Staphylococcus

Staphylococcus is a medically important genera of Gram-positive, aerobic cocci. These bacteria Bacteria Bacteria are prokaryotic single-celled microorganisms that are metabolically active and divide by binary fission. Some of these organisms play a significant role in the pathogenesis of diseases. Bacteriology: Overview form clusters resembling grapes on culture plates. Staphylococci are ubiquitous for humans, and many strains compose the normal skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Structure and Function of the Skin flora. Staphylococcus aureus is the most virulent species; S. epidermidis and S. saprophyticus are less virulent but are also clinically significant. Infection can cause a wide array of disease, including cellulitis Cellulitis Cellulitis is a common infection caused by bacteria that affects the dermis and subcutaneous tissue of the skin. It is frequently caused by Staphylococcus aureus and Streptococcus pyogenes. The skin infection presents as an erythematous and edematous area with warmth and tenderness. Cellulitis, abscesses, endocarditis Endocarditis Endocarditis is an inflammatory disease involving the inner lining (endometrium) of the heart, most commonly affecting the cardiac valves. Both infectious and noninfectious etiologies lead to vegetations on the valve leaflets. Patients may present with nonspecific symptoms such as fever and fatigue. Endocarditis, osteomyelitis Osteomyelitis Osteomyelitis is an infection of the bone that results from the spread of microorganisms from the blood (hematogenous), nearby infected tissue, or open wounds (non-hematogenous). Infections are most commonly caused by Staphylococcus aureus. Osteomyelitis, and medical device infections. Toxins formed by S. aureus can cause gastroenteritis Gastroenteritis Gastroenteritis is inflammation of the stomach and intestines, commonly caused by infections from bacteria, viruses, or parasites. Transmission may be foodborne, fecal-oral, or through animal contact. Common clinical features include abdominal pain, diarrhea, vomiting, fever, and dehydration. Gastroenteritis, SSSS SSSS Staphylococcal scalded skin syndrome (SSSS), also known as Ritter disease and staphylococcal epidermal necrolysis, is a toxin-mediated condition caused by Staphylococcus aureus. The exfoliative toxin produced disseminates and cleaves desmoglein 1 in the epidermis, causing separation and detachment of the skin. Staphylococcal Scalded Skin Syndrome (SSSS), and toxic shock syndrome Toxic Shock Syndrome Toxic shock syndrome (TSS) is an acute, multi-systemic disease caused by the toxin-producing bacteria, Staphylococcus aureus and Streptococcus pyogenes. Staphylococcal TSS is more common and associated with tampons and nasal packing. Toxic Shock Syndrome ( TSS TSS Toxic shock syndrome (TSS) is an acute, multi-systemic disease caused by the toxin-producing bacteria, Staphylococcus aureus and Streptococcus pyogenes. Staphylococcal TSS is more common and associated with tampons and nasal packing. Toxic Shock Syndrome). Antibiotic management varies based on the type of infection, severity, and sensitivity data.

Last update:

Editorial responsibility: Stanley Oiseth, Lindsay Jones, Evelin Maza

Table of Contents

Share this concept:

Share on facebook
Share on twitter
Share on linkedin
Share on reddit
Share on email
Share on whatsapp

Classification

Microbiology flowchart gram-positive bacteria

Gram-positive bacteria Bacteria Bacteria are prokaryotic single-celled microorganisms that are metabolically active and divide by binary fission. Some of these organisms play a significant role in the pathogenesis of diseases. Bacteriology: Overview:
Most bacteria Bacteria Bacteria are prokaryotic single-celled microorganisms that are metabolically active and divide by binary fission. Some of these organisms play a significant role in the pathogenesis of diseases. Bacteriology: Overview can be classified according to a lab procedure called Gram staining.
Bacteria with cell walls that have a thick layer of peptidoglycan retain the crystal violet stain utilized in Gram staining but are not affected by the safranin counterstain. These bacteria Bacteria Bacteria are prokaryotic single-celled microorganisms that are metabolically active and divide by binary fission. Some of these organisms play a significant role in the pathogenesis of diseases. Bacteriology: Overview appear as purple-blue on the stain, indicating that they are gram positive. The bacteria Bacteria Bacteria are prokaryotic single-celled microorganisms that are metabolically active and divide by binary fission. Some of these organisms play a significant role in the pathogenesis of diseases. Bacteriology: Overview can be further classified according to morphology (branching filaments, bacilli, and cocci in clusters or chains) and their ability to grow in the presence of oxygen (aerobic versus anaerobic). The cocci can also be further identified. Staphylococci can be narrowed down on the basis of the presence of the enzyme coagulase and on their sensitivity to the antibiotic novobiocin. Streptococci are grown on blood agar and classified on the basis of which form of hemolysis they employ (α, β, or γ). Streptococci are further narrowed on the basis of their response to the pyrrolidonyl-β-naphthylamide (PYR) test, their sensitivity to specific antimicrobials (optochin and bacitracin), and their ability to grow on sodium chloride (NaCl) media.

Image by Lecturio.

General Characteristics and Epidemiology

Basic features of Staphylococcus

  • Gram-positive cocci
    • Grow in clusters
    • Resemble a cluster of grapes
  • Nonmotile
  • Non-spore-forming
  • Aerobic and facultative anaerobic
  • Catalase-positive:
    • An enzyme that cleaves hydrogen peroxide → water and oxygen 
    • Distinguishing feature from streptococci (which are catalase-negative)
Staphylococcus aureus

Digitally-colorized scanning electron microscopic image under 10,000X magnification of Staphylococcus aureus:
Notice these cocci resemble a “cluster of grapes.”

Image: “10.000x Magnification of Staphylococcus aureus” by CDC/ Matthew J. Arduino, DRPH. License: Public Domain

Clinically relevant species

The clinically relevant species can be classified based on the presence (or absence) of coagulase:

  • Coagulase-positive staphylococci: S. aureus
  • Coagulase-negative staphylococci (CoNS) species (often grouped together):
    • S. epidermidis 
    • S. saprophyticus
    • Infrequent pathogens (list is not exhaustive):
      • S. lugdunensis
      • S. hominis
      • S. capitis
      • S. haemolyticus

Distinguishing features

Table: Distinguishing features among the common pathogenic Staphylococcus species
Species Coagulase Blood agar Mannitol salt agar Novobiocin*
sensitivity
S. aureus Positive Beta-hemolysis Yellow colonies Sensitive
S. epidermidis Negative Nonhemolytic Pink or red colonies Sensitive
S. saprophyticus Negative Nonhemolytic Yellow colonies Resistant
*An antibiotic produced by Streptomyces nivens
Mrsa

Methicillin-resistant Staphylococcus aureus (MRSA):
Coagulase-positive S. aureus ferments mannitol (red), producing yellow colonies on mannitol salt agar plates.

Image: “Methicillin-resistant Staphylococcus aureus (MRSA) bacteria Bacteria Bacteria are prokaryotic single-celled microorganisms that are metabolically active and divide by binary fission. Some of these organisms play a significant role in the pathogenesis of diseases. Bacteriology: Overview” by CDC/ Melissa Dankel. License: Public Domain

Epidemiology

  • S. aureus:
    • Colonizes approximately 30% of the general population
    • Major cause of community-acquired and nosocomial infections
  • S. epidermidis:
    • Most commonly identified Staphylococcus species from human skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Structure and Function of the Skin
    • Common cause of nosocomial bacteremia
  • S. saprophyticus: common cause of urinary tract infections Urinary tract infections Urinary tract infections (UTIs) represent a wide spectrum of diseases, from self-limiting simple cystitis to severe pyelonephritis that can result in sepsis and death. Urinary tract infections are most commonly caused by Escherichia coli, but may also be caused by other bacteria and fungi. Urinary Tract Infections (UTIs) in sexually active young women

Related videos

Pathogenesis

Reservoir

Staphylococcus species are part of the normal human flora:

  • Nasal mucosa
  • Respiratory tract
  • Skin
  • GI tract
  • Genitourinary tract (S. saprophyticus)

Transmission

Staphylococcus aureus can be transmitted via aerosols and contact with:

  • Infected individuals
  • Bodily fluids
  • Contaminated objects

Risk factors

Risk factors for severe Staphylococcus infection include:

  • Hospitalization
  • Surgery
  • Outpatient procedures (e.g., dialysis Dialysis Renal replacement therapy refers to dialysis and/or kidney transplantation. Dialysis is a procedure by which toxins and excess water are removed from the circulation. Hemodialysis and peritoneal dialysis (PD) are the two types of dialysis, and their primary difference is the location of the filtration process (external to the body in hemodialysis versus inside the body for PD). Overview and Types of Dialysis)
  • Implanted or prosthetic material: 
    • Pacemakers/defibrillators
    • Intravascular catheters
    • Urethral catheters
    • Surgical implants
    • Prosthetic valves
  • Immunocompromised individuals
  • Nursing home stays
  • Injection drug use

Virulence factors

Common to most staphylococci:

  • Deoxyribonuclease (DNase): depolymerizes DNA DNA The molecule DNA is the repository of heritable genetic information. In humans, DNA is contained in 23 chromosome pairs within the nucleus. The molecule provides the basic template for replication of genetic information, RNA transcription, and protein biosynthesis to promote cellular function and survival. DNA Types and Structure, a component of neutrophil extracellular traps → ↓ pus viscosity
  • Fibrinolysin Fibrinolysin A product of the lysis of plasminogen (profibrinolysin) by plasminogen activators. It is composed of two polypeptide chains, light (b) and heavy (a), with a molecular weight of 75, 000. It is the major proteolytic enzyme involved in blood clot retraction or the lysis of fibrin and quickly inactivated by antiplasmins. Hemostasis: lyses fibrin walls used to keep an infection contained → aids AIDS Chronic HIV infection and depletion of CD4 cells eventually results in acquired immunodeficiency syndrome (AIDS), which can be diagnosed by the presence of certain opportunistic diseases called AIDS-defining conditions. These conditions include a wide spectrum of bacterial, viral, fungal, and parasitic infections as well as several malignancies and generalized conditions. HIV Infection and AIDS in spread
  • Proteases: degrade proteins of target cells, such as components of the:
    • Extracellular matrix (ECM)
    • Innate immune system Innate immune system Innate immunity, the 1st protective layer of defense, is a system that recognizes threatening microbes, distinguishes self-tissues from pathogens, and subsequently eliminates the foreign invaders. The response is nonspecific and uses different layers of protection: barriers such as the skin, pattern recognition receptors (PRRs) as well as circulating proteins, and immune cells that help eliminate the microbe. Cells of the Innate Immune System
  • Biofilm:
    • An extracellular polysaccharide matrix that encases the bacteria Bacteria Bacteria are prokaryotic single-celled microorganisms that are metabolically active and divide by binary fission. Some of these organisms play a significant role in the pathogenesis of diseases. Bacteriology: Overview after attaching to foreign material
    • Functions as a protective barrier against antibiotics and the host immune system 

Staphylococcus aureus:

  • Hyaluronidase: 
    • Splits hyaluronic acid 
    • Makes it easier for pathogen invasion into the tissues
  • Lipase and hydrolase: 
    • Degrade lipids Lipids Lipids are a diverse group of hydrophobic organic molecules, which include fats, oils, sterols, and waxes. Fatty Acids and Lipids
    • Used for invasion
  • Hemolysins and leukocidins: causes target cell death Cell death Injurious stimuli trigger the process of cellular adaptation, whereby cells respond to withstand the harmful changes in their environment. Overwhelmed adaptive mechanisms lead to cell injury. Mild stimuli produce reversible injury. If the stimulus is severe or persistent, injury becomes irreversible. Apoptosis is programmed cell death, a mechanism with both physiologic and pathologic effects. Cell Injury and Death, including red blood cells and immune cells
  • Clumping factor A: 
    • Binds fibrinogen and other proteins
    • Causes bacteria Bacteria Bacteria are prokaryotic single-celled microorganisms that are metabolically active and divide by binary fission. Some of these organisms play a significant role in the pathogenesis of diseases. Bacteriology: Overview clumping in plasma
    • Particularly important in the pathogenesis of endocarditis Endocarditis Endocarditis is an inflammatory disease involving the inner lining (endometrium) of the heart, most commonly affecting the cardiac valves. Both infectious and noninfectious etiologies lead to vegetations on the valve leaflets. Patients may present with nonspecific symptoms such as fever and fatigue. Endocarditis and endovascular infections
  • Coagulase: 
    • Converts fibrinogen to fibrin to form a wall around the local area of infection (pseudocapsule)
    • Promotes abscess formation
  • Exfoliative toxins A and B:
    • Exotoxins
    • Cause SSSS SSSS Staphylococcal scalded skin syndrome (SSSS), also known as Ritter disease and staphylococcal epidermal necrolysis, is a toxin-mediated condition caused by Staphylococcus aureus. The exfoliative toxin produced disseminates and cleaves desmoglein 1 in the epidermis, causing separation and detachment of the skin. Staphylococcal Scalded Skin Syndrome (SSSS)
      • Cleave desmoglein Desmoglein A group of desmosomal cadherins with cytoplasmic tails that resemble those of classical cadherins. Cell Junctions-1 complex in the stratum granulosum
      • Disrupt keratinocyte-to-keratinocyte adhesion
      • Cause separation and detachment of the superficial epidermis
  • Superantigens:
    • Includes the exotoxins: 
      • Toxic shock syndrome toxin type-1 (TSST-1)
      • Enterotoxin B
    • Cause toxic shock syndrome Toxic Shock Syndrome Toxic shock syndrome (TSS) is an acute, multi-systemic disease caused by the toxin-producing bacteria, Staphylococcus aureus and Streptococcus pyogenes. Staphylococcal TSS is more common and associated with tampons and nasal packing. Toxic Shock Syndrome ( TSS TSS Toxic shock syndrome (TSS) is an acute, multi-systemic disease caused by the toxin-producing bacteria, Staphylococcus aureus and Streptococcus pyogenes. Staphylococcal TSS is more common and associated with tampons and nasal packing. Toxic Shock Syndrome):
      • Bind to MHC class II on antigen-presenting cells → cross-links with the β region of the T cell receptor (TCR)
      • Stimulates T cell activation and an exaggerated cytokine release
      • Results in an excessive inflammatory response
  • Other enterotoxins:
    • Heat stable exotoxins
    • Mode of action unknown
    • Can cause gastroenteritis Gastroenteritis Gastroenteritis is inflammation of the stomach and intestines, commonly caused by infections from bacteria, viruses, or parasites. Transmission may be foodborne, fecal-oral, or through animal contact. Common clinical features include abdominal pain, diarrhea, vomiting, fever, and dehydration. Gastroenteritis (food poisoning)

CoNS:

  • Adhesins: aid CoNS adhesion to host cells
  • Urease:
    • Produced by S. saprophyticus
    • Hydrolyzes urea → C02 and ammonia Ammonia A colorless alkaline gas. It is formed in the body during decomposition of organic materials during a large number of metabolically important reactions. Note that the aqueous form of ammonia is referred to as ammonium hydroxide. Physiology of Acid-Base Balance → ↑ urine pH
    • Makes it particularly virulent within the urinary tract

Diseases Caused by S. aureus

Infections

Staphylococcus aureus can cause a wide range of infections, including (but not limited to):

  • Skin and soft tissue infections
    • Folliculitis
    • Impetigo Impetigo Impetigo is a highly contagious superficial bacterial infection typically caused by Staphylococcus aureus (most common) and Streptococcus pyogenes. Impetigo most commonly presents in children aged 2 to 5 years with lesions that evolve from papules to vesicles to pustules, which eventually break down to form characteristic "honey-colored" crusts. Impetigo
    • Cellulitis
    • Abscess
    • Necrotizing fasciitis Necrotizing fasciitis Necrotizing fasciitis is a life-threatening infection that causes rapid destruction and necrosis of the fascia and subcutaneous tissues. Patients may present with significant pain out of proportion to the presenting symptoms and rapidly progressive erythema of the affected area. Necrotizing Fasciitis
    • Surgical wound infection
  • Bloodstream infection → can seed infections in other tissues
  • Infective endocarditis Endocarditis Endocarditis is an inflammatory disease involving the inner lining (endometrium) of the heart, most commonly affecting the cardiac valves. Both infectious and noninfectious etiologies lead to vegetations on the valve leaflets. Patients may present with nonspecific symptoms such as fever and fatigue. Endocarditis (IE)
    • Leads to cardiac valve vegetations
    • Can release septic emboli → embolic complications and/or metastatic infection
    • S. aureus is associated with acute, rapidly progressive infection.
  • Pneumonia Pneumonia Pneumonia or pulmonary inflammation is an acute or chronic inflammation of lung tissue. Causes include infection with bacteria, viruses, or fungi. In more rare cases, pneumonia can also be caused through toxic triggers through inhalation of toxic substances, immunological processes, or in the course of radiotherapy. Pneumonia
    • S. aureus notably causes secondary bacterial pneumonia in individuals with influenza Influenza Influenza viruses are members of the Orthomyxoviridae family and the causative organisms of influenza, a highly contagious febrile respiratory disease. There are 3 primary influenza viruses (A, B, and C) and various subtypes, which are classified based on their virulent surface antigens, hemagglutinin (HA) and neuraminidase (NA). Influenza typically presents with a fever, myalgia, headache, and symptoms of an upper respiratory infection. Influenza Viruses/Influenza.
    • Complications:
      • Necrotizing infection → tissue destruction → lung cavitation
      • Lung abscess
      • Empyema
  • Septic arthritis Septic arthritis Septic arthritis is an infection of the joint due to direct inoculation, contiguous extension, or hematogenous spread of infectious organisms into the joint space. This process causes an acute, inflammatory, monoarticular arthritis. Septic Arthritis
  • Osteomyelitis
    • Infection of the bone Bone Bone is a compact type of hardened connective tissue composed of bone cells, membranes, an extracellular mineralized matrix, and central bone marrow. The 2 primary types of bone are compact and spongy. Structure of Bones
    • Can be due to hematogenous or nonhematogenous spread
  • Medical device infections, such as:
    • IV catheters
    • Prosthetic valves
    • Prosthetic joints
    • Pacemakers

Toxin-mediated diseases

Table: Features of toxin-mediated diseases caused by S. aureus
Disease Exotoxin Clinical presentation
SSSS SSSS Staphylococcal scalded skin syndrome (SSSS), also known as Ritter disease and staphylococcal epidermal necrolysis, is a toxin-mediated condition caused by Staphylococcus aureus. The exfoliative toxin produced disseminates and cleaves desmoglein 1 in the epidermis, causing separation and detachment of the skin. Staphylococcal Scalded Skin Syndrome (SSSS) Exfoliative toxins A and B
  • Prodromal symptoms
  • Erythematous rash → blisters → desquamation
  • Skin pain Pain Pain has accompanied humans since they first existed, first lamented as the curse of existence and later understood as an adaptive mechanism that ensures survival. Pain is the most common symptomatic complaint and the main reason why people seek medical care. Physiology of Pain
  • Spares mucosa
Toxic shock syndrome ( TSS TSS Toxic shock syndrome (TSS) is an acute, multi-systemic disease caused by the toxin-producing bacteria, Staphylococcus aureus and Streptococcus pyogenes. Staphylococcal TSS is more common and associated with tampons and nasal packing. Toxic Shock Syndrome) Toxic shock syndrome toxin type-1 (TSST-1)
Enterotoxin B
  • Fever
  • Rash
  • Hypotension Hypotension Hypotension is defined as low blood pressure, specifically < 90/60 mm Hg, and is most commonly a physiologic response. Hypotension may be mild, serious, or life threatening, depending on the cause. Hypotension
  • Multiorgan dysfunction
Gastroenteritis Enterotoxins
  • Nausea and vomiting
  • Abdominal cramps
  • Diarrhea

Diseases Caused by CoNS

Coagulase-negative staphylococci can cause many of the same conditions as S. aureus. Notable infections include:

  • Medical device infections (particularly S. epidermidis)
    • IV catheters
    • Prosthetic valves
    • Pacemakers
    • Prosthetic joints
    • CNS shunts
    • Breast implants
  • Surgical wound infection
  • IE (native and prosthetic valve)
  • Osteomyelitis
  • UTIs (particularly S. saprophyticus)

Antibiotics and Resistance

Antibiotic susceptibility

Staphylococcus species can develop antibiotic resistance, and identification of susceptibility is necessary for adequate treatment. Species are often designated as:

  • Methicillin-sensitive 
  • Methicillin-resistant 
  • Vancomycin-resistant

Mechanism of resistance

  • Methicillin: penicillin-binding protein (PBP)-mediated resistance
    • Mutations in the PBPs (encoded by mecA gene) → ↓ affinity of penicillins Penicillins Beta-lactam antibiotics contain a beta-lactam ring as a part of their chemical structure. Drugs in this class include penicillin G and V, penicillinase-sensitive and penicillinase-resistant penicillins, cephalosporins, carbapenems, and aztreonam. Penicillins to the PBP 
    • Despite the mutations, these PBPs are still able to produce a cell wall.
  • Vancomycin: alteration in peptidoglycan synthesis
    • Conferred by vanA gene (on plasmid)
    • Acquired from vancomycin-resistant Enterococcus Enterococcus Enterococcus is a genus of oval-shaped gram-positive cocci that are arranged in pairs or short chains. Distinguishing factors include optochin resistance and the presence of pyrrolidonyl arylamidase (PYR) and Lancefield D antigen. Enterococcus is part of the normal flora of the human GI tract. Enterococcus (VRE)
    • Alters the D-alanyl-D-alanine peptidoglycan target to D-alanyl-D-lactate or D-alanyl-D-serine → poor glycopeptide binding and no disruption of cell wall synthesis

Antibiotic choices

The agent of choice and duration of treatment for Staphylococcus infection depends on the body area affected, the severity of infection, and the antibiotic sensitivity of the strain. 

Table: Antibiotic choices for Staphylococcus based on resistance
Strain Antibiotic
MSSA and CoNS
  • Penicillinase-resistant penicillins Penicillins Beta-lactam antibiotics contain a beta-lactam ring as a part of their chemical structure. Drugs in this class include penicillin G and V, penicillinase-sensitive and penicillinase-resistant penicillins, cephalosporins, carbapenems, and aztreonam. Penicillins
  • Cephalosporins Cephalosporins Cephalosporins are a group of bactericidal beta-lactam antibiotics (similar to penicillins) that exert their effects by preventing bacteria from producing their cell walls, ultimately leading to cell death. Cephalosporins are categorized by generation and all drug names begin with "cef-" or "ceph-." Cephalosporins
MRSA
  • Vancomycin
  • Trimethoprim Trimethoprim The sulfonamides are a class of antimicrobial drugs inhibiting folic acid synthesize in pathogens. The prototypical drug in the class is sulfamethoxazole. Although not technically sulfonamides, trimethoprim, dapsone, and pyrimethamine are also important antimicrobial agents inhibiting folic acid synthesis. The agents are often combined with sulfonamides, resulting in a synergistic effect. Sulfonamides and Trimethoprim-sulfamethoxazole
  • Clindamycin
  • Linezolid
  • Daptomycin
  • Tetracyclines Tetracyclines Tetracyclines are a class of broad-spectrum antibiotics indicated for a wide variety of bacterial infections. These medications bind the 30S ribosomal subunit to inhibit protein synthesis of bacteria. Tetracyclines cover gram-positive and gram-negative organisms, as well as atypical bacteria such as chlamydia, mycoplasma, spirochetes, and even protozoa. Tetracyclines
  • Ceftaroline
  • Tigecycline
VRSA
  • Linezolid
  • Daptomycin
  • Ceftaroline

References

  1. Carroll, KC, & Hobden, JA. (2015). The staphylococci. In Brooks, JE, et al. (Eds.), Jawetz, Melnick, & Adelberg’s Medical Microbiology. (27th ed). [VitalSource Bookshelf 9.4.3]. 
  2. Centers for Disease Control and Prevention. (2020). Staphylococcus aureus in Healthcare Settings. https://www.cdc.gov/hai/organisms/staph.html
  3. Fowler, VG, & Holland, TL. Clinical approach to Staphylococcus aureus bacteremia in adults. UpToDate. Retrieved May 13, 2021, from https://www.uptodate.com/contents/clinical-approach-to-staphylococcus-aureus-bacteremia-in-adults
  4. Tufariello, JM, & Lowy, FD. Infection due to coagulase-negative staphylococci: Epidemiology, microbiology, and pathogenesis. UpToDate. Retrieved May 14, 2021, from https://www.uptodate.com/contents/infection-due-to-coagulase-negative-staphylococci-epidemiology-microbiology-and-pathogenesis
  5. Chu, VH. Staphylococcal toxic shock syndrome. UpToDate. Retrieved May 19, 2021, from https://www.uptodate.com/contents/staphylococcal-toxic-shock-syndrome
  6. McMahon, P. Staphylococcal scalded skin syndrome. UpToDate. Retrieved May 19, 2021, from https://www.uptodate.com/contents/staphylococcal-scalded-skin-syndrome
  7. Cong, Y, Yang, S, & Rao, X. (2020). Vancomycin-resistant Staphylococcus aureus infections: A review of case updating and clinical features. Journal of Advanced Research. 21:169-176. https://www.sciencedirect.com/science/article/pii/S2090123219301638
  8. Gardete, S, & Tomasz, A. (2014). Mechanism of vancomycin resistance in Staphylococcus aureus. The Journal of Clinical Investigation. 124(7):2836-40. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4071404/
  9. Moreillon, P, et al. (1995). Rose of Staphylococcus aureus coagulase and clumping factor in pathogenesis of experimental endocarditis. Infection and Immunity. 63(12):4738-43. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC173679/
  10. Vandenesch, F, Lina, G, & Henry, T. (2012). Staphylococcus aureus hemolysins, bicomponent leukocidins, and cytolytic peptides: A redundant arsenal of membrane-damaging virulence factors? Frontiers in Cellular and Infection Microbiology. 2:12. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3417661/

USMLE™ is a joint program of the Federation of State Medical Boards (FSMB®) and National Board of Medical Examiners (NBME®). MCAT is a registered trademark of the Association of American Medical Colleges (AAMC). NCLEX®, NCLEX-RN®, and NCLEX-PN® are registered trademarks of the National Council of State Boards of Nursing, Inc (NCSBN®). None of the trademark holders are endorsed by nor affiliated with Lecturio.

Study on the Go

Lecturio Medical complements your studies with evidence-based learning strategies, video lectures, quiz questions, and more – all combined in one easy-to-use resource.

Learn even more with Lecturio:

Complement your med school studies with Lecturio’s all-in-one study companion, delivered with evidence-based learning strategies.

User Reviews

0.0

()

¡Hola!

Esta página está disponible en Español.

🍪 Lecturio is using cookies to improve your user experience. By continuing use of our service you agree upon our Data Privacy Statement.

Details