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PubMed1995

The significance of nasal carriage of Staphylococcus aureus and the incidence of postoperative wound infection.

Staphylococcus aureus infections are associated with considerable morbidity and, in certain situations, mortality. The association between the nasal carriage of S. aureus and subsequent infection has been comprehensively established in a variety of clinical settings, in particular, patients undergoing haemodialysis and continuous ambulatory peritoneal dialysis (CAPD), and in patients undergoing surgery. Postoperative wound infections are associated with a high degree of morbidity and represent an important medical issue. Until recently, eradication of S. aureus nasal carriage by various topical and systemic agents had proved unsuccessful. Mupirocin is a novel topical antibiotic with excellent antibacterial activity against staphylococci. Recent studies have demonstrated that intranasal administration of mupirocin is effective in eradicating the nasal carriage of S. aureus and in reducing the incidence of S. aureus infections in haemodialysis and CAPD patients. It has been suggested that sufficient evidence now exists to test the hypothesis that eradication of the carrier state in surgical patients preoperatively may reduce the incidence of S. aureus postoperative wound infections.

Administration, Intranasal↗
PubMed1980

[Staphylococcus aureus infection in chickens in industrialized poultry units. 1. Manifestations of Staphylococcus aureus infection in chickens].

Staphylococcus aureus infection has become an increasingly grave problem in industrialised poultry farming. This first communication in a series of publications on highly involved studies and experiments describes manifestations of the most common staphylococcal infections in fowl, including synovitis with arthritis, osteomyelitis, dermatitis, endocarditis, septicaemia, wound infection, and ophthalmitis. Reference in greater detail is made to manifestations with more important economic consequences, such as synovitis with arthritis, osteomyelitis, and dermatitis. Their frequency, dependence on age, clinical patterns, pathomorphology, pathogenesis are expounded together with peculiarities of differential diagnosis, with reference being made to findings obtained by the authors from their own studies on three industrialised poultry units.

Animals↗
PubMed2004

Preoperative risk factors for postoperative Staphylococcus aureus nosocomial infections.

Of the 40 million patients who undergo surgery each year in the United States, 20% may develop a postoperative nosocomial infection. Staphylococcus aureus (S. aureus) is the most common organism involved, and carriage of S. aureus in the anterior nares has been identified as a risk factor for these infections. Topical mupirocin applied to the anterior nares has been successful in eliminating S. aureus and decreasing nosocomial infections due to S. aureus. Concurrent use of preoperative chlorhexidine showers may further reduce the incidence of S. aureus surgical site infections (SSIs). In addition to treating the patient, active surveillance programs to eliminate nasal colonization in hospital surgical personnel have controlled outbreaks of S. aureus SSIs. Recently, a large study identified risk factors linked to S. aureus nasal colonization, which included obesity, male gender, and a history of a cerebrovascular accident. Protective factors included older age, current smoking, and alcohol use. Thus, by modulating these variables, investigators may create interventions aimed at reducing S. aureus nasal carriage and ultimately, postoperative nosocomial infections.

Antibiotic Prophylaxis↗
PubMed1999

Echocardiography for the Diagnosis of Staphylococcus aureus Infective Endocarditis.

Staphylococcus aureus bacteremia (SAB) is a serious and growing problem. A longstanding controversy in infectious diseases has centered around the duration of therapy for patients with SAB. Fortunately, the refinement of echocardiography and the creation of new diagnostic criteria have aided in the diagnosis of infective endocarditis in patients with SAB. These advancements have resulted in the development of an algorithm that combines clinical, microbiologic, and echocardiographic findings to stratify patients with SAB into different treatment regimens.

Journal Article↗
PubMed1998

Association of borderline oxacillin-susceptible strains of Staphylococcus aureus with surgical wound infections.

Staphylococcus aureus isolates which produce type A staphylococcal beta-lactamase have been associated with wound infections complicating the use of cefazolin prophylaxis in surgery. To further evaluate this finding, 215 wound isolates from 14 cities in the United States were characterized by antimicrobial susceptibility and beta-lactamase type and correlated with the preoperative prophylactic regimen. Borderline-susceptible S. aureus isolates of phage group 5 (BSSA-5), which produce large amounts of type A beta-lactamase and exhibit borderline susceptibility to oxacillin, comprised a greater percentage of the 120 wound isolates associated with cefazolin prophylaxis than they did of the 95 isolates associated with other prophylactic regimens (25% versus 12.6%, respectively; P < 0.05). In contrast, methicillin-resistant S. aureus isolates were distributed evenly between the two groups (8.3% versus 11.6%, respectively). In vitro assays demonstrated that cefazolin was hydrolyzed faster by BSSA-5 strains than by other beta-lactamase-producing, methicillin-susceptible strains (1.54 versus 0.50 microg/min/10(8) CFU, respectively; P < 0.0001). These data demonstrate that BSSA-5 strains are a distinct subpopulation of methicillin-susceptible S. aureus which frequently cause deep surgical wound infections. Cefazolin use in prophylaxis is a risk factor for BSSA-5 infection.

Cefazolin↗
PubMed1999

Nasal carriage of and infection with Staphylococcus aureus in HIV-infected patients.

BACKGROUND: Staphylococcus aureus is a common cause of serious infection in patients infected with HIV. OBJECTIVES: To evaluate risk factors for and quantitative effect of S. aureus infection in HIV-infected patients, with special attention to nasal carriage. DESIGN: Prospective, multihospital cohort study. SETTING: Three tertiary care Veterans Affairs Medical Centers. PARTICIPANTS: 231 ambulatory HIV-infected patients. RESULTS: Thirty-four percent of patients were nasal carriers of S. aureus. Of these patients, 38% were persistent carriers and 62% were intermittent carriers. Twenty-one episodes of infection occurred in 13 patients: Ten were bacteremias (including 2 cases of endocarditis), 1 was pneumonia, and 10 were cutaneous or subcutaneous infections. Seventeen (85%) of these episodes occurred in patients with CD4 counts less than 100 cells/mm3. Recurrent infections occurred in 3 of 7 patients who survived an initial S. aureus infection. The mortality rate was higher among patients with S. aureus infection than among those without infection (P = 0.03). Factors significantly associated with S. aureus infection were nasal carriage, presence of a vascular catheter, low CD4 count, and neutropenia. Molecular strain typing indicated that for 6 of 7 infected patients, the strain of S. aureus isolated from the infected sites was the same as that previously cultured from the nares. CONCLUSION: Nasal carriage is an important risk factor for S. aureus infection in HIV-infected patients. Controlled studies are indicated to determine whether eradication of nasal carriage in a selected subset of patients (for example, those with a low CD4 cell count) might prevent invasive S. aureus infection in patients with HIV infection.

AIDS-Related Opportunistic Infections↗
PubMed2005

Complete osteolysis of the dens with atlantoaxial luxation caused by infection with Staphylococcus aureus: a case report and review of the literature.

STUDY DESIGN: Case report. OBJECTIVES: To present a case of complete osteolysis of the dens and accompanying luxation of the atlantoaxial joint, on the basis of a Staphylococcus aureus infection. SUMMARY OF BACKGROUND DATA: To date, complete osteolysis of the dens followed by atlantoaxial dislocation has only been reported as a rare complication in patients with tuberculosis but not as secondary to a Staphylococcus aureus infection. METHODS: Because of emerging neurological complications in both upper extremities, we chose closed reduction and temporary Halo-fixation together with appropriate antibiotic coverage as primary treatment followed by an operative stabilization with Magerl fusion (Galli fusion combined with transarticular screw fixation of C1 and C2). RESULTS: After the operative procedure (Magerl fusion), immediate pain relief was achieved as well as almost complete resolution of neurological deficits. CONCLUSIONS: To our knowledge, this presents the first reported case of a complete destruction of the dens, as a result of a purulent bacterial infection leading to atlantoaxial luxation. Our case demonstrates that infections of the atlantoaxial region are difficult to diagnose and are seen mostly in immunocompromised patients, such as patients with diabetes. Furthermore, it proves that other infections besides tuberculosis can lead to complete osteolytic destruction of the atlantoaxial joint.

Adult↗
PubMed1979

Antibiotic activity in vitro against methicillin-resistant Staphylococcus epidermidis and therapy of an experimental infection.

Staphylococcus epidermidis is a major pathogen in early prosthetic valve endocarditis and cerebrospinal fluid shunt infections. Approximately 10 to 15% of hospital isolates are methicillin resistant. Ten clinically significant isolates of the latter were collected for antibiotic studies in vitro and in an experimental infection in animals. Time-kill studies of five strains showed gentamicin to be the single most effective antibiotic; however, dwarf colony variants emerged as survivors with two of these strains when challenged with gentamicin alone. The addition of a second antibiotic to gentamicin did not significantly improve the bactericidal rate but prevented the emergence of variant strains. A blood culture isolate of methicillin-resistant S. epidermidis combined with 5% hog gastric mucin was used to establish an experimental intraperitoneal infection in mice. Neither methicillin nor nafcillin treatment reduced mortality below that of untreated animals. Cephalothin treatment delayed early mortality but did not diminish overall mortality. Gentamicin was the most effective single antibiotic, and gentamicin in combination with vancomycin was the most effective regimen overall. The combination of rifampin plus vancomycin was as effective as gentamicin alone. The combinations of cephalothin or nafcillin with gentamicin and cephalothin with vancomycin demonstrated antagonism. The antagonism was not due to multiple injections or drug-drug inactivation.

Animals↗
PubMed1997

Human isolates of Staphylococcus caprae: association with bone and joint infections.

Staphylococcus caprae is a coagulase-negative, DNase-positive member of the genus Staphylococcus usually associated with goats, but since 1991 a few laboratories have reported isolating the organism from human clinical specimens. We report on the isolation of 14 strains from human specimens and note that 10 strains were obtained from patients with bone and joint infections. Nine of the 10 infections started with traumatic fractures, and the other was a case of mastoiditis. Seven of these 10 infections were in patients with orthopedic prostheses, which appears to be a risk factor. Three of the 14 strains were from transplant patients. For three of the patients, S. caprae was the only organism isolated. S. caprae may be misidentified because it is not represented in the current MicroScan or Vitek identification systems which are in use in many laboratories, but the organism can be differentiated by a few biochemical tests. S. caprae produces positive results for DNase, pyrrolidonyl aminopeptidase, and acid production from mannitol and maltose; it produces negative results for ornithine decarboxylase and tube coagulase.

Adolescent↗
PubMed1995

Endogenous gamma interferon, tumor necrosis factor, and interleukin-6 in Staphylococcus aureus infection in mice.

The production and roles of endogenous gamma interferon (IFN-gamma), tumor necrosis factor (TNF), and interleukin-6 (IL-6) in both lethal and nonlethal infections of Staphylococcus aureus were investigated in mice. In the case of nonlethal infection, although no bacteria were detected in the bloodstreams, bacteria that colonized and proliferated persistently for 3 weeks were found in the kidneys. All mice given lethal injections died within 7 days, and large numbers of bacteria were detected in the bloodstreams, spleens, and kidneys. The first peaks of IFN-gamma, TNF, and IL-6 were observed in the bloodstreams and spleens of the mice with nonlethal and lethal infections within 24 h. Thereafter, in the nonlethal cases, IFN-gamma, TNF, and IL-6 peaked again in the spleens and kidneys during the period of maximum growth of bacteria in the kidneys, although only IL-6 was detected in the sera. In contrast, in the case of lethal infection, the titers of IFN-gamma and IL-6 in the sera and TNF in the kidneys peaked before death. Effects of in vivo administration of monoclonal antibodies (MAbs) against IFN-gamma and TNF on the fates of S. aureus-infected mice were studied. In the nonlethal infections, anti-TNF alpha (anti-TNF-alpha) MAb-treated mice, but not anti-IFN-gamma MAb-treated mice, died as a result of worsening infection, suggesting that endogenous TNF plays a protective role in host resistance to S. aureus infection. In the mice that received lethal doses, injection of anti-TNF-alpha MAb accelerated death. However, although injection of anti-IFN-gamma MAb inhibited host resistance of the infected mice early in infection, most of the animals survived the lethal infection by injection of anti-IFN-gamma MAb, suggesting that endogenous IFN-gamma plays a detrimental role in S. aureus infection. Thus, this study demonstrated that IFN-gamma and TNF play different roles in S. aureus infection.

Animals↗
PubMed1992

[Topical use of lysostaphin for Staphylococcus aureus infection of burn wounds in mice].

The effect of lysostaphin on the burn wounds infected with Staphylococcus aureus was studied in mice. The results showed that the mortality and incidence of bacterial isolation in wounds were 17.2% and 8.3%, respectively, in mice treated by lysostaphin, and the figures were significantly lower than that treated by SD-Ag (40.6% and 100%) or base (44.1% and 94.7%). In lysostaphin group the bacterial count of subeschar tissue was 1325 cfu/g, compared with more than 10(9) cfu/g in both SD-Ag and base groups. The results demonstrate that lysostaphin has powerful killing effect on S. aureus, and may be used as atopical antimicrobial to control burn wound infection with S. aureus.

Animals↗
PubMed2001

Staphylococcus aureus infections and antibiotic resistance in older adults.

The prevalence of infection with Staphylococcus aureus among older adults is unknown, but clinical syndromes caused by this organism are common. Bacteremia, pneumonia, endocarditis, and bone and joint infections are encountered with relative frequency in this population, and the clinical presentation may be atypical. Underlying disease and functional debility, rather than age itself, predispose the older adult to staphylococcal carriage and infection. Infections with methicillin-resistant strains of S. aureus are acquired primarily in hospital, rather than in nursing homes or in the community. Lack of clinical suspicion for S. aureus infection and delays in appropriate therapy can be fatal. Staphylococcal infection should be considered for an older adult with risk factors for staphylococcal carriage, comorbid illness, debility, and history of recent hospitalization or nursing home stay. Choices regarding empirical therapy should be made on the basis of knowledge of local antibiotic susceptibility patterns.

Age Factors↗
PubMed1975

Cell-mediated immune responses in Staphylococcus aureus infections in mice.

Delayed hypersensitivity to staphylococcal antigens was shown in mice repeatedly infected with Staphylococcus aureus. It was characterized by footpad swelling at 48 hours with a mononuclear cell infiltrate and could be transferred to non-infected recipients by T lymphocytes from infected animals, but not by serum. Recipients of immune T cells produced very severe necrotic lesions when challenged with staphylococci. This was in contrast to the protection against necrosis in recipients afforded by serum from infected donors. When both serum and cells were transferred into the same mouse the humoral effects overshadowed or perhaps inhibited those mediated by cells with resultant protection against staphylococcal dermonecrosis.

Animals↗
PubMed2001

Impact of oral antimicrobial prophylaxis on surgical site infection and methicillin-resistant Staphylococcus aureus infection after elective colorectal surgery. Results of a prospective randomized trial.

The impact of oral antimicrobial prophylaxis on the surgical site infection and methicillin-resistant Staphylococcus aureus (MRSA) infection after elective colorectal surgery was evaluated by a prospective randomized single-blind study. The patients were randomly allocated to receive either mechanical bowel cleansing with polyethylene glycol alone (group 1) or mechanical cleansing plus oral antimicrobial prophylaxis with kanamycin and erythromycin for 2 days prior to surgery (group 2). In both groups, cefotiam was intravenously given twice a day for 3 days. A total of 143 patients (71 for group 1 and 72 for group 2) were eligible. The incidence of a surgical site infection was 23.9% in group 1 and 11.1% in group 2 (P = 0.04). The incidence of MRSA infection including at surgical and remote sites was 11.1% in group 1 and 5.6% in group 2 (P = 0.19). A multivariate logistic regression analysis showed that the risk of surgical site infection was influenced by the choice of the chemical bowel preparation (P = 0.03) and blood loss (P < 0.01), while an MRSA infection was predominantly influenced by blood loss (P < 0.01) followed by coexisting underlying diseases (P = 0.07). These results suggest that preoperative antimicrobial prophylaxis would be useful for reducing the incidence of a surgical site infection without increasing the risk of an MRSA infection following elective colorectal surgery.

Adult↗
PubMed1985

Staphylococcus aureus infection complicating haemarthroses in elderly patients.

The case histories of 3 elderly patients who developed haemarthrosis of osteoarthritic joints with subsequent infection with staphylococcus aureus, are described. Trauma to the affected joints was a predisposing factor in 2 patients and, while only one patient developed clinical signs of sepsis, all had marked elevation of the erythrocyte sedimentation rate. Although suspicion of joint sepsis was obscured by the presence of a coexistent haemarthrosis, routine culture of joint aspirates showed infection with staphylococcus aureus and all patients recovered well with antibacterial therapy.

Aged↗
PubMed2003

Limited success with open debridement and retention of components in the treatment of acute Staphylococcus aureus infections after total knee arthroplasty.

The purpose of this study was to review our experience in treating acute gram-positive infections after total knee arthroplasty with debridement, component retention, and intravenous antibiotics. Thirty-one total knee arthroplasties with acute gram-positive infections, seen at our institution over a 10-year period, were treated with open debridement and component retention. Eleven (35%) of 31 patients successfully retained their components at most recent follow-up, without ongoing infection (mean, 4 years; range, 2-10 years). Only one (8%) of the 13 patients infected with Staphylococcus aureus was successfully treated, compared with 10 (56%) of 18 patients with either Staphylococcus epidermidis or a streptococcal species. The difference between these groups is statistically significant (P=.007). The high failure rate of debridement and component retention suggests that immediate component removal should be considered in the presence of acute S. aureus infection in total knee arthroplasty.

Acute Disease↗
PubMed2006

Clinical efficacy of local administration of ceftiofur in a Staphylococcus aureus infection in tissue cages in ponies.

Ceftiofur concentrations in an infected and uninfected environment were compared and the efficacy of locally administered ceftiofur was evaluated in an experimental infection with Staphylococcus aureus in tissue cages. Eight ponies had tissue cages (TCs) implanted s.c. on each side of the neck. Into one of the cages 150 mg of ceftiofur was administered and fluid samples were taken to determine ceftiofur concentrations. After 1 week the other TC was infected with S. aureus and subsequently treated with 150 mg ceftiofur administered locally into the TC once daily for 21 days. Samples of fluid were taken to determine ceftiofur concentrations and for bacterial counts. Ceftiofur concentrations did not differ significantly in the infected and uninfected environments after single dose of 150 mg of ceftiofur. Concentrations were considerably in excess of the minimum inhibitory concentration (MIC) of the S. aureus strain used. A marked decrease of viable bacteria in tissue cage fluid (TCF) occurred. In five of seven ponies; however, the infection was not eliminated and abscess formation occurred. Therefore, local application of ceftiofur alone is not advisable for infections with S. aureus in secluded sites in horses, but should be used only with adjunctive therapy.

Animals↗