Staphylococcus aureus: Difference between revisions

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Studies are conflicting whether screening patients upon admittance to the hospital reduces nosocomial MRSA infections. A study of surgical patients was negative<ref name="pmid18334690">{{cite journal |author=Harbarth S, Fankhauser C, Schrenzel J, ''et al'' |title=Universal screening for methicillin-resistant Staphylococcus aureus at hospital admission and nosocomial infection in surgical patients |journal=JAMA |volume=299 |issue=10 |pages=1149-57 |year=2008 |pmid=18334690 |doi=10.1001/jama.299.10.1149 |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=18334690 |issn=}}</ref>, while a study was that screened all admissions was positive.<ref name="pmid18347349">{{cite journal |author=Robicsek A, Beaumont JL, Paule SM, ''et al'' |title=Universal Surveillance for methicillin-resistant Staphylococcus aureus in 3 affiliated hospitals |journal=Ann. Intern. Med. |volume=148 |issue=6 |pages=409-18 |year=2008 |pmid=18347349 |doi= |issn=}}</ref> In the positive study the patients received "5-day regimen comprising mupirocin calcium, 2% twice daily to the nares, and a chlorhexidine 4% wash or shower every 2 days" while in the negative study, patients who were found to have MRSA received "nasal mupirocin ointment and chlorhexidine body washing" without further details provided.
Studies are conflicting whether screening patients upon admittance to the hospital reduces nosocomial MRSA infections. A study of surgical patients was negative<ref name="pmid18334690">{{cite journal |author=Harbarth S, Fankhauser C, Schrenzel J, ''et al'' |title=Universal screening for methicillin-resistant Staphylococcus aureus at hospital admission and nosocomial infection in surgical patients |journal=JAMA |volume=299 |issue=10 |pages=1149-57 |year=2008 |pmid=18334690 |doi=10.1001/jama.299.10.1149 |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=18334690 |issn=}}</ref>, while a study was that screened all admissions was positive.<ref name="pmid18347349">{{cite journal |author=Robicsek A, Beaumont JL, Paule SM, ''et al'' |title=Universal Surveillance for methicillin-resistant Staphylococcus aureus in 3 affiliated hospitals |journal=Ann. Intern. Med. |volume=148 |issue=6 |pages=409-18 |year=2008 |pmid=18347349 |doi= |issn=}}</ref> In the positive study the patients received "5-day regimen comprising mupirocin calcium, 2% twice daily to the nares, and a chlorhexidine 4% wash or shower every 2 days" while in the negative study, patients who were found to have MRSA received "nasal mupirocin ointment and chlorhexidine body washing" without further details provided.


===Eradication of MRSA===
Numerous studies have looked at the role of decolonization to stop carriage.<ref name="pmid8585642">{{cite journal |author=Watanakunakorn C, Axelson C, Bota B, Stahl C |title=Mupirocin ointment with and without chlorhexidine baths in the eradication of Staphylococcus aureus nasal carriage in nursing home residents |journal=Am J Infect Control |volume=23 |issue=5 |pages=306–9 |year=1995 |pmid=8585642 |doi= |issn=}}</ref><ref name="pmid17173213">{{cite journal |author=Simor AE, Phillips E, McGeer A, ''et al'' |title=Randomized controlled trial of chlorhexidine gluconate for washing, intranasal mupirocin, and rifampin and doxycycline versus no treatment for the eradication of methicillin-resistant Staphylococcus aureus colonization |journal=Clin. Infect. Dis. |volume=44 |issue=2 |pages=178–85 |year=2007 |pmid=17173213 |doi=10.1086/510392 |issn=}}</ref><ref name="pmid12919762">{{cite journal |author=Rohr U, Mueller C, Wilhelm M, Muhr G, Gatermann S |title=Methicillin-resistant Staphylococcus aureus whole-body decolonization among hospitalized patients with variable site colonization by using mupirocin in combination with octenidine dihydrochloride |journal=J. Hosp. Infect. |volume=54 |issue=4 |pages=305–9 |year=2003 |pmid=12919762 |doi= |issn=}}</ref><ref name="pmid16465636">{{cite journal |author=Sandri AM, Dalarosa MG, Ruschel de Alcantara L, da Silva Elias L, Zavascki AP |title=Reduction in incidence of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection in an intensive care unit: role of treatment with mupirocin ointment and chlorhexidine baths for nasal carriers of MRSA |journal=Infect Control Hosp Epidemiol |volume=27 |issue=2 |pages=185–7 |year=2006 |pmid=16465636 |doi=10.1086/500625 |issn=}}</ref><ref name="pmid12473473">{{cite journal |author=Dupeyron C, Campillo B, Bordes M, Faubert E, Richardet JP, Mangeney N |title=A clinical trial of mupirocin in the eradication of methicillin-resistant Staphylococcus aureus nasal carriage in a digestive disease unit |journal=J. Hosp. Infect. |volume=52 |issue=4 |pages=281–7 |year=2002 |pmid=12473473 |doi= |issn=}}</ref><ref name="pmid8328783">{{cite journal |author=Walsh TJ, Standiford HC, Reboli AC, ''et al'' |title=Randomized double-blinded trial of rifampin with either novobiocin or trimethoprim-sulfamethoxazole against methicillin-resistant Staphylococcus aureus colonization: prevention of antimicrobial resistance and effect of host factors on outcome |journal=Antimicrob. Agents Chemother. |volume=37 |issue=6 |pages=1334–42 |year=1993 |pmid=8328783 |doi= |issn=}}</ref><ref name="pmid17828692">{{cite journal |author=Ridenour G, Lampen R, Federspiel J, Kritchevsky S, Wong E, Climo M |title=Selective use of intranasal mupirocin and chlorhexidine bathing and the incidence of methicillin-resistant Staphylococcus aureus colonization and infection among intensive care unit patients |journal=Infect Control Hosp Epidemiol |volume=28 |issue=10 |pages=1155–61 |year=2007 |pmid=17828692 |doi=10.1086/520102 |issn=}}</ref>


Whole body washing alone does not seem sufficient to reduce carriage.<ref name="pmid17932823">{{cite journal |author=Wendt C, Schinke S, Württemberger M, Oberdorfer K, Bock-Hensley O, von Baum H |title=Value of whole-body washing with chlorhexidine for the eradication of methicillin-resistant Staphylococcus aureus: a randomized, placebo-controlled, double-blind clinical trial |journal=Infect Control Hosp Epidemiol |volume=28 |issue=9 |pages=1036–43 |year=2007 |pmid=17932823 |doi=10.1086/519929 |issn=}}</ref> Intranasal mupirocin with chlorhexidine soap body washing does not always suffice.mupirocin (group M) or placebo (group P) applied to the anterior nares for 5 days; both groups used chlorhexidine soap for body washing. Mupirocin alone may not work, especially in long-term care facilities<ref name="pmid8475930">{{cite journal |author=Kauffman CA, Terpenning MS, He X, ''et al'' |title=Attempts to eradicate methicillin-resistant Staphylococcus aureus from a long-term-care facility with the use of mupirocin ointment |journal=Am. J. Med. |volume=94 |issue=4 |pages=371–8 |year=1993 |pmid=8475930 |doi= |issn=}}</ref> or military recruits<ref name="pmid17682105">{{cite journal |author=Ellis MW, Griffith ME, Dooley DP, ''et al'' |title=Targeted intranasal mupirocin to prevent colonization and infection by community-associated methicillin-resistant Staphylococcus aureus strains in soldiers: a cluster randomized controlled trial |journal=Antimicrob. Agents Chemother. |volume=51 |issue=10 |pages=3591–8 |year=2007 |pmid=17682105 |doi=10.1128/AAC.01086-06 |issn=}}</ref>.
A [[meta-analysis]] by the [[Cochrane Collaboration]] was inconclusive.<ref name="pmid14583969">{{cite journal |author=Loeb M, Main C, Walker-Dilks C, Eady A |title=Antimicrobial drugs for treating methicillin-resistant Staphylococcus aureus colonization |journal=Cochrane Database Syst Rev |volume= |issue=4 |pages=CD003340 |year=2003 |pmid=14583969 |doi=10.1002/14651858.CD003340 |issn=}}</ref>


==References==
==References==

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"Staphylococcus aureus"
Bad bacteria.jpg
Scientific classification
Domain: Bacteria
Phylum: Firmicutes
Class: Bacilli
Order: Bacillales
Family: Staphylococcaceae
Genus: Staphylococcus
Species

Staphylococcus aureus

Description and significance

Staphylococcus aureus is a gram-positive spherical cocci that grows in a loose, irregular cluster resembling clusters of grapes. The cluster formation is due to the cell division occuring in three planes, with the daughter cell remaining in close proximity.[1] Staphylococcus aureus may also be found singly, in pairs and in short chains of three or four cells. The bacterium can never be found in long chains. They are non-motile and non-sporing. On an ordinary medium, Staphylococcus aureus can grow within a temperature range of 10-42°C. The optimum pH ranges in between pH 7.4-7.6. The bacteria thrives best in an oxygen rich environment. S. aureus can grow on all common laboratory media such as milk, nutrient gelatin or agar. When grown on a nutrient agar and incubated for 24 hours the colonies appear to be 2-4mm in diameter. The colonies appear circular, smooth, convex, shiny, and opaque.

Staphylococcus aureus was first observed in 1871 by von Recklinghausen. In 1880 Pasture obtained cultures of the bacteria and inoculated them into rabbits. Then in 1881 a surgeon by the name of Alexander Ogston documented two kinds of micrococci. The already known streptococci, arranged in chains and the other cocci arranged in clusters. Ogston named the cocci cluster Staphylococci because “Staphyle” in Greek means "bunches of grapes" and “kokakos” meaning a "berry". Unfortunately, Ogston did not provide a description of the genus and therefore it was not recognized. In 1884 Rosenbach successfully isolated and grew Staphylococcus aureus from pus. Rosenbach is credited with proposing the genus Staphylococcus and the species Staphylococcus aureus. He kept the genus name Staphlococcus because the bacteria was similar to that studied by Ogston. Rosenbach proposed the nomenclature for Staphylococcus aureus based on the yellow pigmentation of the colony.

In recent years the Staphylococcus aureus species has become a serious health issue. The bacteria has built up a strong resistance to treatment. By unlocking the genome sequence, researchers could understand the nature of its resistance, virulence, genetic flexibility, epidiology and physiology. Comparing the genome sequence of S. aureus with the genomes of a less virulent form and nonpathogenic species could help researchers have a better understanding of the nature of Staphylococcal aureus infections.[2]

Describe the appearance, habitat, etc. of the organism, and why it is important enough to have its genome sequenced. Describe how and where it was isolated. Include a picture or two (with sources) if you can find them.

Genome structure

The Staphylococcus aureus genome contains about 2.800 to 2.903 million base pairs of DNA. The bacteria has about 2,600 genes in its chromosome. The first whole genome sequence of S. aureus strains were completed by shot-gun random sequencing in 2001. S. aureus plasmids contains genes that encode resistance to antibiotics, heavy metals, or antiseptics. Some virulence genes have been reported to be carried on plasmid, such as exfoliative toxin B and some superantigens.[6] Approximatly 75% of S. aureus genome comprises a core component of genes present in all of the strains.[7]


Describe the size and content of the genome. How many chromosomes? Circular or linear? Other interesting features? What is known about its sequence? Does it have any plasmids? Are they important to the organism's lifestyle?

Cell structure and metabolism

Staphylococcus aureus can be found in spherical clusters with a thick peptidoglycan layer of cell wall. Some young cultures posses microscopically visible capsules. Many noncapsulated strains of S.aureus have small amounts of capsular material on the surface.

Staphylococci are facultative anaerobes that grow by aerobic respiration or by fermentation that yields lactic acid. S. aureus ferments sugars by producing acid but no gas.

Phagocytosis is a mechanism used by the host organism to combat a staphylococcal infections. S. aureus produces leukocidin, which cause the distruction of leukocytes allowing the bacteria to escape phagocytosis. Leukocidin is produced in skin lesions such as boils which results in cell distruction of white blood cells and is one of the factors responsible for pus formation.


Describe any interesting features and/or cell structures; how it gains energy; what important molecules it produces.

Ecology

Staphylococcus aureus is commonly found on the skin and in various mucous membranes of man and other animals. About 20-30% of healthy people in the United States are carriers of the bacteria.[3] These individuals are usually unaware that they are carriers of the bacteria and usually never get sick from it. In hospitals the percentage is higher because of more possible contact with infected cases.

Describe any interactions with other organisms (included eukaryotes), contributions to the environment, effect on environment, etc.

Pathology

Staphylococcus aureus is one of the most common pathogenic bacteria. The organism may cause disease through tissue invasion and toxin production. The bacteria could cause a wide range of infections both internally and externally. It may cause skin infections, bone infections, pneumonia, food poisoning, Toxic shock syndrome, life threatening bloodstream infections and other serious illnesses.

Staphyolococcus aureus may cause boils usually by entering the skin through a hair folicle or a cut. They may be red, swollen and painful, and sometimes have pus. They can turn into impetigo, which turns into a crust on the skin. The organism could also cause internal abscesses. In recent years Staphylococcus aureus has become one of the leading causes of hospital acquired infections. People prone to staphylococcal infections include newborns, drug users; breastfeeding women; and people with skin disorders, surgical incisions, a weakened immune system, or chronic diseases[4]

Staphylococcus aureus has a high incidence of drug resistance with methicillin-resistant strains resistant to ß-lactams and most other antibiotics. Infections are enhanced in the presence of foreign materials inside the body such as tampons, surgical packing or intravenous catheters.[5]

Treatment is usually unnecessary but can be treated with an antibiotic. Maintaninting good hygiene and avoiding contact with exposed outbreaks could prevent spreading the bacteria.

How does this organism cause disease? Human, animal, plant hosts? Virulence factors, as well as patient symptoms.

Application to Biotechnology

In an anaerobic environment Staphylococcus aureus can reduce mannitol to lactic acid, which differentiates it from other species of staphylococci. The bacterium is the only coagulase positive and ß-hemolytic staphylococcus. When grown on a nutrient agar containing phenolphtalein diphosphate the bacterium produces phosphatase. When ammonia vapor is introduced to the culture, the colonies assume a bright pink color due to the presence of free phenophalein. Researchers use this test to distinguish between Staphylococcus aureus from S. epidermidis.


Does this organism produce any useful compounds or enzymes? What are they and how are they used?

Current Research

Enter summaries of the most recent research here--at least three required


Methicillin-resistant staphylococcus aureus

Methicillin-resistant staphylococcus aureus (MRSA) is a variety of staphylococcus that is resistant to commonly used antibiotics such as methicillin. MRSA has become an important public health problem.[1][2]

Screening for MRSA

Studies are conflicting whether screening patients upon admittance to the hospital reduces nosocomial MRSA infections. A study of surgical patients was negative[3], while a study was that screened all admissions was positive.[4] In the positive study the patients received "5-day regimen comprising mupirocin calcium, 2% twice daily to the nares, and a chlorhexidine 4% wash or shower every 2 days" while in the negative study, patients who were found to have MRSA received "nasal mupirocin ointment and chlorhexidine body washing" without further details provided.


References

  1. Klevens RM, Morrison MA, Nadle J, et al (2007). "Invasive methicillin-resistant Staphylococcus aureus infections in the United States". JAMA 298 (15): 1763–71. DOI:10.1001/jama.298.15.1763. PMID 17940231. Research Blogging.
  2. Sack K (2007). Deadly Bacteria Found to Be More Common. Retrieved on 2008-01-03.
  3. Harbarth S, Fankhauser C, Schrenzel J, et al (2008). "Universal screening for methicillin-resistant Staphylococcus aureus at hospital admission and nosocomial infection in surgical patients". JAMA 299 (10): 1149-57. DOI:10.1001/jama.299.10.1149. PMID 18334690. Research Blogging.
  4. Robicsek A, Beaumont JL, Paule SM, et al (2008). "Universal Surveillance for methicillin-resistant Staphylococcus aureus in 3 affiliated hospitals". Ann. Intern. Med. 148 (6): 409-18. PMID 18347349[e]

http://www.nih.org/NIHnewWebsite/nihPublicHealth/pdfs/MRSAParentsGuide.pdf

http://www.emedicine.com/ped/topic2704.htm

http://www.merck.com/mmhe/sec17/ch190/ch190r.html