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About 15–40 per cent of healthy humans are carriers of S aureus, that is, they have the bacteria on their skin without any active infection or disease (colonisation).
Despite being harmless in most individuals, S aureus is capable of causing various infections of the skin and other organs.
Most staph infections occur in normal individuals, but underlying illness and certain skin diseases increase the risk of infection. Staphylococcal aureus bacteria are classified as Gram-positive cocci based on their appearance under a microscope.
They are only able to invade via broken skin or mucous membranes, hence intact skin is an excellent human defence. Release toxins (intoxication) – these do not require the presence of live bacteria to have an effect. Staphylococcal scalded skin syndrome (SSSS), which usually affects children less than five years old or rarely, adults with kidney failure.
In staphylococcal intoxications there may be no viable bacteria to culture and the diagnosis may be made retrospectively on the basis of a blood test demonstrating an immune response (seroconversion) to toxins following a compatible illness. Staphylococci are becoming increasingly resistant to many commonly used antibiotics including penicillins, macrolides such as erythromycin, tetracyclines and aminoglycosides.
Penicillin resistance in S aureus is due to production of an enzyme called beta-lactamase or penicillinase.


Penicillins with a beta-lactamase-inhibitor such as amoxicillin + clavulonic acid may be used to treat Staph. Patients who are allergic to penicillin are most reliably treated with vancomycin, although for minor infections macrolides such as erythromycin may be adequate.
Due to widespread antibiotic resistance, it is better to prevent staphylococcal infections where possible.
It is also important to clear bacteria colonising the nostrils and under the fingernails with either antibiotic ointment (eg.
Author: Amy Stanway MBChB, Registrar, Department of Dermatology, Waikato Hospital, Hamilton, New Zealand, 2002. Staphylococcus aureus (S aureus) is the most important of these bacteria in human diseases. The carrier sites are usually the nostrils and flexures, where the bacteria may be found intermittently or every time they are looked for. S aureus infections are common in people with frequent skin injury, particularly if the skin is dry.
This is a relatively uncommon illness usually resulting from the release of Toxic Shock Syndrome Toxin-1 (TSST-1) or enterotoxin B. If there are difficulties in diagnosis, or firstline treatment fails, the diagnosis can be confirmed by a positive laboratory culture of a swab from the infected site or blood culture.
Methicillin (meticillin) and flucloxacillin are lactamase-resistant penicillins so are the antibiotics of choice in most staphylococcal skin infections.


Macrolide resistance is also high among S aureus but macrolides may be taken by mouth whereas vancomycin requires intravenous administration.
Updated by Dr Jannet Gomez, Postgraduate student in Clinical Dermatology, Queen Mary University London, UK. Other staphylococci, including S epidermidis, are considered commensals, or normal inhabitants of the skin surface.
Staph skin infections are seen most commonly in pre-pubertal children and certain occupational groups such as healthcare workers. They are usually facultative anaerobes, that is, they are capable of surviving at various levels of oxygenation, and are generally very hardy organisms. These toxins are also known as superantigens as they are capable of generating a massive inflammatory response. These antibiotics have a broad range of action against several bacteria and are best reserved for patients with mixed bacterial infections. Previous exposure makes a patient immune to these toxins, ie they will not have a second attack.



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