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SUMMARIES OF MEDICALLY IMPORTANT BACTERIA

GRAM-POSITIVE COCCI

Staphylococcus aureus (CHAPTER 15)

  • Diseases—Abscesses of many organs, endocarditis, osteomyelitis, septic arthritis, and impetigo. Also hospital-acquired pneumonia, surgical wound infections, and sepsis. Also exotoxin-mediated diseases such as gastroenteritis (food poisoning), toxic shock syndrome, and scalded skin syndrome. It is one of the most common causes of human infections.

  • Characteristics—Gram-positive cocci in clusters. Coagulase-positive. Catalase-positive. Most isolates produce β-lactamase.

  • Habitat and Transmission—Main habitat is human nose; also found on human skin. Transmission is via the hands.

  • Pathogenesis—Abscess containing pus is the most common lesion. Three exotoxins are also made. Toxic shock syndrome toxin is a superantigen and causes toxic shock syndrome by stimulating many helper T cells to release large amounts of lymphokines, especially IL-2. Enterotoxin, which causes food poisoning, is also a superantigen. Food poisoning has a short incubation period because it is preformed in food. Scalded skin syndrome toxin is a protease that cleaves desmoglein in tight junctions in the skin. Protein A is an important virulence factor because it binds to the heavy chain of IgG and prevents the activation of complement. Predisposing factors to infection include breaks in the skin, foreign bodies such as sutures, neutrophil levels below 500/μL, intravenous drug use (predisposes to right-sided endocarditis), and tampon use (predisposes to toxic shock syndrome).

  • Laboratory Diagnosis—Gram-stained smear and culture. Yellow or gold colonies on blood agar; colonies often β-hemolytic. Staphylococcus aureus is coagulase-positive; Staphylococcus epidermidis is coagulase-negative. Serologic tests not useful.

  • Treatment—Penicillin G for sensitive isolates; β-lactamase–resistant penicillins such as nafcillin for resistant isolates; vancomycin for isolates resistant to nafcillin. About 85% are resistant to penicillin G. Plasmid-encoded β-lactamase mediates most resistance. Resistance to nafcillin is caused by changes in binding proteins. Some isolates are tolerant to penicillin. Rare vancomycin-resistant strains have emerged.

  • Prevention—Cefazolin is used to prevent surgical wound infections. No vaccine is available. Handwashing reduces spread.

Staphylococcus epidermidis

  • Diseases—Endocarditis on prosthetic heart valves, prosthetic hip infection, intravascular catheter infection, cerebrospinal fluid shunt infection, neonatal sepsis.

  • Characteristics—Gram-positive cocci in clusters. Coagulase-negative. Catalase-positive.

  • Habitat and Transmission—Normal flora of the human skin and mucous membranes. It is probably the patient’s own strains that cause infection, but transmission from person to person via hands may occur.

  • Pathogenesis—Glycocalyx-producing strains adhere well to foreign bodies such as prosthetic implants and catheters. It is a low-virulence organism that causes disease primarily in immunocompromised patients and in those with implants. It is a major cause of hospital-acquired infections. Unlike S. aureus, no exotoxins have been identified.

  • Laboratory Diagnosis—Gram-stained smear and culture. Whitish, nonhemolytic colonies on blood agar. It is coagulase-negative. Staphylococcus epidermidis is sensitive to novobiocin, whereas the other coagulase-negative staphylococcus, Staphylococcus saprophyticus, is resistant. Serologic tests are not useful.

  • Treatment—Vancomycin plus either rifampin or an aminoglycoside. It produces β-lactamases and is resistant to many antibiotics.

  • Prevention...

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