Clinical manifestations of Staphylococcus aureus infection
- Vance G Fowler, Jr, MD
Vance G Fowler, Jr, MD
- Professor of Medicine
- Duke University Medical Center
- Daniel J Sexton, MD
Daniel J Sexton, MD
- Editor-in-Chief — Infectious Diseases
- Section Editor — Bacterial Infections
- Professor of Medicine
- Duke University Medical Center
Staphylococcus aureus is a frequent colonizer of the skin and mucosa and can cause a broad range of clinical manifestations, ranging from relatively benign skin infections to life-threatening conditions such as endocarditis and osteomyelitis.
Risk factors for complications of S. aureus infection include community acquisition of infection, presence of prosthetic material [1-6], and underlying medical conditions including immunosuppression [7-12]. Other factors that may predict complications in patients with S. aureus bacteremia include growth of S. aureus within 14 hours following blood culture incubation, positive follow-up blood cultures 48 to 96 hours after admission (odds ratio [OR] 5.58, 95% CI 3.93-7.95), and persistent fever 72 hours after admission (OR 2.23, 95% CI 1.55-3.12) [2,10,13-15].
Patients with community-acquired S. aureus bacteremia have an increased risk for metastatic complications [2,16-20]. In one study including 281 patients with S. aureus bacteremia, metastatic complications were more common among patients with community-acquired rather than hospital-acquired bacteremia (43 versus 21 percent) . The explanation may be related to prolonged duration of bacteremia. In an observational study including 245 patients with S. aureus bacteremia, the complication rate increased with duration of bacteremia (6, 24, and 38 percent in bacteremia for 1 to 2, 3, and ≥4 days, respectively) .
The absence of a clinically identifiable source of S. aureus bacteremia is an important predictor of subsequent complications [18,19]. In a series of 281 patients with S. aureus bacteremia, the incidence of a metastatic complication was lower among patients with an identifiable source of bacteremia than among patients without a clear source (21 versus 51 percent, respectively) .
The clinical manifestations of S. aureus infection will be reviewed here. The clinical approach to S. aureus bacteremia is discussed separately. (See "Clinical approach to Staphylococcus aureus bacteremia in adults".)
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- CLINICAL MANIFESTATIONS
- Skin and soft tissue infection
- - Infective endocarditis
- - Cardiac device infection
- - Intravascular catheter infection
- - Sepsis and toxic shock syndrome
- - Splenic abscess
- Bone and joint infection
- - Osteomyelitis
- - Prosthetic joint infection
- - Septic arthritis or bursitis
- Pulmonary infection
- Other manifestations