Staphylococcus aureus

AKA: S. aureus

By Kim Oakley

S. aureus

S. aureus is a G+ coccal bacterium. Under microscope: Purple, Grape like clusters. S. aureus ferments mannitol, causing phenol red on Mannitol Salt Agar to turn yellow. Pathogenic, opportunistic bacteria.

ETIOLOGY• 1880, Staphylococcus bacteria isolated by Scottish surgeon Alex Ogston

from pus in knee wound

• 1884 German surgeon, Anton Rosenbach labels S. “aureus” from Latin word “aurum”= gold

• 1929, Scottish Biologist, Alexander Fleming discovers Penicillin to treat S. aureus

* In 1941, Penicillin used to treat S. aureus (MSSA) during WW2, saves many

lives

* By 1968: 1st documented USA case Methicillin-resistant S. aureus in an American hospital (HA-MRSA)

* By 1980’s: 1st USA reported case of Community-Acquired MRSA: (CA-MRSA)

MSSA vs. MRSA

• What is MSSA? Methicillin-susceptible Staphylococcus aureus. A staph infection susceptible to penicillin antibiotics

• What is MRSA? Methicillin-resistant Staphylococcus aureus. A staph infection resistant to penicillin drugs and thus requires use of alternative antibiotics

CA-MRSA vs. HA-MRSA

How do you know? By Genetic ProfilingHA-MRSA: Example: A clonal group calledUSA100, USA200

CA-MRSA: Often has Panton-Valentine gene, USA300, USA400.

EPIDEMIOLOGY•29% US population colonized with S. aureus

•One study showed 31% of RNs & CNAs tested had nasal colonization S. aureus

•1.5% US population has had MRSA

•12% Patients in US hospitals are colonized with MRSA

•USA in top ten countries plagued by MRSA

•Romania, Argentina & Malta highest MRSA prevalence

•Iceland, Norway, Sweden lowest MRSA prevalence

EPIDEMIOLOGY…

EPIDEMIOLOGY 2005: MRSA deaths surpassed AIDS

MRSA does not discriminate.

IV drug Addict. CA-MRSA. Unknown outcome

UFC fighter. Kevin Randleman. CA-MRSA. Treated. Returned. Retired. Kidney’s affected.

2013. Kentucky college student. Soccer player. Jailed for taking RX drugs w/o prescript. Died CA-MRSA while in jail for only 6 days. The irony.

MRSA does not discriminate continued…

Carl Nicks NFL player SURVIVED CA-MRSA

Roy Scheider, famous actor. DIED. HA-MRSA

Middle class man, Died. MRSA via IV Dialysis line HA-MRSA

4-yr old. SURVIVED MRSA invasion spine HA-MRSA

More faces of MRSA

Clinical Presentations

Honey Colored Crusty Blisters

Hot, swollen area of ankle

Red Painful Bumps/Boils

Eye infected with MRSA

After getting tattoo: Patient’s skin infected with MRSA

(Photo_ Toledo-Lucas County (Ohio) Health Department)

RAPID DETECTION TEST vs. Conventional testing Culture can take up to 72 hrs. Some people can’t wait that long!

Diagnostic Tests

Diagnostic tests: Taking MRSA wound culture

Treatment of S. aureus

Antibiotics specifically used for MRSA

• HIBICLENS effective against MRSA skin infections

May 29, 2013 - Study New England Journal: "germ-killing soaps and ointments" used in ICUs reduced

MRSA by 40%.

Popular “natural” and “adjunct” treatment for MRSA

CONTROL MEASURES

HOT water. DryerCover wounds!

EDUCATION

SOURCES

1. University of Chicago, Medicine, Science Division. 2010. http://mrsa-researchcenter.bsd.uchicago.edu/timeline.html

2. http://www.bostonglobe.com/sports/2013/10/26/buccaneers-dealing-with-mrsa outbreak/story.html

3. http://www.cdc.gov/mrsa/tracking/index.html

4. Brown, K. (2004). Penicillin Man: Alexander Fleming and the Antibiotic Revolution. 320 pp. Sutton Publishing.

5.  Cooper BS, Medley GF, Stone SP, Kibbler CC, Cookson BD, Roberts JA, Duckworth G, Lai R, Ebrahim S (2004). "Methicillin-resistant Staphylococcus aureus in hospitals and the community: stealth dynamics and control catastrophes". Proc Natl Acad Sci USA 101

6. Suffaleto, B. et al. Prevalence Staphylococcus aureus nasal colonization in emergency department personnel. Annals Emergency Med 2008 Apr 25

7. Gregory J. Moran, M.D., Anusha Krishnadasan, Ph.D., Rachel J. Gorwitz, M.D.,

M.P.H., Gregory E. Fosheim, M.P.H., Linda K. McDougal, M.S., Roberta B. Carey, Ph.D., and David A. Talan, M.D. for the Emergency ID Net Study Group

N Engl J Med 2006; 355:666-674