Staphylococcus aureus - University Research Administration

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Staphylococcus aureus - University Research Administration

Staphylococcus aureusThe University of ChicagoSelect Agent Institutional Biosafety CommitteeAgent Profile FormSection I - Infectious AgentAgentRisk Group:RG2Synonym or Cross Reference:Staphylococcal diseases, impetigo, toxic shock syndrome, food poisoning, intoxicationCharacteristics:NOT A SELECT AGENTGram positive cocci, usually in clusters; coagulase positive; non-spore forming; non-motile; many strains produce exotoxinsincluding staphylococcal enterotoxins A,B,C,D,E, toxic shock syndrome toxin (TSST-1) and exfoliative toxins A, and BACUP #(s):The rest of Section I is to be completed by Principal InvestigatorIs this a clinical isolate?YesNoIs this an attenuated strain?YesNoWill you be working with or generating recombinant derivatives of this organism?YesNoBy completion and submission of this form, I as Principal Investigator confirm that the information provided is correct andcomplete.Section II - Health HazardPathogenicity:Opportunistic pathogen, normal flora; produces a variety of syndromes with a range of clinical manifestations; clinicallydifferent in general community, newborns, menstruating women, and hospitalized patients; food intoxication ischaracterized by abrupt/violent onset, severe nausea, cramps, vomiting, and diarrhea using lasting 1-2days; animal bitescan result in localized infections; may cause surface or deep/system infections in both community and hospital settings;surface infections include impetigo, folliculitis, abscesses, boils, infected lacerations; deep infections include endocarditis,meningitis, septic arthritis, pneumonia, osteomyelitis; systemic infection may cause fever, headache malaise, myalgia;newborns are susceptible to scalded skin syndrome (SSS) caused by exfoliative toxins; my be colonized during deliveryresulting in sepsis meningitis; toxic shock syndrome is an acute multi-system illness caused by TSST-1 a super antigen;characterized by sudden onset, high fever, vomiting, profuse watery diarrhea, myalgia, hypotension erythematous rash.Epidemiology:Occurs worldwide; particularly in areas where personal hygiene is suboptimal; in hospitals by development of antibioticresistantstrainsHost Range:Approved by SA-IBC 8/5/2011 SA-IBC Agent Profile Form Page 1 of 4


Humans; to a lesser extent, warm-blooded animalsInfectious Dose:Virulence of strains varies greatlyNatural Mode of Transmission: (for lab hazards see Section VI)Contact with nasal carriers (30-40% of population); from draining lesions or purulent discharges; spread person-to-person;ingestion of food containing staphylococcal enterotoxin (food may be contaminated by food handlers hands); from motherto neonate during delivery.Incubation Period:Variable and indefinite, commonly 4-10 days; disease may not occur until several months after colonization; intervalbetween eating food and onset of symptoms is usually 2-4 hours (30 min to 8 hours)Communicability:As long as purulent lesions continue to drain or carrier state persists; auto-infection may continue for the period of nasalcolonization or duration of active lesionsReservoir:Section III - DisseminationHuman; patients with indwelling catheters or IVs act as reservoirs for nosocomial infections; food borne - occasionally cowswith infected uddersZoonosis:ZOONOSIS: Yes - direct or indirect contact with infected animalsVectors:NoneSusceptibility to Disinfectants:Section IV - ViabilitySusceptible to many disinfectants - 10% bleach, iodine/alcohol solutions, glutaraldehyde, formaldehyde and Clidox.Physical Inactivation:Organisms are destroyed by heat (moist heat - 121° C for at least 15 min, dry heat - 160-170° C for at least 1 hour;enterotoxins are heat resistant, stable at boiling temperatureSurvival Outside Host:Carcass and organs - up to 42 days; floor - less than 7 days; glass - 46 hours; sunlight - 17 hours; UV - 7 hours; meatproducts - 60 days; coins - up to 7 days; skin from 30 min to 38 daysSurveillance:Section V - MedicalMonitor for skin inflammation if wounded by a sharp instrument; isolation of organism from wound or blood, CSF, urine;isolation of >10 5 organisms or enterotoxin from suspected foodImmunization:None availableDrug Susceptibility:Approved by SA-IBC 8/5/2011 SA-IBC Agent Profile Form Page 2 of 4


Many strains are multi-resistant to antibiotics and are of increasing importance; methicillin resistant (MRSA) strains havecaused major outbreaks world-wide; Vancomycin resistant (VRSA) are being increasingly isolated; sensitivity must bedetermined for each strainProphylaxis:NoneClinical Monitoring, including fever watch:Monitor for symptoms (See PATHOGENICITY above).Treatment:Fluid replacement for food poisoning; in localized skin infections, drain abscesses; antibiotic therapy for severe infectionsNewman strain is susceptible to Cefazolin, Ciprofloxacin, Clindamycin, Erythromycin, Gentamicin, Methicilin, Rifampin,Vancomycin, Tetracycline, Synercid, Linezolid, Trimeth/SulfaUSA300 strain is susceptible to Clindamycin, Gentamicin, Rifampin, Vancomycin, Trimeth/SulfaMW2 strain is susceptible to Clindamycin, Erythromycin, Gentamicin, Rifampin, Vancomycin, Trimeth/SulfaRN4220 strain is susceptible to Ciprofloxacin, Clindamycin, Erythromycin, Gentamicin, Oxacilin, Penicillin, Quinupristin/dalfopristin, Teicoplanin, Vancomycin, Trimeth/SulfaA laboratory worker who may have developed a staphylococcal infection with the strains being used in the lab may requireantibiotic therapy. Since staphylococcal infections are also common and could occur with other strains, the followingtreatment approach is recommended.1. If the lab worker has no recent direct or indirect contact with the medical system, i.e., has not been hospitalized or inclose contact with someone recently hospitalized, minor infections, such as minor skin and soft tissue infections, could beempirically treated with oral clindamycin 300-450 mg PO four times a day or TMP/Sx two double strength tablests twice aday. For more serious infections, IV therapy with clindamycin 600-900 mg every 8 hours, bactrim 5 mg/kg every 12 hours,vancomycin 1 gram very 12 hours, should be used. Daptomycin and linezolid are alternative agents for serious infections.2. If the lab worker has had direct or indirect contact with the medical system, the infecting agent may actually be moreresistant. For minor infections, empiric oral therapy with linezolid 600 mg twice a day would adequate. For seriousinfection, IV therapy with vanco, datpomycin, or linezolid would be appropriate.It will be important to have cultures collected to help guide therapy.Section VI - Laboratory HazardsLaboratory-Acquired Infections:29 reported cases up to 1973 with 1 deathSources/Specimens:Clinical specimens - blood, abcesses, lesion exudates, CSF, respiratory specimens, feces, urinePrimary Hazards:Injuries from contaminated sharp instruments; ingestion; aerosolsSpecial Hazards:Direct contact with open cuts and lesions of skinContainment Requirements:Section VII - Recommended PrecautionsApproved by SA-IBC 8/5/2011 SA-IBC Agent Profile Form Page 3 of 4


Biosafety level 2 practices, containment equipment and facilities for activities with cultures or potentially infectious clinicalmaterialsProtective Clothing:Laboratory coat: gloves when skin contact is unavoidableOther Precautions:Thorough handwashing before leaving the laboratory and after handling infectious materialsSpills:Section VIII - Handling InformationImmediately exit room and alert others in the room to exit as well. Wait 30 min to re-enter. Re-enter room and spray spill area with10% bleach or Clidox (being careful not to generate aerosols) and cover with paper towels. Wait 30 min, then pick up paper towels,disposing of them as biohazardous waste. When finished, mop area with 10% bleach or Clidox.Disposal:Decontaminate before disposal; steam sterilization, chemical disinfection of contaminated liquid.Storage:In sealed containers that are appropriately labeled.Section IX - ApprovalAlthough the information, opinions and recommendations contained in this Agent Profile Form are compiled from sourcesbelieved to be reliable, we accept no responsibility for the accuracy, sufficiency, or reliability or for any loss or injury resultingfrom the use of the information. Newly discovered hazards are frequent and this information may not be completely up-todate.Date approved by SA-IBCApproved by SA-IBC 8/5/2011 SA-IBC Agent Profile Form Page 4 of 4

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