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S aureus bacteria are classified as Gram-positive cocci based on their appearance under a microscope . They may occur singly or grouped in pairs, short chains or grape-like clusters.

They are usually facultative anaerobes , that is, they are capable of surviving at various levels of oxygenation, and are generally very hardy organisms . They are only able to invade via broken skin or mucous membranes , hence intact skin is an excellent human defence.

Once they have

invaded

they have various ways to avoid host defences. They: Hide their antigens to avoid an immune response Kill infection-fighting cells ( phagocytes ) Survive within host infection-fighting cells.

Develop resistance to antibiotics Release toxins (intoxication) – these do not require the presence of live bacteria to have an effect. Staphylococcal skin infection can present in a variety of ways: Hair follicle infections including staphylococcal folliculitis, boils (furuncles and carbuncles), abscess and sycosis (beard infection) Impetigo (school sores) Ecthyma ( crusted ulcers ) Cellulitis (more often due to streptococcus) Secondary skin infection of wounds, dermatitis, scabies, diabetic ulcers etc. Mastitis ( inflammation of the breast) and abscess of the breast; the bacteria may pass from a breast abscess into milk Staphylococcal hypersensitivity reactions such as folliculitis decalvans (a cause of scarring hair loss) Staphylococcal infection. Skin disease due to toxins produced by the bacteria include: Staphylococcal scalded skin syndrome (SSSS), which usually affects children less than five years old or rarely, adults with kidney failure. This is a relatively uncommon illness usually resulting from the release of Toxic Shock Syndrome Toxin -1 (TSST-1) or enterotoxin B. These toxins are also known as superantigens as

they

are capable of generating a massive inflammatory response.

Previous exposure makes a patient immune to these toxins, ie they will not have a second attack.

Staphylococcal toxins can also cause food poisoning.

The diagnosis of staphylococcal skin infection is often clinical. If there are difficulties in diagnosis, or first-line treatment fails, the diagnosis can be confirmed by a positive laboratory culture of a swab from the infected site or blood culture.

In staphylococcal intoxication, 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.

The treatment of staphylococcal infection includes: Appropriate antibiotics, including oral antibiotics cephalexin, clindamycin, amoxicillin/clavulanate Drainage of pus from infection site Surgical removal ( debridement ) of dead tissue ( necrosis ) Removal of foreign bodies (eg stitches) that may be a focus of persisting infection Treating the underlying skin disease (eg atopic

eczema

) Antibiotic resistance. 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. Methicillin (meticillin) and flucloxacillin are lactamase-resistant penicillins so are the antibiotics of choice in most staphylococcal skin infections. Unfortunately, there is now increasing methicillin resistance (MRSA). Penicillins with a beta-lactamase- inhibitor such as amoxicillin + clavulonic acid may be used to treat Staph.

aureus infections and are sometimes effective against bacteria resistant to flucloxacillin. These antibiotics have a broad range of action against several bacteria and are best reserved for patients with mixed bacterial infections. Patients who are allergic to penicillin are most reliably treated with vancomycin, although for minor infections macrolides such as erythromycin may be adequate. Macrolide resistance is also high among S aureus but macrolides may be taken by mouth whereas vancomycin requires intravenous

administration

.

Due to widespread antibiotic resistance, it is better to prevent staphylococcal infection where possible. The most effective way is to wash hands often, and before and after touching broken skin. It is also important to clear bacteria colonising the nostrils and under

the

fingernails with either antibiotic ointment (eg.

fusidic acid or mupirocin) or petroleum jelly several times daily for one week of each month. 5 things you need to know about antibiotics this flu season. When Joseph developed a persistent cough, he booked a visit with his longtime family physician. The doctor diagnosed bronchitis and recommended rest and plenty of fluids.

“The flu is going around my office, and I have deadlines to meet.” The doctor hesitated.

Then he saw how anxious Joseph was and agreed to call in a prescription.

Joseph and his doctor are unknowingly contributing to the rise of “superbugs,” or drug-resistant germs. Treating a cough with an occasional Tylenol or Advil won’t do any harm, even if the medication doesn’t relieve your symptoms. But antibiotics are

different

, as overuse and misuse can harm you ? and the people you love ? in the long term.

Read on to learn which flu treatments are most effective, how to avoid unnecessary antibiotics, and ways you can help fight the rise of dangerous superbugs. The drugs won’t relieve your symptoms, reduce the length of your illness or boost your immunity to other germs.

Sure, you may feel better after taking antibiotics, for a simple reason: You were already on the road to recovery.

We all tend to seek treatment when our symptoms are at their peak.



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