Staphylococcus

Slidex Staph Plus: Use

Detects all Staphylococcus aureus even

MRSA

Methicillin Resistant Staphylococcus aureus

Chapter 6.2
The staphylococcaceae

Slidex Staph Plus: Interest

Staphylococcus aureus: Commonly isolated in human infec4ons:

Skin infec4ons (impe4go, furoncles)

Mucous infec4ons (sinusi4s, o44s)
Systemic infec4ons (the most serious):

sep4cemia, pneumonia,
endocardi4s,meningi4s,
osteomyeli4s, toxic shock

Food poisoning (enterotoxins)

MRSA: Clinical signicance:

Staphylococcus
Resistance Mechanisms

Mul$ Drug Resistant (MDR) bacteria:

limits the choice of an4bio4c therapy

Major Nosocomial bacteria
(Hospital Acquired Infec4ons)
The incidence of MRSA strains varies
greatly from country to country

Wild Phenotype
Staphylococcus spp are naturally suscep4ble to all
an4bio4cs except:
Monobactam
Aztreonam
Quinolone 1st genera4on

S. saprophy1cus is naturally resistant to fosfomycin and

fusidic acid

-lactams

lactams Known Mechanisms of Resistance

Penicillinase
Target Modica$on (MRSA)

-lactams acquired
resistance
Wild

Pase

MecA/PBP 2A
MRSA

BORSA
(rare)

Peni G & A
Carboxy
Ureido

Peni
+
lactamase inhibitor

S/R

Methicillin

Cephalosporins
Carbapenems

lactamase test

-/+

Penicillinase test
Cenase#
For rapid detec$on of -Lactamase produc$on
Chromogenic cephalosporin (Nitrocen)
Pick up Colonies

(-)

(+)

5 mins to 1 hour
Also for H. influenzae, N. gonorrhoae, Enterococci, and anaerobes

-lactams

Aminoglycosides
Known Mechanisms of Resistance

Target modica4on = oxacillin R

Enzymes produc$on
Enzymes

Peptidoglycane

PBP
Permease

Peptidoglycane

Phenotype

Kana
Amika

Tobra

Genta
Netil

Wild type

APH (3)-III

ANT (4)-(4)

KT

APH(2)
+AAC(6)

KGT

Groupe Hospitalier Piti-Salptrire

100

PBP2a

80

Permease

60
40
20
0

PBP2a encoded by the

MRSA mecA gene

1992
K T (MR S A )
K T (MS S A )

Tetracyclines

2004
K G T (MR S A )
K G T (MS S A )

MLSK

Known Mechanisms of Resistance

Eux
Target Modica$on

Known Mechanisms of Resistance

TET

MIN

Partial R (efflux)

Ribosome protection

Impossible

Target Modica$on
Enzyme
Eux

Glycopeptides
Known Mechanisms of Resistance

Other antibiotics
Quinolones 2nd gen
Target modica4on or eux eect (natural R to 1st gen)

S.aureus

VRSA

Teicoplanin

Vancomycin

Resistance

MIC > 64 mg/l

MIC > 16 mg/l

5 strains (acquired
Enterococcus VanA)
Not known yet
(target modification,
enzyme,)

Staph. spp

VISA or
GISA

MIC>= 8mg/l

MIC = 8mg/l

Staph. spp

Hetero
VISA

MIC >= 8 mg/l

MIC = 2-4 mg/l but

sub-population
MIC = 6-8 mg/l

Reservoir of the
VISA/GISA?

Trimethoprim / sulfamethoxazole
Target modica4on or hyperproduc4on of enzyme

Fosfomycin
Muta4on (natural resistance of S.saprophy1cus)

Other antibiotics
Fusidic acid
Muta4on (natural resistance of S.saprophy1cus)

Rifampicin
Muta4on

ATB STAPH (5)

Chloramphenicol
Enzyme dependent resistance

Oxazolidinone
Rare and unknown mecanism

For all Staphylococci, even urinary

PEN G: For Penicillinase detec$on

OXA Test: For MRSA detec$on in hypersaline medium

Remember to staphylococci ac4vi4es:

Natural Suscep$bility:

Natural Resistance:

Vancomycin

Aztreonam
Quinolones 1 (Nalidixic Ac)
Colis4n

For Staph. xylosus, S. cohnii, S. Sciuri:

Lincosamid

INFORMATION ABOUT MRSA:

MRSA = Methicillin Resistant Staphylococcus (aureus)

Clinical signicance:
Limits the choice of an$bio$c therapy (mul$-resistant bacteria):
no -Lactams for treatment

One of the main bacteria responsible for nosocomial infec$ons

Q&A
Code

ANTIBIOTICS

PEN

Penicillin

OXA

Code

ANTIBIOTICS

TET

Tetracyclin

Oxacillin

MIN

Minocyclin

Oxacillin coag-

TSU

Cotrimoxazol

GEN

Gentamicin

FUR

Nitrofurantoin

ERY

Erythromycin

RFA

Rifampicin

CLI

Clindamycin

VAN

Vancomycin

QDA

Quinu-Dalfopristin

TEC

Teicoplanin

NOR

Norfloxacin

LEV

Levofloxacin

FUC

Fusidic Acid

OXAE