Gram Positive Cocci

Micrococaceae
Micrococci
Staphylococci
Stomatococci

Coagulase Positive


Staphylococcus aureus
- bunches of grapes
-butyrous
-Mannital salt agar (yellow)
-catalase positive



-Characteristics that differentiate coagulase positive staphylococci 



organism      Slide    tube         pyr   thermostable 
        nuclease 
       VP      ornithine
S. aureus   +  + - + + -
S. lugdunenis  + - + - + +
S.intermedius - + + + - -
S.schleiferi + - + + + -



S.aureus

Pathogen
skin, wounds, pneumonia, osteomylitis,
endocarditis, septic shock , toxic shock syndrome
food poisoning-intoxication



Virulence factors
cell wall- tough
polysaccharide capsule
protein A
enzymes
toxins
superantigens- immune modulators

exfoliatin-scalded skin syndrome

-enterotoxin

-toxin 1 TSST-1-toxic shock syndrome



Antibiotic Resistance
Most strains are penicillin resistant
-beta lactamase
-Also resistant to synthetic B-lactamase penicillin, oxacillin, methicllin, nafcillin
-penicillin binding protein in the cell wall

MRSA(Methicillin Resistant S. aureus)





Detect MRSA



1ug oxacillin disk
on20%NaCL to cation supplementedMueller Hinton Broth


Screen MRSA



6ug oxacillin
on 4%NaClsupplemented Mueller Hinton Agar


Sensitive to 
Vancomycin , rifampin



Carrier State



-Reservoir is hospitalized patients
-hospital and nursing homes require
MRSA screening
Strain identification
-phage typing



Coagulase Negative



Infections
-compromised host, cancer patients, neutropenic patients, indwelling catheters, shunts, CAPD, UTI in sexual active young women



S. epidermidis



Infections
-native heart valves, intravenous catheters, artificial heart valves, CAPD, bacterial adherence, prosthetic joints, CNS shunts



S. saprohyticus



Urinary Tract infections (UTI)
Novobiocin resistant
5 ug disc<5mm diameter



Other coagulase staphylococci identified by Staph TracTM, Micro Scan, Vitek



Infections



Prosthetic devices:
S.warneri
S. ludenesiscoagulase positive

Compromised hosts:
S.cohnii

S.haemolyticus

S.hominis

S.saccharolyticus

S.schleiferi - coagulase positive

S.simulans



Coagulase negative staphylococci 



Extracellular products
hemolysins, capsules, slime(adherence) , formation of a glycocalyx
UTI suceptible to most antibiotics except nalidixic (gram - )
MRS- resistant to Beta lactams and cephalosporin, imipenin



Stomatococcus

S. mucilaginus
-encapsulated normal flora of the oral cavity
-opportunist in drug abusers
-sticky capsule adheres to agar
-grows well on 5% NaCL
-poor growth on Mueller Hinton

-vancomycin sensitive




Micrococci
-saprophytic, pigmented
-tetrads
-opportunist by accidental introduction

M.agilis (motile)

M.kristinae

M.luteus

M.lylae

M.nishinominacnsis

M.roseus

M.sedentarius

M.varians

Differentiation

Catalase +

Coagulase -

-Not lysed by lysostaphin

-resistant to furazolidone

-contains cytochrome e (modified oxidase test)

-susceptible to 0.04 units of bacitracin

Selected characteristics of coagulase negative staphylococci

PYR

clumping factor

urease

maniton

sucrose

zone of inhibition

10u<11mm bacitracin

300u<10mm polymyxin

5ug<12mm nobobiocin