Clinical manifestations of Staphylococcus aureus infection
- Thomas Holland, MD
Thomas Holland, MD
- Medical Instructor, Department of Medicine
- Duke University Medical Center
- Vance G Fowler, Jr, MD
Vance G Fowler, Jr, MD
- Professor of Medicine
- Duke University Medical Center
Staphylococcus aureus is an important pathogen responsible for a broad range of clinical manifestations ranging from relatively benign skin infections to life-threatening conditions such as endocarditis and osteomyelitis. It is also a commensal bacterium (colonizing approximately 30 percent of the human population).
Two major shifts in S. aureus epidemiology have occurred since the 1990s: an epidemic of community-associated skin and soft tissue infections (largely driven by specific methicillin-resistant S. aureus [MRSA] strains), and an increase in the number of healthcare-associated infections (especially infective endocarditis and prosthetic device infections).
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".)
Issues related to MRSA are also discussed separately. (See "Methicillin-resistant Staphylococcus aureus infection in adults: Epidemiology" and "Treatment of skin and soft tissue infections due to methicillin-resistant Staphylococcus aureus in adults" and "Treatment of invasive methicillin-resistant Staphylococcus aureus infections in adults".)
Skin and soft tissue infection — Skin and soft tissue infections due to S. aureus include:
- Tong SY, Davis JS, Eichenberger E, et al. Staphylococcus aureus infections: epidemiology, pathophysiology, clinical manifestations, and management. Clin Microbiol Rev 2015; 28:603.
- Lowy FD. Staphylococcus aureus infections. N Engl J Med 1998; 339:520.
- Fowler VG Jr, Justice A, Moore C, et al. Risk factors for hematogenous complications of intravascular catheter-associated Staphylococcus aureus bacteremia. Clin Infect Dis 2005; 40:695.
- Fowler VG Jr, Miro JM, Hoen B, et al. Staphylococcus aureus endocarditis: a consequence of medical progress. JAMA 2005; 293:3012.
- Fowler VG Jr, Olsen MK, Corey GR, et al. Clinical identifiers of complicated Staphylococcus aureus bacteremia. Arch Intern Med 2003; 163:2066.
- Gopal AK, Fowler VG Jr, Shah M, et al. Prospective analysis of Staphylococcus aureus bacteremia in nonneutropenic adults with malignancy. J Clin Oncol 2000; 18:1110.
- Chang FY, MacDonald BB, Peacock JE Jr, et al. A prospective multicenter study of Staphylococcus aureus bacteremia: incidence of endocarditis, risk factors for mortality, and clinical impact of methicillin resistance. Medicine (Baltimore) 2003; 82:322.
- Valente AM, Jain R, Scheurer M, et al. Frequency of infective endocarditis among infants and children with Staphylococcus aureus bacteremia. Pediatrics 2005; 115:e15.
- Fang G, Keys TF, Gentry LO, et al. Prosthetic valve endocarditis resulting from nosocomial bacteremia. A prospective, multicenter study. Ann Intern Med 1993; 119:560.
- El-Ahdab F, Benjamin DK Jr, Wang A, et al. Risk of endocarditis among patients with prosthetic valves and Staphylococcus aureus bacteremia. Am J Med 2005; 118:225.
- Hill EE, Vanderschueren S, Verhaegen J, et al. Risk factors for infective endocarditis and outcome of patients with Staphylococcus aureus bacteremia. Mayo Clin Proc 2007; 82:1165.
- Nadji G, Rémadi JP, Coviaux F, et al. Comparison of clinical and morphological characteristics of Staphylococcus aureus endocarditis with endocarditis caused by other pathogens. Heart 2005; 91:932.
- Chamis AL, Peterson GE, Cabell CH, et al. Staphylococcus aureus bacteremia in patients with permanent pacemakers or implantable cardioverter-defibrillators. Circulation 2001; 104:1029.
- Robinson SL, Saxe JM, Lucas CE, et al. Splenic abscess associated with endocarditis. Surgery 1992; 112:781.
- Ting W, Silverman NA, Arzouman DA, Levitsky S. Splenic septic emboli in endocarditis. Circulation 1990; 82:IV105.
- Johnson JD, Raff MJ, Barnwell PA, Chun CH. Splenic abscess complicating infectious endocarditis. Arch Intern Med 1983; 143:906.
- Ebright JR, Alam E, Ahmed H, et al. Splenic infarction and abscess in the setting of infective endocarditis. Infect Dis Clin Pract 2007; 15:17.
- Weinstein L. Life-threatening complications of infective endocarditis and their management. Arch Intern Med 1986; 146:953.
- Espersen F, Frimodt-Møller N, Thamdrup Rosdahl V, et al. Changing pattern of bone and joint infections due to Staphylococcus aureus: study of cases of bacteremia in Denmark, 1959-1988. Rev Infect Dis 1991; 13:347.
- Murdoch DR, Roberts SA, Fowler Jr VG Jr, et al. Infection of orthopedic prostheses after Staphylococcus aureus bacteremia. Clin Infect Dis 2001; 32:647.
- Fowler VG Jr, Kong LK, Corey GR, et al. Recurrent Staphylococcus aureus bacteremia: pulsed-field gel electrophoresis findings in 29 patients. J Infect Dis 1999; 179:1157.
- Pintado V, Meseguer MA, Fortún J, et al. Clinical study of 44 cases of Staphylococcus aureus meningitis. Eur J Clin Microbiol Infect Dis 2002; 21:864.
- Jensen AG, Espersen F, Skinhøj P, et al. Staphylococcus aureus meningitis. A review of 104 nationwide, consecutive cases. Arch Intern Med 1993; 153:1902.
- Aguilar J, Urday-Cornejo V, Donabedian S, et al. Staphylococcus aureus meningitis: case series and literature review. Medicine (Baltimore) 2010; 89:117.
- Lee BK, Crossley K, Gerding DN. The association between Staphylococcus aureus bacteremia and bacteriuria. Am J Med 1978; 65:303.
- Sheth S, DiNubile MJ. Clinical significance of staphylococcus aureus bacteriuria without concurrent bacteremia. Clin Infect Dis 1997; 24:1268.
- Muder RR, Brennen C, Rihs JD, et al. Isolation of Staphylococcus aureus from the urinary tract: association of isolation with symptomatic urinary tract infection and subsequent staphylococcal bacteremia. Clin Infect Dis 2006; 42:46.
- Anderson DJ, Kaye KS, Sexton DJ. Methicillin-resistant Staphylococcus aureus bacteremia after isolation from urine. Clin Infect Dis 2006; 42:1504.
- Adem PV, Montgomery CP, Husain AN, et al. Staphylococcus aureus sepsis and the Waterhouse-Friderichsen syndrome in children. N Engl J Med 2005; 353:1245.
- Herold BC, Immergluck LC, Maranan MC, et al. Community-acquired methicillin-resistant Staphylococcus aureus in children with no identified predisposing risk. JAMA 1998; 279:593.
- Centers for Disease Control and Prevention (CDC). Four pediatric deaths from community-acquired methicillin-resistant Staphylococcus aureus — Minnesota and North Dakota, 1997-1999. MMWR Morb Mortal Wkly Rep 1999; 48:707.
- Mongkolrattanothai K, Boyle S, Kahana MD, Daum RS. Severe Staphylococcus aureus infections caused by clonally related community-acquired methicillin-susceptible and methicillin-resistant isolates. Clin Infect Dis 2003; 37:1050.
- Eftychiou C, Samarkos M, Golfinopoulou S, et al. Henoch-Schonlein purpura associated with methicillin-resistant Staphylococcus aureus infection. Am J Med 2006; 119:85.
- 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