Treatment of Staphylococcus aureus Infections

Abstract

Staphylococcus aureus, although generally identified as a commensal, is also a common cause of human bacterial infections, including of the skin and other soft tissues, bones, bloodstream, and respiratory tract. The history of S. aureus treatment is marked by the development of resistance to each new class of antistaphylococcal antimicrobial drugs, including the penicillins, sulfonamides, tetracyclines, glycopeptides, and others, complicating therapy. S. aureus isolates identified in the 1960s were sometimes resistant to methicillin, a ß-lactam antimicrobial active initially against a majority S. aureus strains. These MRSA isolates, resistant to nearly all ß-lactam antimicrobials, were first largely confined to the health care environment and the patients who attended it. However, in the mid-1990s, new strains, known as community-associated (CA-) MRSA strains, emerged. CA-MRSA organisms, compared with health care-associated (HA-) MRSA strain types, are more often susceptible to multiple classes of non ß-lactam antimicrobials. While infections caused by methicillin-susceptible S. aureus (MSSA) strains are usually treated with drugs in the ß-lactam class, such as cephalosporins, oxacillin or nafcillin, MRSA infections are treated with drugs in other antimicrobial classes. The glycopeptide drug vancomycin, and in some countries teicoplanin, is the most common drug used to treat severe MRSA infections. There are now other classes of antimicrobials available to treat staphylococcal infections, including several that have been approved after 2009. The antimicrobial management of invasive and noninvasive S. aureus infections in the ambulatory and in-patient settings is the topic of this review. Also discussed are common adverse effects of antistaphylococcal antimicrobial agents, advantages of one agent over another for specific clinical syndromes, and the use of adjunctive therapies such as surgery and intravenous immunoglobulin. We have detailed considerations in the therapy of noninvasive and invasive S. aureus infections. This is followed by sections on specific clinical infectious syndromes including skin and soft tissue infections, bacteremia, endocarditis and intravascular infections, pneumonia, osteomyelitis and vertebral discitis, epidural abscess, septic arthritis, pyomyositis, mastitis, necrotizing fasciitis, orbital infections, endophthalmitis, parotitis, staphylococcal toxinoses, urogenital infections, and central nervous system infections.

Investigation of biofilm production and its association with genetic and phenotypic characteristics of OM (osteomyelitis) and non-OM orthopedic Staphylococcus aureus

“…Drug resistance is a great concern in the treatment of infectious diseases [3], and biofilm plays an important role in causing drug resistance [8,10,20]. S. aureus is usually the most common pathogen in orthopedic infections, and skilled in biofilm formation [2,8].…”

“…Staphylococcus aureus is a common and versatile grampositive pathogen in orthopedic patients [1,2]. The notorious bacterium attracts more and more attention because of its ability of producing various virulence factors and the worsening situation of drug resistance [3]. Biofilm is an important tool of pathogenic bacteria, and…”

MRSA dynamic circulation between the community and the hospital setting: New insights from a cohort study

“…22 This clone (ST100-IVNv) has several features to be considered an important concern for the public health system in Argentina and in neighboring countries as well. Thus, (i) it is one of the main clones colonizing the patients upon admission, as demonstrated in this paper (ii) the high stability over time in our country, causing infections particularly invasive, in the hospital setting (HAHO), where it remained in the third place in prevalence, since 1998 to 2009 13 , 21 as well as in the community (HACO) before the emergence of CA-MRSA clone ST5-IVa-PVL + 13 , 20-22 (iii) its capacity to cause outbreaks among infected patients and colonized health-care-workers, 66 (iv) its capacity to express the h-VISA phenotype, 22 along with the fact that vancomycin is still considered the first-line therapy for invasive MRSA infections, 67 (v) its ability to acquire resistance to antibiotics and new types of SCCmec. 22 , 66 Hence, all these features have enough intrinsic relevance for the recommendation of the molecular vigilance over time of the HA-MRSA Pediatric clone Argentinean variant.…”

Studying Staphylococcal Leukocidins: A Challenging Endeavor

“…Staphylococcus aureus is a major bacterial pathogen in humans that, combined with the acquisition of antibiotic resistance, is of serious concern to public health (Katayama et al, 2000;Whitby et al, 2001;Thwaites et al, 2011;David and Daum, 2017). Neutrophils are the first to arrive at the site of infection and subsequently phagocytose and kill S. aureus (Rigby and DeLeo, 2012;Spaan et al, 2013b;van Kessel et al, 2014).…”