Staph aureus : Wheeless' Textbook of Orthopaedics

  - Discussion:
- is a coagulase positive, gram positive organism (as opposed to coag neg s. epidermidis)
    - has a strong propensity to invade traumatized tissue;
- often responsible for toxic shock syndrome and necrotizing fascitis;
- serious infection that spreads rapidly along fascial planes and is commonly caused by staph or strep pyogenes;
- anaerobes - especially clostridia and bacteroides can also be the cause;
    - MRSA
    - staph aureus osteomyelitis is unique in that there is an ability to survive and hide withing osteocytes;
           - references:
                    - Intracellular Staphylococcus aureus. A mechanism for the indolence of osteomyelitis.
                    - In vivo internalization of Staphylococcus aureus by embryonic chick osteoblasts.
                    - Internalization of Bacteria by Osteoblasts in a Patient with Recurrent, Long-Term Osteomyelitis.
                    - Osteomyelitis and Intraosteoblastic. Staphylococcus aureus
    - biofilm formation
    - progressive bacterial synergistic infections:
- may begin as a small lesion that rapidly developes into synergistic gangrene, necessitating amputation;
- peptostreptococcus and staphylococcus, the 2 organisms most often involved in this disease;
- organisms act synergistically to produce necrosis and ulceration of both skin and subcutaneous tissues;