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CME

Staphylococcus aureus

General Information

Description

  • Staphylococcus aureus is a ubiquitous human pathogen associated with a broad spectrum of clinical illnesses including skin and soft tissue infections, pulmonary infections, bone and joint infections, bacteremia, and infective endocarditis as well as toxin-mediated diseases 1,2,3,4
  • clinical features vary by infection location and severity1
  • common pathogen in both community- and hospital-acquired infections2

References

General references used

  1. Tong SY, Davis JS, Eichenberger E, Holland TL, Fowler VG Jr. Staphylococcus aureus infections: epidemiology, pathophysiology, clinical manifestations, and management. Clin Microbiol Rev. 2015 Jul;28(3):603-61
  2. Fry DE. The continued challenge of Staphylococcus aureus in the surgical patient. Am Surg. 2013 Jan;79(1):1-10
  3. Tong SY, Chen LF, Fowler VG Jr. Colonization, pathogenicity, host susceptibility, and therapeutics for Staphylococcus aureus: what is the clinical relevance? Semin Immunopathol. 2012 Mar;34(2):185-200full-text
  4. Spaulding AR, Salgado-Pabón W, Kohler PL, Horswill AR, Leung DY, Schlievert PM. Staphylococcal and streptococcal superantigen exotoxins. Clin Microbiol Rev. 2013 Jul;26(3):422-47full-text
  5. Murray RJ. Recognition and management of Staphylococcus aureus toxin-mediated disease. Intern Med J. 2005 Dec;35 Suppl 2:S106-19
  6. Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis. 2014 Jul 15;59(2):e10-52full-text, executive summary can be found in Clin Infect Dis 2014 Jul 15;59(2):147

Recommendation grading systems used

  • Infectious Diseases Society of America (IDSA) grading system for recommendations
    • strength of recommendations
      • Grade A - good evidence to support a recommendation for or against use
      • Grade B - moderate evidence to support a recommendation for or against use
      • Grade C - poor evidence to support a recommendation
    • quality of evidence
      • Level I - evidence from > 1 properly randomized, controlled trial
      • Level II - evidence from > 1 well-designed clinical trial, without randomization; from cohort or case-controlled analytic studies (preferably from > 1 center); from multiple time series; or from dramatic results from uncontrolled experiments
      • Level III - evidence from opinions of authorities, based on clinical experience, descriptive studies, or reports of expert committees
    • Reference - IDSA 2009 clinical practice guidelines on diagnosis and management of intravascular catheter-related infection (19489710Clin Infect Dis 2009 Jul 1;49(1):1full-text), corrections can be found in Clin Infect Dis 2010 Feb 1;50(3):457 and Clin Infect Dis 2010 Apr 1;50(7):1079, commentary can be found in Clin Infect Dis 2009 Dec 1;49(11);1770
  • Infectious Diseases Society of America (IDSA) 2014 uses Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system
    • strength of recommendation
      • Strong recommendation - desirable effects clearly outweigh undesirable effects, or vice versa
      • Weak recommendation - desirable effects closely balanced with undesirable effects, or (with low- or very low-quality evidence) uncertainty in estimates of desirable effects, harms, and burden so they may be closely balanced
    • quality of evidence
      • High-quality evidence - consistent evidence from well-performed randomized controlled trials (RCTs) or exceptionally strong evidence from unbiased observational studies
      • Moderate-quality evidence - evidence from RCTs with important limitations (inconsistent results, methodologic flaws, indirect, or imprecise) or exceptionally strong evidence from unbiased observational studies
      • Low-quality evidence - evidence for ≥ 1 critical outcome from observational studies, RCTs with serious flaws, or indirect evidence
      • Very low-quality evidence - evidence for ≥ 1 critical outcome from unsystematic clinical observations or very indirect evidence
    • Reference - IDSA practice guideline on diagnosis and management of skin and soft tissue infections: 2014 update can be found in Clin Infect Dis 2014 Jul 15;59(2):147full-text
  • American Heart Association/American College of Cardiology (AHA/ACC) grading system for recommendations
    • classifications of recommendations
      • Class I - procedure or treatment should be performed or administered
      • Class IIa - reasonable to perform procedure or administer treatment, but additional studies with focused objectives needed
      • Class IIb - procedure or treatment may be considered; additional studies with broad objectives needed, additional registry data would be useful
      • Class III - procedure or treatment should not be performed or administered because it is not helpful or may be harmful
        • Class III ratings may be subclassified as Class III No Benefit or Class III Harm
    • levels of evidence
      • Level A - data derived from multiple randomized clinical trials or meta-analyses
      • Level B - data derived from single randomized trial or nonrandomized studies
      • Level C - only expert opinion, case studies, or standard of care
    • Reference - AHA scientific statement on diagnosis, antimicrobial therapy, and management of complications of infective endocarditis in adults (26373316Circulation 2015 Oct 13;132(15):1435full-text)

DynaMed Editorial Process

  • DynaMed topics are created and maintained by the DynaMed Editorial Team and Process.
  • All editorial team members and reviewers have declared that they have no financial or other competing interests related to this topic, unless otherwise indicated.
  • DynaMed content includes Practice-Changing Updates, with support from our partners, McMaster University and F1000.

Special acknowledgements

  • DynaMed topics are written and edited through the collaborative efforts of the above individuals. Deputy Editors, Section Editors, and Topic Editors are active in clinical or academic medical practice. Recommendations Editors are actively involved in development and/or evaluation of guidelines.
  • Editorial Team role definitions
    Topic Editors define the scope and focus of each topic by formulating a set of clinical questions and suggesting important guidelines, clinical trials, and other data to be addressed within each topic. Topic Editors also serve as consultants for the internal DynaMed Editorial Team during the writing and editing process, and review the final topic drafts prior to publication.
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How to cite

National Library of Medicine, or "Vancouver style" (International Committee of Medical Journal Editors):

  • DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 - . Record No. T904266, Staphylococcus aureus; [updated 2019 Jul 17, cited place cited date here]. Available from https://www.dynamed.com/topics/dmp~AN~T904266. Registration and login required.

Published by EBSCO Information Services. Copyright © 2020, EBSCO Information Services. All rights reserved. No part of this may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission.

EBSCO Information Services accepts no liability for advice or information given herein or errors/omissions in the text. It is merely intended as a general informational overview of the subject for the healthcare professional.

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