicillins for the treatment of patients with Staphylococcus aureus bacteraemia. Clin Microbiol Infect. 2019 Mar 27. [QxMD MEDLINE Link]. [Full Text].
Al-Hasan MN, Rac H. Transition from intravenous to oral antimicrobial therapy in patients with uncomplicated and complicated bloodstream infections. Clin Microbiol Infect. 2019 May 22. [QxMD MEDLINE Link].
Iversen K, Ihlemann N, Gill SU, Madsen T, Elming H, Jensen KT, et al. Partial Oral versus Intravenous Antibiotic Treatment of Endocarditis. N Engl J Med. 2019 Jan 31. 380 (5):415-424. [QxMD MEDLINE Link].
Bouza E. New therapeutic choices for infections caused by methicillin-resistant Staphylococcus aureus. Clin Microbiol Infect. 2009. 15:44-52.
Cunha BA. Oral antibiotic therapy of serious systemic infections. Med Clin North Am. 2006 Nov. 90(6):1197-222. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Daum RS, Miller LG, Immergluck L, Fritz S, Creech CB, Young D, et al. A Placebo-Controlled Trial of Antibiotics for Smaller Skin Abscesses. N Engl J Med. 2017 Jun 29. 376 (26):2545-2555. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
[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. [QxMD MEDLINE Link].
[Guideline] Rybak MJ, Le J, Lodise TP, Levine DP, Bradley JS, Liu C, et al. Therapeutic monitoring of vancomycin for serious methicillin-resistant Staphylococcus aureus infections: A revised consensus guideline and review by the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the Society of Infectious Diseases Pharmacists. Am J Health Syst Pharm. 2020 May 19. 77 (11):835-864. [QxMD MEDLINE Link].
Bellos I, Daskalakis G, Pergialiotis V. Relationship of vancomycin trough levels with acute kidney injury risk: an exposure-toxicity meta-analysis. J Antimicrob Chemother. 2020 Oct 1. 75 (10):2725-2734. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link]. [Full Text].
Geriak M, Haddad F, Rizvi K, Rose W, Kullar R, LaPlante K, et al. Clinical Data on Daptomycin plus Ceftaroline versus Standard of Care Monotherapy in the Treatment of Methicillin-Resistant Staphylococcus aureus Bacteremia. Antimicrob Agents Chemother. 2019 May. 63 (5):e02483-18. [QxMD MEDLINE Link].
Cheng MP, Lawandi A, Butler-Laporte G, De l'Étoile-Morel S, Paquette K, Lee TC. Adjunctive Daptomycin in the Treatment of Methicillin-susceptible Staphylococcus aureus Bacteremia: A Randomized, Controlled Trial. Clin Infect Dis. 2021 May 4. 72 (9):e196-e203. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link]. [Full Text].

Media Gallery

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.