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Staphylococcal infections, including meticillin (INN)-resistant Staphylococcus aureus 

Staphylococcal infections, including meticillin (INN)-resistant Staphylococcus aureus
Chapter:
Staphylococcal infections, including meticillin (INN)-resistant Staphylococcus aureus
DOI:
10.1093/med/9780198729228.003.0114
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date: 17 November 2019

Staphylococci are Gram-positive cocci that are among the most frequently encountered causes of localized and systemic bacterial infections in children. Staphylococcus aureus is the major pathogen. In Europe, most strains are sensitive to a wide range of common antibiotics, including β‎-lactam antibiotics such as methicillin (methicillin-sensitive S. aureus, MSSA). Strains that are resistant to methicillin (methicillin-resistant S. aureus, MRSA) are often resistant to other commonly used oral antibiotics. Coagulase-negative staphylococci (CoNS) are ubiquitous skin commensals that are an important cause of opportunistic infections in patients with impaired defences. Staphylococcal infections can be endogenous or exogenous. S. aureus causes both mild (mainly skin) and serious (bacteraemia, pneumonia, bone, and joint, etc.) infections. Strains of S. aureus can produce a variety of important toxins, including enterotoxins, toxic shock syndrome toxin, exfoliatins, and Panton–Valentine leukocidin (PVL). Skin infections and necrotizing pneumonia are characteristic of infections with PVL-producing S. aureus. CoNS are most important as a cause of device-associated infections. Staphylococcal infections are diagnosed mainly by culture. Flucloxacillin is the mainstay of treatment of infections with MSSA, although a wide variety of other oral and intravenous antibiotics are suitable alternatives. Options for treatment of infections with MRSA and CoNS are much more limited; glycopeptides are often the first line of treatment. There are specific recommendations for the treatment of PVL-producing S. aureus. Good hygiene is the most important infection prevention and control measure. Patients with MRSA should be isolated in hospital.

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