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Staphylococcus aureus


General Information


  • 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


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):603-61OpenInNew
  2. Fry DE. The continued challenge of Staphylococcus aureus in the surgical patient. Am Surg. 2013 Jan;79(1):1-10OpenInNew
  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):185-200OpenInNewfull-textOpenInNew
  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):422-47OpenInNewfull-textOpenInNew
  5. Murray RJ. Recognition and management of Staphylococcus aureus toxin-mediated disease. Intern Med J. 2005 Dec;35 Suppl 2:S106-19OpenInNew
  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):e10-52OpenInNewfull-textOpenInNew, executive summary can be found in Clin Infect Dis 2014 Jul 15;59(2):147OpenInNew

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):1OpenInNewfull-textOpenInNew), 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);1770OpenInNew
  • 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):147OpenInNewfull-textOpenInNew
  • 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):1435OpenInNewfull-textOpenInNew)

DynaMed Editorial Process

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.
    Section Editors have similar responsibilities to Topic Editors but have a broader role that includes the review of multiple topics, oversight of Topic Editors, and systematic surveillance of the medical literature.
    Recommendations Editors provide explicit review of DynaMed Overview and Recommendations sections to ensure that all recommendations are sound, supported, and evidence-based. This process is described in "Synthesized Recommendation Grading."
    Deputy Editors are employees of DynaMed and oversee DynaMed internal publishing groups. Each is responsible for all content published within that group, including supervising topic development at all stages of the writing and editing process, final review of all topics prior to publication, and direction of an internal team.

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 Registration and login required.
  • KeyboardArrowRight

    Overview and Recommendations

    • Background

    • Evaluation

    • Management

  • Related Summaries

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    General Information

    • Description

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    • Classification

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      Virulence factors

      • Cytolysins

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        • Toxic shock syndrome toxin 1 (TSST-1)

        • Staphylococcal enterotoxins

      • Exfoliatins

      • Other virulence factors

    • Biofilm formation

    • Host environment

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    • Geographic distribution

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      Incidence and prevalence

      • Global

      • United States

    • Risk factors

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    Host-Pathogen Interaction

    • Transmission

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      • Mechanisms of resistance

    • Immune response

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    Clinical Features

    • Overview of clinical feature variation

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      Toxin-mediated diseases

      • Staphylococcal toxic shock syndrome (STSS)

      • Staphylococcal food poisoning

      • Staphylococcal scalded skin syndrome (Ritter disease)

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      Infection-mediated diseases

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        Skin and soft tissue infections

        • Anatomy of infections

        • Impetigo

        • Folliculitis

        • Skin abscess

        • Furuncles and carbuncles

        • Erysipelas

        • Cellulitis

        • Mastitis

        • Necrotizing fasciitis

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        Systemic infections

        • Bacteremia

        • Infective Endocarditis (IE)

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        Pulmonary Infections

        • Pneumonia

        • Necrotizing pneumonia

        • Parapneumonic effusion and empyema

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        Bone, joint, and muscle infections

        • Osteomyelitis

        • Septic arthritis

        • Prosthetic joint infection (PJI)

        • Pyomyositis

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    • Principles of diagnosis

    • Culture-based identification

    • Molecular diagnosis

    • Antibiotic resistance testing

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    • Principles of management

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        Antistaphylococcal penicillins

        • Nafcillin and Oxacillin

        • Dicloxacillin

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        • Cefazolin

        • Ceftriaxone

        • Cefadroxil

        • Cephalexin

      • Adjunctive rifampin

      • Comparative efficacy of empiric vancomycin and beta-lactam antibiotics

      • Comparative efficacy of beta-lactam antibiotics

    • Surgery and procedures

  • Prognosis

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    Prevention and Infection Control

    • Infection prevention

    • Prevention of recurrence

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    Guidelines and Resources

    • KeyboardArrowRight


      • International guidelines

      • United States guidelines

      • United Kingdom guidelines

      • Canadian guidelines

      • European guidelines

      • Central and South American guidelines

    • Review articles

    • MEDLINE search

  • Patient Information

  • KeyboardArrowRight

    ICD Codes

    • ICD-10 codes

  • KeyboardArrowRight


    • General references used

    • Recommendation grading systems used

    • DynaMed Editorial Process

    • Special acknowledgements

    • How to cite

Topic Editor
J Martin Rodriguez MD, FACP, FIDSA

Professor of Medicine and Public Health, Division of Infectious Diseases, University of Alabama; Alabama, United States; Medical Director of Spain Wallace S9 General Medicine Inpatient Unit, Director of UAB Travel Clinic, and Co-director of UAB Undiagnosed Diseases Program, University of Alabama Health System; Alabama, United States

Conflicts of Interest

Dr. Rodriguez declares relevant financial relationships with Finch, Seres, and Syneos (Grant/Research Support).

Recommendations Editor
Zbys Fedorowicz MSc, DPH, BDS, LDSRCS

Director of Bahrain Branch of the United Kingdom Cochrane Center, The Cochrane Collaboration; Awali, Bahrain

Conflicts of Interest

Dr. Fedorowicz declares no relevant financial conflicts of interest.

Deputy Editor
Vito Iacoviello MD, FIDSA

Deputy Editor of Infectious Diseases, Immunology and Rheumatology, Dynamed; Massachusetts, United States; Assistant Professor of Medicine, Harvard Medical School; Massachusetts, United States; Chief of the Division of Infectious Diseases, Mount Auburn Hospital; Massachusetts, United States

Conflicts of Interest

Dr. Iacoviello declares no relevant financial conflicts of interest.

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Skin disorders

Skin disorders

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