Infectious diseases Board Review Manual
Statement of
Editorial Purpose
The Hospital Physician Infectious Diseases Board
Review Manual is a study guide for fellows
and practicing physicians preparing for board
exam­inations in infectious diseases. Each manual reviews a topic essential to current practice in the subspecialty of infectious diseases.
Treatment of
Staphylococcus aureus
Infections
Series Editor:
Varsha Moudgal, MD
Infectious Diseases Fellowship Program Director, St. Joseph
Mercy Hospital, Ann Arbor, MI; and Assistant Professor
of Medicine, Wayne State University School of Medicine,
Detroit, MI
PUBLISHING STAFF
PRESIDENT, Group PUBLISHER
Bruce M. White
Senior EDITOR
Contributor:
Nabin K. Shrestha, MD, MPH, FACP, FIDSA
Staff Physician, Division of Infectious Disease, Cleveland
Clinic, Cleveland, OH
Robert Litchkofski
executive vice president
Barbara T. White
executive director
of operations
Jean M. Gaul
NOTE FROM THE PUBLISHER:
This publication has been developed without involvement of or review by the
Amer­ican Board of Internal Medicine.
Table of Contents
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Case Presentations . . . . . . . . . . . . . . . . . . . . . . . . 2
Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Board Review Questions. . . . . . . . . . . . . . . . . . . 15
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Tr e a t m e n t o f S t a p h y l o c o c c u s a u r e u s I n f e c t i o n s
Infectious Diseases Board Review Manual
Treatment of Staphylococcus aureus Infections
Nabin K. Shrestha, MD, MPH, FACP, FIDSA
Introduction
Staphylococcus aureus is one of the most common human pathogens. It is commonly present on
the skin and mucous membranes of healthy individuals.1 Spread of the bacteria from colonized sites to
normally sterile sites due to breach of local immune
defense mechanisms leads to locally invasive infections, or distant infections secondary to dissemination through the bloodstream.
CASE PRESENTATIONS
Case Patient 1
A 28-year-old previously healthy man presents with
a 1-week history of progressive fever and fatigue. The
patient works on an oil rig. Four or 5 days before the
onset of this illness he sustained a minor injury of the
skin overlying his right knee. Two days after the injury
the area became red and painful, but then appeared
to heal without any specific treatment. The patient
then developed low-grade fever and noticed that he
was exhausted by the end of his work shift. Over successive days fever became more pronounced and
was associated with shaking chills. This prompted
him to visit his local emergency department (ED).
At the time of presentation the patient is alert and
oriented. He has a temperature of 38.9°C, heart
rate 108 beats/min, respiratory rate 18 breaths/min,
and blood pressure 110/68 mm Hg. He appears
flushed. His heart rhythm is normal and cardiac
examination does not reveal the presence of murmurs. There is no tenderness over the spine and
there are no inflamed joints. He has what appears
to be a healing abrasion over his right knee without
any evidence of purulence. White blood cell (WBC)
count is 12,600/µL with 90% neutrophils, and the
platelet count is 126,000/µL. His serum creatinine
concentration is 1.2 mg/dL. Two blood cultures are
obtained, which subsequently grow S. aureus.
• What are the clinical syndromes caused by
S. aureus?
The clinical syndromes that result from S. aureus
infections are varied. They range from relatively
benign skin conditions to life-threatening illnesses.
Table 1 lists important clinical syndromes that can
be caused by S. aureus; management of specific
syndromes is discussed later in the section “Clinical Syndromes Caused by S. aureus.” Some of
these are infections that occur at or around the
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2 Hospital Physician Board Review Manual
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