International Journal Dental and Medical Sciences Research

Volume 4, Issue 4, July-Aug 2022 pp 861-865 www.ijdmsrjournal.com ISSN: 2582-6018

Staphylococcus aureus: Review of literature in brief

Dr.Parul Parvesh Verma1, Dr. Anisha Yadav2, Dr. Ashu Gautam3, Samim Ali4
Senior Resident, MD Microbiology, Department of Microbiology, Kalpana Chawla Government Medical
College, Karnal
PG resident, Department of Microbiology, Kalpana Chawla Government Medical College, Karnal
PG resident, Department of Microbiology, Kalpana Chawla Government Medical College, Karnal
Research Assistant, Department of Microbiology, Kalpana Chawla Government Medical College, Karnal

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Submitted: 25-08-2022 Accepted: 05-09-2022
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ABSTRACT This organism is extensively studied in patients
Staphylococcus aureus (S. aureus) is both a with surgical site infections (SSIs), patients
commensal bacterium and a major human pathogen undergoing hemodialysis and in patients on
causing a wide range of clinical infections. S. continuous ambulatory peritoneal dialysis (CAPD).
aureus has been identified as a risk factor for the It causes blood stream infections (BSIs), skin and
development of various infections. It causes blood soft tissue infections (SSTIs), osteomyelitis,
stream infections (BSIs), skin and soft tissue endocarditis and nosocomial infections and is the
infections (SSTIs), osteomyelitis, endocarditis and major cause of community-acquired infections.
nosocomial infections and is the major cause of Staphylococci are generally found on the skin and
community-acquired infections. This review mucous membrane of the humans. It predominantly
comprehensively covers the discovery, taxonomy, colonizes the anterior nares (vestibulum nasi).
virulence factors and pathogenesis. The mortality Persistent carriage is more common in children
of S. aureus bacteremia remains approximately 20 than in adults. The prevalence and incidence of S.
to 40% despite the availability of effective aureus varies according to the population studied.
antimicrobials. Introduction of penicillin in the Treating the anterior nares with topical antibiotics,
early 1940s dramatically improved the prognosis of may cause the organism to disappear. Penicillin
patients with Staphylococcal infection. However, was the original drug for the treatment of infections
as early as 1942, penicillin resistant Staphylococci caused by S. aureus and the emergence of
were recognized, first in the hospitals and resistance was due to the acquisition of plasmid-
subsequently in the community. This pattern of borne genetic elements encoding β-lactamases.
resistance first emerging in hospitals and then Penicillinase-resistant penicillins were developed
spreading to the community, is now a well- for the treatment. S. aureus has been recognized as
established pattern that recurs with each new wave an important human pathogen. Staphylococcal
of antimicrobial resistance. Therefore, accurate and infections occur regularly in hospitalized patients
early detection of S.aureus is mandatory for and have severe consequences, despite antibiotic
effective management of infections caused by it. therapy.1,2
KEYWORDS: S.aureus , bloodstream infections,
antibiotic resistance, skin and soft tissue infections Discovery
S. aureus was discovered in 1880 by a
STAPHYLOCOCCUS AUREUS: REVIEW OF surgeon, Alexander Ogston, who described
LITERATURE IN BRIEF Staphylococcal disease and its role in sepsis and
Infections have been one of the major abscesses. S. aureus remains a versatile and
causes of morbidity and mortality worldwide dangerous pathogen to human health over the last
among the human population. All the 100 years and has become one of the leading
microorganisms including bacteria, viruses, causes of hospital-acquired infection worldwide.3,4,5
parasites and fungi cause a variety of infections
affecting every organ of the body. The immune Taxonomy
system is an effective barrier against these The genus Staphylococcus belongs to the
infectious agents. family Staphylococcaceae, class Bacilli and order
Staphylococcus aureus (S. aureus) is both Bacillales. The term Staphylococcus is derived
a commensal bacterium and a major human from the greek term staphyle, meaning “a bunch of
pathogen causing a wide range of clinical grapes.” Under the microscope, Staphylococcus
infections. S. aureus has been identified as a risk appears as gram-positive cocci (0.5-1.5µm)
factor for the development of various infections. arranged in single cells, tetrads and short chains,
DOI: 10.35629/5252-0404861865 |Impact Factorvalue 6.18| ISO 9001: 2008 Certified Journal Page 861
 International Journal Dental and Medical Sciences Research
Volume 4, Issue 4, July-Aug 2022 pp 861-865 www.ijdmsrjournal.com ISSN: 2582-6018

but predominantly as “grape like” clusters. They carrier versus non-carrier state and viral
are facultative anaerobes (except S. aureus subsp. infections of the upper respiratory tract.
anaerobius and S. saccharolyticus), non-motile, 2. Nasal abnormalities
non-spore forming and catalase positive. They 3. HLA type
don’t produce gas from carbohydrates. The 4. Ecology of nasal flora
organisms are resistant to high temperatures 5. Race
(50°C), to high salt concentrations, and to drying.6 6. Age
A major genotypic criterion of this genus is G+C 7. Genetic makeup
content of 30 to 39 mol%. Whole genome 8. Immunological status
sequencing has been performed for many 9. Hospitalization
Staphylococcal strains and complete genome 10. Repeated needle injections
sequences are available for S. aureus. The S. aureus 11. Hormonal status in women
genome is composed of a single chromosome
ranging in size from 2.8 to 2.9 Mbp. Incidence
In the past 30 years, both the community-
Carriage of S. aureus acquired and hospital-acquired Staphylococcal
Staphylococci are ubiquitous colonizers of skin and infections have increased. According to the data
mucous membrane. S. aureus can exist as normal from national nosocomial infections surveillance
flora. Primary reservoir of Staphylococci is anterior system, centers for disease control and prevention
nares. Three patterns of carriage can be (CDC), during the period from 1990 to 1992, S.
distinguished: 1 aureus was the most common cause of pneumonia
1. Persistent carriers: About 20% of individuals and surgical wound infections and the second most
almost always carry one type of strain (two S. common cause of nosocomial BSIs. Another data
aureus positive culture) from national nosocomial infections surveillance
2. Intermittent carriers: About 60% of system during the period from 1989 to 1997
individuals harbors S. aureus intermittently showed that the number of infections in intensive
and the strains change with varying frequency care units has continued to increase.3
(one S. aureus positive culture)
3. Non-carriers: A minority (20%) of people Virulence factors
never carry S. aureus (no S. aureus positive A large number of virulence factors have
culture). been identified for S. aureus and their possible role
The reasons for these differences in colonization in pathogenesis. These include the slime layer,
patterns are unknown. capsular polysaccharides, cell wall constituents
Factors influencing the rate of S. aureus nasal (peptidogylycan, teichoic acid, protein A and
carriage 1 adhesions), exoenzymes and exotoxins.3,7
1. Adherence to epithelia which is mediated by:
lipoteichoic acid, surface associated proteins,

DOI: 10.35629/5252-0404861865 |Impact Factorvalue 6.18| ISO 9001: 2008 Certified Journal Page 862
 International Journal Dental and Medical Sciences Research
Volume 4, Issue 4, July-Aug 2022 pp 861-865 www.ijdmsrjournal.com ISSN: 2582-6018

Figure 1: Virulence factors in Staphylococcus aureus8

“Although this organism is frequently a part of the Staphylococcal avidly adhere to endothelial
normal flora, it can cause significant infections cells and bind through adhesion receptor
under appropriate conditions.” interactions. In vitro studies demonstrate that
after adherence, Staphylococci are
Predisposing factors to S. aureus infection phagocytosed by endothelial cells.6The
 Defects in leucocyte chemotaxis; hallmark of Staphylococcal infection is the
 Defects in opsonization by antibodies abscess, which consists of a fibrin wall
secondary to congential or acquired surrounded by inflamed tissues enclosing a
hypogammaglobinemias or complement central core of pus containing the organisms
component deficiencies; and leukocytes. The organism from the focus
 Defects in intracellular killing of bacteria; may disseminate hematogenously. This may
 Skin injuries; result in pneumonia, bones and joints
 Presence of foreign bodies; infection, and infection of heart valves.
 Viral infections;
2. Toxin mediated disease: the organism
 Chronic underlying diseases like malignancy;
elaborates toxins that cause specific diseases.
 Therapeutic or prophylactic antimicrobial
Pyrogenic toxin being a superantigen can
administration.
cause life threatening disease that is
characterized by rapid onset of high grade
Pathogenesis
fever, shock, capillary leak, and multiorgan
S. aureus has a diverse arsenal of
dysfunction. Superantigens are T-cell mitogens
components and products that contribute to
that bind directly to invariant regions of major
pathogenesis of infection. These components and
histocompatibility complex (MHC) class II
products have overlapping roles and can either in
molecules, bypassing intracellular protein
concert or alone. The organism may cause disease
ingestion and digestion and subsequent peptide
through tissue invasion and toxin production.3
presentation by the antigen presenting cells.
1. Tissue invasion: The postulated sequence of
The MHC bound superantigens attach to T
events that leads to S. aureus infection is
cells according to the composition of the
initiated with endothelial cell injury which is
variable region of the T cell receptor β-chain.
the potential target of S. aureus.
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 International Journal Dental and Medical Sciences Research
Volume 4, Issue 4, July-Aug 2022 pp 861-865 www.ijdmsrjournal.com ISSN: 2582-6018

Toxic shock syndrome toxin 1 (TSST-1) binds Staphylococci and then left at 28°C for 2-4
all the variable region of β2-positive T cells, hours. Commonly incriminated foods include
causing an expansion of clonal T cells, cooked or processed meat or dairy products.
resulting in the massive cytokines release. Ham is most frequently incriminated,
These cytokines mediate the toxic shock accounting for 24% of outbreaks reported to
syndrome (TSS).3,9 the CDC from 1921 to 1981.13
7. TSS: With the introduction of superabsorbent
Infections associated with S. aureus: tampons used during menstruation
1. Folliculitis is a benign infection of superficial Staphylococcal toxic shock syndrome came
dermis (Ostia of the hair follicles) into prominence. The disease is characterized
characterized by presence of small, reddish, by fulminant onset. Clinical findings include
painful lesions. high fever, erythematous rash with subsequent
2. Impetigo is a superficial infection of the desquamation, hypotension and multiorgan
dermis most commonly seen in children. Two damage. It often develops from the site of
forms: nonbullous and bullous. S. aureus colonization rather than infection.14
accounts for 80% to 90% cases of impetigo.10 8. Staphylococcal bacteremia seed to distant
3. Cellulitis refers to rapidly spreading sites, leading to endocarditis, osteomyelitis,
inflammation and infection of the soft polyarthritis, and metastatic abscess
subcutaneous tissues. Erysipelas is a type of formation.15,16
cellulitis occasionally caused by S. aureus. In the early 1970s, physicians were finally
Necrotizing fasciitis is another cutaneous forced to abandon their belief that, given the vast
infection caused by S. aureus. array of effective antimicrobial agents, virtually all
4. Endocarditis: S. aureus is a cause of native bacterial infections were treatable. Their optimism
valve endocarditis and is also a leading cause was shaken by the emergence of resistance to
of prosthetic valve endocarditis.11 multiple antibiotics among such pathogens as S.
5. Skin and soft-tissue infections (SSTIs) occur aureus, Streptococcus pneumoniae, Pseudomonas
after 2 to 5% of all surgeries. According to aeruginosa, and Mycobacterium tuberculosis. The
2009-2010 U.S. National Healthcare Safety evolution of increasingly antimicrobial resistance
Network data, S. aureus was the most common bacterial species stems from a multitude of factors
cause of SSIs accounting for 30% of that includes the widespread and sometimes
infections.12 inappropriate use of antimicrobials, the extensive
6. Staphylococcal food poisoning follows the use of these agents as growth enhancer in animal
ingestion of preformed enterotoxins produced feed, and with the increase in regional and
in the food contaminated with enterotoxigenic international travel, the relative.2

Figure 2: Emergence of antibiotic resistance against S. aureus 17

The mortality of S. aureus bacteremia availability of effective antimicrobials. S. aureus is

remains approximately 20 to 40% despite the now the leading overall cause of the nosocomial
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 International Journal Dental and Medical Sciences Research
Volume 4, Issue 4, July-Aug 2022 pp 861-865 www.ijdmsrjournal.com ISSN: 2582-6018

infections. The mortality of patients with S. aureus type (ST)22 and ST 772 in Mumbai, India. J
bacteremia in the pre antibiotic era exceeded 80% Clin microbio2010;48:1806-11.
and over 70% developed metastatic infections. [8]. Verma S, Joshi S, Chitnis V, Hemwani N,
Introduction of penicillin in the early 1940s Chitnis D. Growing problem of methicillin
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recognized, first in the hospitals and subsequently management of Hypersensitive reactions-
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80% of both community and hospital acquired 2011;94:817-24.
Staphylococcal isolates were resistant to penicillin. [10]. Cassandra.D, Farr.B.M. Community
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hospitals and then spreading to the community, is prevalence and risk factors.
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