STAPHYLOCOCCUS

• DEFINITION OF STAPHYLOCOCCUS

• FAMILY: MICROCOCCACEAE
• GENUS: STAPHYLOCOCCUS
• SPECIES : S. aureus, S. epidermidis, S. saprophyticus, S. simulans,
• S. capitis, S. xylosus, S. warneri, S. cohnii,
• S. haemolyticus, S. hominis, S. saccharolyticus.
• 32 species.
• Some possess the ability to produce – coagulase, protein A,
• Cell associated clumping
• Factor.
• They are called STAPHYLOCOCCUS AUREUS.
• All others are called coagulase- negative staphylococci.
• 60% - 90% of coagulase – negative staphylococci from humans
• are STAPHYLOCOCCUS EPIDERMIDIS.

STAPHYLOCOCCUS

• Staphyle - a cluster of grapes

• Facultative anaerobe
•
• 0.5 - 1u in diameter
• Temp. 18 - 400 C

• Coagulase Positive – Staphylococcus aureus

• Coagulase Negative – Staphylococcus epidermidis, S. warnerii,

S.cohnii, S.saprophyticus.

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 STAPHYLOCOCCUS

STAPHYLOCOCCUS AUREUS

• PHYSIOLOGY AND STRUCTURE

• Capsule – loose-fitting polysaccharide layer ( slime )

• . adherence to catheters and synthetic material

• . inhibits chemotaxis and phagocytosis

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 STAPHYLOCOCCUS AUREUS
• PHYSIOLOGY AND STRUCTURE
• Peptidoglycan – 10 to 12 alternating chains of amino sugars.
(N-acetyl muramic acid, N-acetyl glutamic acid )
• . side chains of tetrapeptide
• . cross-linkage with pentapeptide, L- lysine to L- alanine

• . elicits pyrogens - interleukin – 1

• . attracts polymorphonucleoleukocytes( PMO)

• . activates complement

STAPHYLOCOCCUS AUREUS
• PHYSIOLOGY AND STRUCTURE
• Protein A.
• . Staph. aureus only

• . co-valently linked to peptidoglycan

• . binds to the FC portion of immunoglobulins Ig G1,

Ig G2, Ig G4

• . forms immune complexes

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STAPHYLOCOCCUS AUREUS
• PHYSIOLOGY AND STRUCTURE
• Teichoic Acid
• . phosphate polymers
• . co-valently bound to peptidoglycan and
cytoplasmic membrane
•
• . ribitol teichoic acid - Staph. aureus

• . glycerol teichoic acid – Staph. epidermidis

• . antibodies to teichoic acid -- active disease

STAPHYLOCOCCUS AUREUS
• PHYSIOLOGY AND STRUCTURE
• Clumping Factor ( Bound Coagulase )
• . fibrinogen to fibrin

• Cytoplasmic Membrane
• . osmotic barrier
• . anchor for biosynthetic and respiratory enzymes

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STAPHYLOCOCCUS AUREUS
• PATHOGENIC MECHANISMS
• Enzymes
• . coagulase - abscess, fibrin layer
• . catalase - H2 O2 to water
• . hyaluronidase - mucopolysaccharide in
connective tissue
• . fibrinolysin ( staphylokinase ) dissolves fibrin clots
• . lipase - abscesses in sebaceous areas
• . nuclease DNA
• . penicillinase

STAPHYLOCOCCUS AUREUS
• PATHOGENIC MECHANISMS
• Toxins
• . cytotoxins - alpha, beta, gamma, leukocidin disrupt
smooth muscle of blood vessels, haemolysins

• . exfoliative toxins - superantigen

• . toxic shock syndrome toxin-1 superantigen

• . enterotoxins ( A,B,C,D,E ) superantigen

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STAPHYLOCOCCUS AUREUS
• EPIDEMIOLOGY
• WHO, WHAT, WHERE, WHEN, HOW?
• . all are colonized with Staph. epidermidis - skin, hair
• . Staph. aureus in moist folds – groin, perineum
• . oropharynx - both
• . anterior nasopharynx 15% Staph. aureus
• . GI tract, uroepithelium
• More persistent carriage
• . medical personnel
• . eczema
• . IV drug abusers
• . diabetics - insulin use
• . haemodialysis patients
• . allergy desensitizing shots

• Transmission – fomites (bed linen, clothes ), hands

STAPHYLOCOCCUS AUREUS
• CLINICAL SYNDROMES
• STAPH. AUREUS
• . equipped to produce toxin diseases
• . equipped to cause tissue invasion and destruction
• . colonizes foreign bodies – catheters, shunts, prostheses
• . patients with impaired chemotaxis and phagocytosis –
• susceptible - Job syndrome, Wiscott – Aldrich, Chronic
Granulomatous Disease.

• 1.Staphylococcal Scalded Skin Syndrome ( SSSS )

• Less than 1 month old. Bullous exfoliative dermatitis

• ( Ritter’s Disease ). redness, large bullae – desmosomes or
• intercellular bridges destroyed by exfoliative toxin.

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STAPHYLOCOCCUS AUREUS

STAPHYLOCOCCUS AUREUS
• CLINICAL SYNDROMES
• STAPH.AUREUS
• 2. Bullous Impetigo
• . localized
• . infants and older children

• 3. Toxic Shock Syndrome

• 1928 Australia contaminated vaccine
• 1978 USA Todd
• 1980 menstruating women. Rely tampons

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STAPHYLOCOCCUS AUREUS
• CLINICAL SYNDROMES
• STAPH. AUREUS
• 4. Staphylococcal Food Poisoning: Preformed toxin – vomiting
• and diarrhoea

• 5. Staphylococcal Enterocolitis – overgrowth due to Abx

• 6. Skin Infections – impetigo, folliculitis, furuncle, carbuncle

• 7. Bacteremia and Endocarditis – remote focus, post-surgical,

• . Acute endocarditis, IV drug abusers.

• 8. Pneumonia and Empyema - aspiration, haematogenous

• 9. Osteomyelitis and Septic Arthritis – haematogenous, direct

STAPHYLOCOCCUS AUREUS
• LABORATORY DIAGNOSIS
• Microscopy - single, diplococci or clusters

• Culture - oil paint, golden, haemolytic

• Identification – 10% salt , mannitol fermentation,

coagulase. Phosphatase.

• Serology - antibodies to teichoic acid

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STAPHYLOCOCCUS AUREUS
• TREATMENT
• Antibiotic susceptibility - Penicillin G
• Penicillinase - Penicillinase- resistant penicillins-
Isoxazole pens – methicillin, oxacillin, nafcillin.

• Altered penicillin binding proteins PBP 2’

MRSA –
• Vancomycin - glycopeptide
• Linezolid - oxazolidinone
• Synercid - 2 Streptogramins – Quinupristin/
• Dalfopristin

STAPHYLOCOCCUS EPIDERMIDIS

1.REVIEW OF PROSTHETIC JOINT INFECTION.

2.DEFINITION OF STAPH. EPIDERMIDIS.

3.PROBLEMS WITH STAPH. EPIDERMIDIS AS A.

PATHOGEN- Biofilm. . Link with infection. . Antibiotic Resistance

4.LOCAL RESOURCES.

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 STAPHYLOCOCCUS
• DEFINITION OF STAPHYLOCOCCUS

• FAMILY: MICROCOCCACEAE
• GENUS: STAPHYLOCOCCUS
• SPECIES : S. aureus, S. epidermidis, S. saprophyticus, S. simulans,
• S. capitis, S. xylosus, S. warneri, S. cohnii,
• S. haemolyticus, S. hominis, S. saccharolyticus.
• 32 species.
• Some possess the ability to produce – coagulase, protein A,
• Cell associated clumping
• Factor.
• They are called STAPHYLOCOCCUS AUREUS.
• All others are called coagulase- negative staphylococci.
• 60% - 90% of coagulase – negative staphylococci from humans
• are STAPHYLOCOCCUS EPIDERMIDIS.

STAPHYLOCOCCUS EPIDERMIDIS
• PROBLEMS WITH STAPH. EPIDERMIDIS AS A PATHOGEN
• . Link with disease- 1. A variety of infections of prosthetic
• devices.
• 2. Native valve infection – IV DRUGS
•
• 3. Eye infections.
• Distinguish normal skin flora from infective agent.
• Specimen quality, source. Bone , cement.
• Methods to distinguish strains of S. epidermidis –
• Biochemical, antibiogram, phage typing – not sensitive
• Molecular techniques – PCR, PFGE.
• . Biofilm ( glycocalyx ) - adherence, fibronectin
• multilayered clusters
• exopolysaccharide matrix
• Protects organism from antibiotics and phagocytic cells.

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 STAPHYLOCOCCUS EPIDERMIDIS

• CLINICAL SYNDROMES
• STAPH. EPIDERMIDIS
• . prosthetic material – valves, graphs, shunts
• . endocarditis

• STAPH. SAPROPHYTICUS
• . urinary tract infections

STAPHYLOCOCCUS EPIDERMIDIS
• PROBLEM WITH STAPH. EPIDERMIDIS AS A PATHOGEN
. Antibiotic Resistance.
• Nosocomial Pathogens – high resistance rates
• Plasmids abound – encode for resistance to all
• Groups – penicillins, macrolides
• Tetracyclines,
• Aminoglycosides,
• Trimethoprim,
• Chloramphenicol.
• Can be mobilized to take up other resistance genes.
• ( disinfectants ).
•
• Transfer by conjugation – rapid increase in rates.
• Well known association with antibiotic resistance.

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 STAPHYLOCOCCUS EPIDERMIDIS
• PROBLEMS WITH STAPH. EPIDERMIDIS AS A PATHOGEN.
• Methicillin Resistance ( MRSE )
• - penicillin resistance -betalactamase 80%-90% all Staph
• - methicillin – PBP 2 – 2’ MecA gene
• - Heterotypy – different patterns of resistance in
• Individual members of a colony.
• Technical problems – salt, temp, antibiotic- ox. Plate.
• May miss MRSEs.
• Broth dilution may miss MIC >4.
• Suggestion of lower threshold.
• MecA, MecR, MecI genes
• . Susceptible
• Vancomycin, Rifampicin, ciprofloxacin- resistance.
• Streptogramins, oxazolidinones(linezolid).
• Synergistic combinations.

STAPHYLOCOCCUS EPIDERMIDIS

• LOCAL RESOURCES

• Technical Education

• Physician Education - specimens.

• Procedure Development – PCR,PFGE,Rapid screen.

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