The changing face of Staphylococcus aureus: a continuing surgical challenge.

BACKGROUND

Staphylococcus aureus continues to be an important pathogen for surgeons. Surgical infections of interest caused by this pathogen include community-acquired infections, especially of skin and soft tissue; surgical site infections; and nosocomial infections during the post-operative period.

METHODS

A literature review was conducted to detail the history of S. aureus in surgical care; to identify the structural elements of the pathogen, the secreted exotoxins and enzymes, and the changing resistance patterns that make S. aureus an ever-formidable clinical foe; to consider whether screening for the pathogen and directed antimicrobial prophylaxis are useful; and to identify antimicrobial agents employed currently in treatment of established infections.

RESULTS

Staphylococcus aureus has shown a pattern of increasing prevalence of infections among hospitalized patients and a pattern of increasing resistance. A broad array of virulence factors account for its continued pathogenicity, and new virulence characteristics continue to be acquired. Staphylococcus aureus has an uncanny ability to adapt and develop resistance to each new antibiotic as it is introduced into clinical care. Although screening and directed surgical prophylaxis against methicillin- (now sometimes referred to as meticillin-) resistant S. aureus (MRSA) is controversial, effective efforts to decrease the incidence of nosocomial infections may be decreasing the numbers of MRSA infections encountered, and current agents remain effective for therapy.

CONCLUSIONS

Staphylococcus aureus continues to be a major pathogen for surgical patients. The scope of infections has expanded recently to include toxic shock syndrome, severe community-acquired soft tissue infections with unique virulence characteristics, and highly resistant pathogens. The adaptability of the organism requires that new prevention and treatment strategies be developed continuously to meet the challenge of future infections.