tailieunhanh - Chapter 129. Staphylococcal Infections (Part 8)

Urinary Tract Infections Urinary tract infections (UTIs) are infrequently caused by S. aureus. In contrast with that of most other urinary pathogens, the presence of S. aureus in the urine suggests hematogenous dissemination. Ascending S. aureus infections occasionally result from instrumentation of the genitourinary tract. Prosthetic Device–Related Infections S. aureus accounts for a large proportion of prosthetic device–related infections. These infections often involve intravascular catheters, prosthetic valves, orthopedic devices, peritoneal or intraventricular catheters, left-ventricularassist devices, and vascular grafts. In contrast with the more indolent presentation of CoNS infections, S. aureus device-related infections often present more acutely, with both localized and systemic manifestations | Chapter 129. Staphylococcal Infections Part 8 Urinary Tract Infections Urinary tract infections UTIs are infrequently caused by S. aureus. In contrast with that of most other urinary pathogens the presence of S. aureus in the urine suggests hematogenous dissemination. Ascending S. aureus infections occasionally result from instrumentation of the genitourinary tract. Prosthetic Device-Related Infections S. aureus accounts for a large proportion of prosthetic device-related infections. These infections often involve intravascular catheters prosthetic valves orthopedic devices peritoneal or intraventricular catheters left-ventricular-assist devices and vascular grafts. In contrast with the more indolent presentation of CoNS infections S. aureus device-related infections often present more acutely with both localized and systemic manifestations. The latter infections also tend to progress more rapidly. It is relatively common for a pyogenic collection to be present at the device site. Aspiration of these collections and performance of blood cultures are important components in establishing a diagnosis. S. aureus infections tend to occur more commonly soon after implantation unless the device is used for access . intravascular or hemodialysis catheters . In the latter instance infections can occur at any time. As in most prosthetic-device infections successful therapy usually involves removal of the device. Left in place the device is a potential nidus for either persistent or recurrent infections. Infections Associated with Community-Acquired Mrsa The many unusual clinical presentations encountered in patients with community-associated MRSA infections include necrotizing fasciitis necrotizing pneumonia and sepsis with Waterhouse-Friderichsen syndrome or purpura fulminans. These life-threatening infections reflect the increased virulence of MRSA strains. Toxin-Mediated Diseases Toxic Shock Syndrome TSS was first recognized as a disease in children in 1978. The .