Review

Authors: Karsten Becker, Christine Heilmann, Georg Peters...

The definition of the heterogeneous group of coagulase-negative staphylococci (CoNS) is still based on diagnostic procedures that fulfill the clinical need to differentiate between Staphylococcus aureus and those staphylococci classified historically as being less or nonpathogenic. Due to patient- and procedure-related changes, CoNS now represent one of the major nosocomial pathogens, with S. epidermidis and S. haemolyticus being the most significant species. They account substantially for foreign body-related infections and infections in preterm newborns. While S. saprophyticus has been associated with acute urethritis, S. lugdunensis has a unique status, in some aspects resembling S. aureus in causing infectious endocarditis. In addition to CoNS found as food-associated saprophytes, many other CoNS species colonize the skin and mucous membranes of humans and animals and are less frequently involved in clinically manifested infections. This blurred gradation in terms of pathogenicity is reflected by species- and strain-specific virulence factors and the development of different host-defending strategies. Clearly, CoNS possess fewer virulence properties than S. aureus, with a respectively different disease spectrum. In this regard, host susceptibility is much more important. Therapeutically, CoNS are challenging due to the large proportion of methicillin-resistant strains and increasing numbers of isolates with less susceptibility to glycopeptides.

Topics: Coagulase; Disease Management; Drug Resistance, Bacterial; Humans; Microbial Sensitivity Tests; Staphylococcal Infections; Staphylococcus

PubMed: 25278577
DOI: 10.1128/CMR.00109-13

Review

Authors: Daniel J Minter, Ayesha Appa, Henry F Chambers...

Staphylococcus aureus bacteremia (SAB) carries a high risk for excess morbidity and mortality. Despite its prevalence, significant practice variation continues to permeate clinical management of this syndrome. Since the publication of the 2011 Infectious Diseases Society of America (IDSA) guidelines on management of methicillin-resistant Staphylococcus aureus infections, the field of SAB has evolved with the emergence of newer diagnostic strategies and therapeutic options. In this review, we seek to provide a comprehensive overview of the evaluation and management of SAB, with special focus on areas where the highest level of evidence is lacking to inform best practices.

Topics: Humans; Methicillin-Resistant Staphylococcus aureus; Staphylococcus aureus; Anti-Bacterial Agents; Staphylococcal Infections; Bacteremia

PubMed: 37950887
DOI: 10.1093/cid/ciad500

Review

Authors: Pipat Piewngam, Michael Otto

Staphylococcus aureus is a leading cause of death by infectious diseases worldwide. Treatment of S aureus infections is difficult due to widespread antibiotic resistance, necessitating alternative approaches and measures for prevention of infection. Because S aureus infections commonly arise from asymptomatic colonisation, decolonisation is considered a key approach for their prevention. Current decolonisation procedures include antibiotic-based and antiseptic-based eradication of S aureus from the nose and skin. However, despite the widespread implementation and partial success of such measures, S aureus infection rates remain worrisome, and resistance to decolonisation agents is on the rise. In this Review we outline the epidemiology and mechanisms of S aureus colonisation, describe how colonisation underlies infection, and discuss current and novel approaches for S aureus decolonisation, with a focus on the latest findings on probiotic strategies and the intestinal S aureus colonisation site.

Topics: Humans; Staphylococcal Infections; Staphylococcus aureus; Anti-Bacterial Agents; Carrier State; Probiotics

PubMed: 38518792
DOI: 10.1016/S2666-5247(24)00040-5

Review

Authors: James E Cassat, Isaac Thomsen

PURPOSE OF REVIEW

Staphylococcus aureus is the most common invasive bacterial pathogen infecting children in the U.S. and many parts of the world. This major human pathogen continues to evolve, and recognition of recent trends in epidemiology, therapeutics and future horizons is of high importance.

RECENT FINDINGS

Over the past decade, a relative rise of methicillin-susceptible S. aureus (MSSA) has occurred, such that methicillin-resistant S. aureus (MRSA) no longer dominates the landscape of invasive disease. Antimicrobial resistance continues to develop, however, and novel therapeutics or preventive modalities are urgently needed. Unfortunately, several recent vaccine attempts proved unsuccessful in humans.

SUMMARY

Recent scientific breakthroughs highlight the opportunity for novel interventions against S. aureus by interfering with virulence rather than by traditional antimicrobial mechanisms. A S. aureus vaccine remains elusive; the reasons for this are multifactorial, and lessons learned from prior unsuccessful attempts may create a path toward an effective preventive. Finally, new diagnostic modalities have the potential to greatly enhance clinical care for invasive S. aureus disease in children.

Topics: Anti-Bacterial Agents; Child; Humans; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Staphylococcal Infections; Staphylococcus aureus

PubMed: 34524201
DOI: 10.1097/QCO.0000000000000752

Review

Authors: Ilse J E Kouijzer, Vance G Fowler, Jaap Ten Oever...

The current duration of therapy in patients with Staphylococcus aureus bacteremia (SAB) is based on differentiating complicated from uncomplicated disease. While this approach allows clinicians and investigators to group SAB patients into broadly similar clinical categories, it fails to account for the intrinsic heterogeneity of SAB. This is due in part to the fact that risk factors for metastatic infection and confirmed metastatic infection are considered as equivalent in most scoring systems. In this viewpoint, we propose a two-step system of categorizing patients with SAB. Initially, patients with SAB would be categorized as 'high risk' or 'low risk' for metastatic infection based upon an initial set of diagnostic procedures. In the second step, patients identified as 'high-risk' would undergo additional diagnostic evaluation. The results of this stepwise diagnostic evaluation would define a 'final clinical diagnosis' to inform an individualized final treatment plan.

Topics: Humans; Staphylococcus aureus; Bacteremia; Staphylococcal Infections; Risk Factors

PubMed: 36370898
DOI: 10.1016/j.jinf.2022.10.042

Review

Authors: Yves Gillet, Thomas Henry, Francois Vandenesch...

Fulminant staphylococcal infection indicates an explosive, intense, and severe infection occurring in a patient whose previous condition and antecedent would never have caused any anticipation of life-threatening development. This includes necrotizing pneumonia, necrotizing fasciitis, and to some extent toxic shock syndrome and infective endocarditis. In the three former diseases, toxin production plays a major role whereas in the latter (fulminant presentation of infective endocarditis), association with any particular toxinic profile has never been demonstrated. This article reviews the clinical, pathophysiological, and therapeutic aspects of these diseases.

Topics: Bacteremia; Endocarditis; Fasciitis, Necrotizing; Humans; Pneumonia, Necrotizing; Shock, Septic; Staphylococcal Infections; Staphylococcus aureus

PubMed: 30291703
DOI: 10.1128/microbiolspec.GPP3-0036-2018

Review

Authors: Hezzy Shmueli, Felix Thomas, Nir Flint...

Compared with the extensive data on left-sided infective endocarditis (IE), there is much less published information on the features and management of right-sided IE. Right-sided IE accounts for 5% to 10% of all IE cases, and compared with left-sided IE, it is more often associated with intravenous drug use, intracardiac devices, and central venous catheters, all of which has become more prevalent over the past 20 years. In this manuscript on right-sided IE we provide an up-to-date overview on the epidemiology, etiology, microbiology, potential locations of infection in the right heart, diagnosis, imaging, common complications, management, and prognosis. We present updated information on the treatment of pacemaker and device infections, infected fibrin sheaths that appear to be an easily missed source of infection after central line as well as pacemaker removal. We review current data on the AngioVac percutaneous aspiration device, which can obviate the need for surgery in patients with infected pacemaker leads and fibrin sheaths. We also focused on advanced diagnostic modalities, such as positron emission tomography/computed tomography. All of these are supported by specific case examples with detailed echocardiographic imaging from our experience.

Topics: Adult; Aged; Anti-Bacterial Agents; Cardiac Surgical Procedures; Echocardiography; Electrodes, Implanted; Endocarditis; Female; Humans; Male; Staphylococcal Infections; Staphylococcus aureus; Substance Abuse, Intravenous

PubMed: 32700630
DOI: 10.1161/JAHA.120.017293

Review

Authors: Barbara C Kahl, Karsten Becker, Bettina Löffler...

Small colony variants (SCVs) were first described more than 100 years ago for Staphylococcus aureus and various coagulase-negative staphylococci. Two decades ago, an association between chronic staphylococcal infections and the presence of SCVs was observed. Since then, many clinical studies and observations have been published which tie recurrent, persistent staphylococcal infections, including device-associated infections, bone and tissue infections, and airway infections of cystic fibrosis patients, to this special phenotype. By their intracellular lifestyle, SCVs exhibit so-called phenotypic (or functional) resistance beyond the classical resistance mechanisms, and they can often be retrieved from therapy-refractory courses of infection. In this review, the various clinical infections where SCVs can be expected and isolated, diagnostic procedures for optimized species confirmation, and the pathogenesis of SCVs, including defined underlying molecular mechanisms and the phenotype switch phenomenon, are presented. Moreover, relevant animal models and suggested treatment regimens, as well as the requirements for future research areas, are highlighted.

Topics: Animals; Bacterial Typing Techniques; Cross Infection; Disease Models, Animal; Humans; Phenotype; Staphylococcal Infections; Staphylococcus aureus

PubMed: 26960941
DOI: 10.1128/CMR.00069-15

Review

Authors: A Pantosti, M Venditti

For decades methicillin-resistant Staphylococcus aureus (MRSA) has been considered the prototype of multi-resistant nosocomial pathogens, causing infections in high-risk patients. Changes in the healthcare system, coupled with the evolution of this versatile microorganism, have transformed MRSA into a cause of community-onset infections, in both patients who have contact with the healthcare system and patients without such a risk factor. New lineages of MRSA, defined as community acquired (CA)-MRSA, have emerged that have a propensity to cause infections in young individuals without risk factors. CA-MRSA primarily causes skin infections and, rarely, necrotising pneumonia. In the USA, these strains belong to a single widespread clone, designated USA300, while in Europe they belong to a variety of clones. Most strains carry genes for the Panton-Valentine leukocidin, whose role in diseases is under debate. In subjects living in the community who have contact with the healthcare system, MRSA strains of the nosocomial type are a frequent cause of infection and of pneumonia in particular. The detection of a large MRSA reservoir in pigs and the finding that professionally exposed individuals are colonised, has further shown that it is necessary to closely follow the epidemiology of MRSA if we want to combat it effectively.

Topics: Animals; Anti-Bacterial Agents; Bacterial Toxins; Communicable Disease Control; Cross Infection; Europe; Exotoxins; Genotype; Hospitals; Humans; Leukocidins; Methicillin-Resistant Staphylococcus aureus; Phenotype; Risk Factors; Staphylococcal Infections

PubMed: 19880619
DOI: 10.1183/09031936.00007709

Review

Authors: Aotong Liu, Shari Garrett, Wanqing Hong...

() is a common pathogen that can cause many human diseases, such as skin infection, food poisoning, endocarditis, and sepsis. These diseases can be minor infections or life-threatening, requiring complex medical management resulting in substantial healthcare costs. Meanwhile, as the critically ignored "organ," the intestinal microbiome greatly impacts physiological health, not only in gastrointestinal diseases but also in disorders beyond the gut. However, the correlation between infection and intestinal microbial homeostasis is largely unknown. Here, we summarized the recent progress in understanding infections and their interactions with the microbiome in the intestine. These summarizations will help us understand the mechanisms behind these infections and crosstalk and the challenges we are facing now, which could contribute to preventing infections, effective treatment investigation, and vaccine development.

Topics: Animals; Humans; Gastrointestinal Microbiome; Staphylococcal Infections; Staphylococcus aureus

PubMed: 38668232
DOI: 10.3390/pathogens13040276