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Staphylococcal Infection

Staphylococcal Infection. Bacteriology. Bacteriology. Gm +ve cocci Cluster Facultative Nonfastidious. Classification. Classification. Staph. Aureus; Coagulase positive Staph. Epidermidis; Coagulase negative. Staph. Aureus Infections. Mechanism of pathogenesis;

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Staphylococcal Infection

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  1. Staphylococcal Infection

  2. Bacteriology

  3. Bacteriology • Gm +ve cocci • Cluster • Facultative • Nonfastidious

  4. Classification

  5. Classification • Staph. Aureus; Coagulase positive • Staph. Epidermidis; Coagulase negative

  6. Staph. Aureus Infections • Mechanism of pathogenesis; 1-coenzymes local destruction 2-Secretion of Toxins 3-Superantigens activating T cell receptors 4-Interfer with opsonophagocytosis

  7. Epidemiology • Normal human flora; nose& moist areas • Transmission; Hands/nose sec/contact/rarely air. • Colonize; skin, newborn nasoph& umb. • Invasion; Skin breaks, I/V access, immune defect, steroids and neutropenea.

  8. Clinical conditions

  9. Clinical conditions • Suppurative. • Toxic related;

  10. Clinical conditions • Suppurative. • Toxic related; Scalded Skin Syndrome SSS Toxic Shock Syndrome ??Kawasaki’ Disease Food poisoning

  11. Skin • Foliculitis • Furaculosis (Boils)/Carbunkles • Emptigo contagoesa • Bullous Emptigo • SSS (Ritter disease)

  12. Respiratory Infections • Sinusitis • Parotitis • Cervical adenitis • Tracheitis compared to croup • Pnumonia;

  13. Sepsis • Start as focal lesion e.g. a boil • Yield to septicemia • Localize to organs e.g. lung, bone, heart, brain etc

  14. Muscles/Bone/Joints • Tropical pyomyositis; Localized abscesses and high CPK • Osteomylitis; Trauma/Sx, pain, fever • Septic arthritis; Usually hematogenous

  15. CNS • Meningitis; Bacteremea, O.M, skull osteo., neural canal defects. • Neurosurgical procedures and VP shunt

  16. Heart • Bacterial endocarditis; -Perforated heart valve -myocardial abscess -purulent pericarditis -Sudden death

  17. Kidney • Perinephric abscess • UTI; Staph. saprophyticus (CONS) Sexually active adolescent girls

  18. G.I. • Food poisoning; Meat, mayonnase, creamed foods Short incubation period of 1 to 7 HRs Perfuse vomiting, no fever Test susp. food for staph bacteria/ toxins

  19. Diagnosis • Isolate staph. bacteria • Gram stain • Identify Toxins

  20. Treatment • Penicillinase resistant antibiotics; Oxacillin (Cloxacillin, Flucloxacillin) methicillin Nafcillin 1st generation cephalosporine, cefazolin (Ultracef)

  21. Treatment cont. • Betalacamase hyperprodcer staph.; Amoxicillin/Clavulenic acid(Augumentin) Ampicillin/Salbactam Imipenem Fluoroquinilones 1st generation cephalosporin Vancomycin

  22. Coagulase negative Staph. (CONS) • Common Skin Flora • Ubiquitous organism • Has affinity to plastic (surface hydophobicity & production of slim) • Neonates, I/V access and shunt devices infections (nosocomial infections)

  23. Clinical Conditions • Premature neonatal sepsis/NEC. • Older children sepsis is rare (minimal signs of sepsis) • Persistent pactreamia usual with indwelling devices (I/V cath, VP shunt, cardiac grafts and prosthesis etc.)

  24. Clinical Cond. Cont. • Single positive blood culture is a contaminant • UTI in adolescent girls Staphylococcus Saprophyticus (CONS)

  25. Treatment • Remove the access devices/shunts. • May externalize the VP shunt. • Vancomycin or Rifampin. • Amoxicillin or Quinolones for the Staph Saprophyticus UTI.

  26. Nosocomial Infections

  27. Definition Infections not present or incubating at the time of admission that develop during admission or less than one incubation period after discharge

  28. Definition cont. Infections 48 HRs or more after admission is assumed to be nosocomial unless the infection is clearly community acquired

  29. Clean Surgery

  30. Clean Surgery Incision through prepared normal skin and the operative field dose not include infected tissue , abscess, or entry into normally unsterile areas such as the bowel, the upper respiratory tract, or the lower female genital tract.

  31. Rate of Nosocomial Infections Number of nosocomial infections divided by the number of patients at risk multiplied by 100

  32. Epidemiology • 1/3 hospital infections are nosocomial (estimate in the USA) i.e. 2 million patients i.e. 4 million patient days of hospitalization i.e. 4.5 Billion USD i.e. 17 Billion SAR

  33. Epidemiology cont. In USA (1978) nosocomial inf. rate; -All services 3.37% -Pediatric services 1.2%

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