Staph Lo Cocci
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Surgery Essay
Describe the types of staphylococcal infections encountered in surgical practice and outline their treatment. Normal body flora is usually involved in infections in surgical patients. Staphylococci are such organisms: normal commensals of the skin, oropharynx and nasopharynx. Staphylococcus aureus is an important pathogen in many surgical infections such as wound infections and device related infections. The latter include infections of indwelling catheters and prosthetic joints. Due to its coagulase enzyme, plasma is coagulated, resulting in fibrin deposition which interferes with phagocytosis and increase the ability of the organism to invade tissues causing septicaemia, including infective endocarditis, deep abscess in the brain, liver and spleen and toxic shock syndrome (TSS). TSS is due to the ability of the staphylococcus aureus to produce enterotoxins, which bind to cytokines causing TSS. Coagulase negative effectively means non Staphylococcus aureus staphylococci, for example Staphylococcus epidermis. These are usually dismissed as contaminants, but they are increasingly the cause of line and prosthesis infections, particularly in imuunocompromised patients. The organism colonizes plastic devices by attaching firmly to artificial surfaces. Some strains also produce a slime layer, glycocalyx, which appears to facilitate adhesion and protect organisms 1
Surgery Essay
from antibiotics and host defences. Staphylococcus epidermis infection may cause bacterial endocarditis especially in people with prosthetic heart valves. The treatment of staphylococci includes second generation cephalosporins such as cefuroxime. This is given mostly intravenously and has a very broad spectrum against both gram positive and negative bacteria. Gentamycin, an aminoglycoside is another good option. Penecillins such as benzylpenecillin and co-amoxiclav are now insensitive. As antiseptics, chlorhexadine and povidone-iodine are sensitive. Methicillin- resistant Staphylococcus aureus (MRSA) is resistant to all cephalosporins. Advancing age lengthy hospitalization, stays in ITU, chronic illness, prior and prolonged antibiotic therapy are all risk factors for infection. Patients will present with a pneumonia, surgical site infection, intraabdominal sepsis and toxic shock syndrome. In these patients, vancomycin is the antibiotic of choice. Teicoplanin is used if the organism is insensitive to vancomycin. Flucloxacilin may also be used against MRSA. 17/01/09
2
Describe the types of staphylococcal infections encountered in surgical practice and outline their treatment. Normal body flora is usually involved in infections in surgical patients. Staphylococci are such organisms: normal commensals of the skin, oropharynx and nasopharynx. Staphylococcus aureus is an important pathogen in many surgical infections such as wound infections and device related infections. The latter include infections of indwelling catheters and prosthetic joints. Due to its coagulase enzyme, plasma is coagulated, resulting in fibrin deposition which interferes with phagocytosis and increase the ability of the organism to invade tissues causing septicaemia, including infective endocarditis, deep abscess in the brain, liver and spleen and toxic shock syndrome (TSS). TSS is due to the ability of the staphylococcus aureus to produce enterotoxins, which bind to cytokines causing TSS. Coagulase negative effectively means non Staphylococcus aureus staphylococci, for example Staphylococcus epidermis. These are usually dismissed as contaminants, but they are increasingly the cause of line and prosthesis infections, particularly in imuunocompromised patients. The organism colonizes plastic devices by attaching firmly to artificial surfaces. Some strains also produce a slime layer, glycocalyx, which appears to facilitate adhesion and protect organisms 1
Surgery Essay
from antibiotics and host defences. Staphylococcus epidermis infection may cause bacterial endocarditis especially in people with prosthetic heart valves. The treatment of staphylococci includes second generation cephalosporins such as cefuroxime. This is given mostly intravenously and has a very broad spectrum against both gram positive and negative bacteria. Gentamycin, an aminoglycoside is another good option. Penecillins such as benzylpenecillin and co-amoxiclav are now insensitive. As antiseptics, chlorhexadine and povidone-iodine are sensitive. Methicillin- resistant Staphylococcus aureus (MRSA) is resistant to all cephalosporins. Advancing age lengthy hospitalization, stays in ITU, chronic illness, prior and prolonged antibiotic therapy are all risk factors for infection. Patients will present with a pneumonia, surgical site infection, intraabdominal sepsis and toxic shock syndrome. In these patients, vancomycin is the antibiotic of choice. Teicoplanin is used if the organism is insensitive to vancomycin. Flucloxacilin may also be used against MRSA. 17/01/09
2
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