Document Type : Review Article


1 Department of Epidemiology and Biostatics, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Tehran, Iran

2 Biotechnology and Biological Science Research Center, Faculty of Science, Shahid Chamran University of Ahvaz, Ahvaz, Iran

3 School of Science and Engineering, Duquesne University, Pittsburgh, PA, USA

4 Department of Food Microbiology, School of Allied Medical Sciences, Iran University of Medical Sciences, Tehran, Iran

5 Department of Bacteriology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran


Staphylococcus aureus is gram-positive cocci, which is consistently one of the four causes of hospital infections. S. aureus is a member of the normal nasal and intestinal flora in 30-50% of the population. But this organism is carried in almost 90% of the clinical staff of hospitals. S. aureus is an important cause of a wide variety of infectious diseases in humans. This bacterium often causes infections such as endocarditis, bacteremia, and pneumonia. S. aureus species are typically resistant to a large number of drugs. These bacteria are able to sustain and grow properly in the hospital environment and are easily transmitted to people who have weak immune systems. So far, methicillin-resistant S. aureus  (MRSA) has been limited to hospitals, but with the increase in skin and soft tissue infections and necrotizing pneumonia in younger patients, methicillin-resistant staphylococci in the community (CA-MRSA) has spread throughout the world.

Graphical Abstract

Staphylococcus aureus in the environment of healthcare centers


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Selected author of this article by journal

Amir Hossein Omidi
Pasteur Institute of Iran

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  1. Becker K, Skov RL, von Eiff C (2015) Staphylococcus, Micrococcus, and other catalase‐positive cocci. Manual of clinical microbiology: 354-382. doi:
  2. O'Riordan K, Lee JC (2004) Staphylococcus aureus capsular polysaccharides. Clinical microbiology reviews 17 (1): 218-234. doi:
  3. Boldock E, Surewaard BG, Shamarina D, Na M, Fei Y, Ali A, Williams A, Pollitt EJ, Szkuta P, Morris P (2018) Human skin commensals augment Staphylococcus aureus pathogenesis. Nature microbiology 3 (8): 881-890. doi:
  4. Alfaiz FA (2021) Molecular studies of immunological enzyme clumping factor B for the inhibition of Staphylococcus aureus with essential oils of Nigella sativa. Journal of Molecular Recognition 34 (12): e2941. doi:
  5. Rahnama M, Fazeli-Nasab B, Mazarei A, Shahriari A (2018) Evaluation of antimicrobial activity hydro alcoholic extract of some medicinal herbs against a range of Gram-positive and gram-negative bacteria. NFVM 1 (1): 1-18. doi:
  6. Fazeli-Nasab B, Rahnama M, Shahriari S (2019) The antimicrobial properties of hydro-alcoholic extracts of 29 medicinal plants on E. Coli and Staphylococcus aureus microbes. NFVM 1 (2): 1-15. doi:
  7. Otto M (2018) Staphylococcal biofilms. Microbiology spectrum 6 (4): 6.4. 27. doi:
  8. Oliveira D, Borges A, Simões M (2018) Staphylococcus aureus toxins and their molecular activity in infectious diseases. Toxins 10 (6): 252. doi:
  9. Kolata J, Bode LG, Holtfreter S, Steil L, Kusch H, Holtfreter B, Albrecht D, Hecker M, Engelmann S, van Belkum A (2011) Distinctive patterns in the human antibody response to Staphylococcus aureus bacteremia in carriers and non‐carriers. Proteomics 11 (19): 3914-3927. doi:
  10. Malayeri FA, Yazdanpour Z, Bandani H, Fazeli-Nasab B, Saeidi S (2020) Antimicrobial and anti-biofilm effects of Thyme essential oils and Peppermint on Acinetobacter baumannii and Staphylococcus aureus resistant to different antibiotics. NFVM 2 (2): 41-51. doi:
  11. Fazeli-Nasab B, Solouki M, Sobhanizadeh A (2021) Green Synthesis of Silver Nanoparticles Using an Ephedra sinica Herb Extract with Antibacterial Properties. Journal of Medical Bacteriology 10 (1,2): 30-47. doi:
  12. Fazeli-Nasab B, Valizadeh M, Beigomi M (2021) The Effect of Artichoke Ethanolic Extract on Antibiotic-Resistant Clinical Strains of Staphylococcus aureus Isolated from Women. Int J Infect 8 (3): e114588. doi:
  13. Fritz SA, Tiemann KM, Hogan PG, Epplin EK, Rodriguez M, Al-Zubeidi DN, Bubeck Wardenburg J, Hunstad DA (2013) A serologic correlate of protective immunity against community-onset Staphylococcus aureus infection. Clinical Infectious Diseases 56 (11): 1554-1561. doi:
  14. Adhikari RP, Ajao AO, Aman MJ, Karauzum H, Sarwar J, Lydecker AD, Johnson JK, Nguyen C, Chen WH, Roghmann M-C (2012) Lower antibody levels to Staphylococcus aureus exotoxins are associated with sepsis in hospitalized adults with invasive S. aureus infections. The Journal of infectious diseases 206 (6): 915-923. doi:
  15. Otto M (2014) Staphylococcus aureus toxins. Current Opinion in Microbiology 17: 32-37. doi:
  16. Berube BJ, Bubeck Wardenburg J (2013) Staphylococcus aureus α-toxin: nearly a century of intrigue. Toxins 5 (6): 1140-1166. doi:
  17. Dinges MM, Orwin PM, Schlievert PM (2000) Exotoxins of Staphylococcus aureus. Clinical microbiology reviews 13 (1): 16-34. doi:
  18. Katayama Y, Baba T, Sekine M, Fukuda M, Hiramatsu K (2013) Beta-hemolysin promotes skin colonization by Staphylococcus aureus. Journal of bacteriology 195 (6): 1194-1203. doi:
  19. Divyakolu S, Chikkala R, Ratnakar KS, Sritharan V (2019) Hemolysins of Staphylococcus aureus—An update on their biology, role in pathogenesis and as targets for anti-virulence therapy. Advances in Infectious Diseases 9 (2): 80-104. doi:
  20. Balasubramanian D, Harper L, Shopsin B, Torres VJ (2017) Staphylococcus aureus pathogenesis in diverse host environments. Pathogens and disease 75 (1): ftx005. doi:
  21. Association AD (2015) Standards of medical care in diabetes—2015 abridged for primary care providers. Clinical diabetes: a publication of the American Diabetes Association 33 (2): 97. doi:
  22. Wertheim HF, Melles DC, Vos MC, van Leeuwen W, van Belkum A, Verbrugh HA, Nouwen JL (2005) The role of nasal carriage in Staphylococcus aureus infections. The Lancet infectious diseases 5 (12): 751-762. doi:
  23. Yamashita K, Kawai Y, Tanaka Y, Hirano N, Kaneko J, Tomita N, Ohta M, Kamio Y, Yao M, Tanaka I (2011) Crystal structure of the octameric pore of staphylococcal γ-hemolysin reveals the β-barrel pore formation mechanism by two components. Proceedings of the National Academy of Sciences 108 (42): 17314-17319. doi:
  24. Aman MJ, Karauzum H, Bowden MG, Nguyen TL (2010) Structural model of the pre-pore ring-like structure of Panton-Valentine leukocidin: providing dimensionality to biophysical and mutational data. Journal of Biomolecular Structure and Dynamics 28 (1): 1-12. doi:
  25. Yoong P, Torres VJ (2013) The effects of Staphylococcus aureus leukotoxins on the host: cell lysis and beyond. Current Opinion in Microbiology 16 (1): 63-69. doi:
  26. Bellido JLM (2017) Mechanisms of resistance to daptomycin in Staphylococcus aureus. Rev Esp Quimioter 30 (6): 391-396. doi:
  27. Bukowski M, Wladyka B, Dubin G (2010) Exfoliative toxins of Staphylococcus aureus. Toxins 2 (5): 1148-1165. doi:
  28. Nishifuji K, Sugai M, Amagai M (2008) Staphylococcal exfoliative toxins: “Molecular scissors” of bacteria that attack the cutaneous defense barrier in mammals. Journal of Dermatological Science 49 (1): 21-31. doi:
  29. Grumann D, Nübel U, Bröker BM (2014) Staphylococcus aureus toxins – Their functions and genetics. Infection, Genetics and Evolution 21: 583-592. doi:
  30. Guo Y, Song G, Sun M, Wang J, Wang Y (2020) Prevalence and therapies of antibiotic-resistance in Staphylococcus aureus. Frontiers in cellular and infection microbiology 10: 107. doi:
  31. Foster TJ (2017) Antibiotic resistance in Staphylococcus aureus. Current status and future prospects. FEMS microbiology reviews 41 (3): 430-449. doi:
  32. Bush K, Bradford PA (2020) Epidemiology of β-lactamase-producing pathogens. Clinical microbiology reviews 33 (2): 10.1128/cmr. 00047-00019. doi:
  33. Ince D, Zhang X, Hooper DC (2003) Activity of and resistance to moxifloxacin in Staphylococcus aureus. Antimicrobial agents and chemotherapy 47 (4): 1410-1415. doi:
  34. Tarai B, Das P, Kumar D (2013) Recurrent challenges for clinicians: emergence of methicillin-resistant Staphylococcus aureus, vancomycin resistance, and current treatment options. Journal of laboratory physicians 5 (02): 071-078. doi:
  35. Turner NA, Sharma-Kuinkel BK, Maskarinec SA, Eichenberger EM, Shah PP, Carugati M, Holland TL, Fowler Jr VG (2019) Methicillin-resistant Staphylococcus aureus: an overview of basic and clinical research. Nature Reviews Microbiology 17 (4): 203-218. doi:
  36. Tong SY, Davis JS, Eichenberger E, Holland TL, Fowler Jr VG (2015) Staphylococcus aureus infections: epidemiology, pathophysiology, clinical manifestations, and management. Clinical microbiology reviews 28 (3): 603-661. doi:
  37. Garg M, Bhargava J, Garg M, Garg S (2021) Isolated myocardial abscess cavity: An incidental finding on intraoperative transesophageal echocardiography. Annals of cardiac anaesthesia 24 (3): 411-414. doi:
  38. Kim IC, Chang S, Hong GR, Lee SH, Lee S, Ha JW, Chang BC, Kim YJ, Shim CY (2018) Comparison of Cardiac Computed Tomography With Transesophageal Echocardiography for Identifying Vegetation and Intracardiac Complications in Patients With Infective Endocarditis in the Era of 3-Dimensional Images. Circulation Cardiovascular imaging 11 (3): e006986. doi:
  39. Ouchi K, Ebihara T, Niitani M, Makino M, Hirose M, Iiduka D, Misumi K (2019) Diagnosis of infective endocarditis with cardiac CT in an adult. Radiology case reports 14 (5): 544-547. doi:
  40. Kosar L, Laubscher T (2017) Management of impetigo and cellulitis: Simple considerations for promoting appropriate antibiotic use in skin infections. Canadian Family Physician 63 (8): 615-618. doi:
  41. Stryjewski ME, Chambers HF (2008) Skin and soft-tissue infections caused by community-acquired methicillin-resistant Staphylococcus aureus. Clinical Infectious Diseases 46 (Supplement_5): S368-S377. doi:
  42. Chaves F, Garnacho-Montero J, del Pozo JL, Bouza E, Capdevila JA, de Cueto M, Domínguez MÁ, Esteban J, Fernández-Hidalgo N, Fernández Sampedro M, Fortún J, Guembe M, Lorente L, Paño JR, Ramírez P, Salavert M, Sánchez M, Vallés J (2018) Diagnosis and treatment of catheter-related bloodstream infection: Clinical guidelines of the Spanish Society of Infectious Diseases and Clinical Microbiology and (SEIMC) and the Spanish Society of Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC). Medicina Intensiva 42 (1): 5-36. doi:
  43. Dugdale DC, Ramsey PG (1990) Staphylococcus aureus bacteremia in patients with Hickman catheters. The American Journal of Medicine 89 (2): 137-141. doi:
  44. Kavanagh N, Ryan EJ, Widaa A, Sexton G, Fennell J, O'Rourke S, Cahill KC, Kearney CJ, O'Brien FJ, Kerrigan SW (2018) Staphylococcal osteomyelitis: disease progression, treatment challenges, and future directions. Clinical microbiology reviews 31 (2): 10.1128/cmr. 00084-00017. doi:
  45. Tande AJ, Patel R (2014) Prosthetic joint infection. Clinical microbiology reviews 27 (2): 302-345. doi:
  46. Nair GB, Niederman MS (2011) Community-acquired pneumonia: an unfinished battle. Medical Clinics 95 (6): 1143-1161. doi:
  47. Aguilar J, Urday-Cornejo V, Donabedian S, Perri M, Tibbetts R, Zervos M (2010) Staphylococcus aureus meningitis: case series and literature review. Medicine 89 (2): 117-125. doi:
  48. Nandhini P, Kumar P, Mickymaray S, Alothaim AS, Somasundaram J, Rajan M (2022) Recent developments in methicillin-resistant Staphylococcus aureus (MRSA) treatment: A review. Antibiotics 11 (5): 606. doi:
  49. Shokouhi S, Darazam IA, Zamanian MH (2017) Community-acquired methicillin-resistant Staphylococcus aureus carriage rate and antimicrobial susceptibility in a tertiary center, Iran. Journal of research in medical sciences : the official journal of Isfahan University of Medical Sciences 22: 71. doi:
  50. Song Z, Gu FF, Guo XK, Ni YX, He P, Han LZ (2017) Antimicrobial Resistance and Molecular Characterization of Staphylococcus aureus Causing Childhood Pneumonia in Shanghai. Front Microbiol 8: 455. doi:
  51. El Aila NA, Al Laham NA, Ayesh BM (2017) Nasal carriage of methicillin resistant Staphylococcus aureus among health care workers at Al Shifa hospital in Gaza Strip. BMC infectious diseases 17 (1): 1-7. doi:
  52. Cimolai N (2008) The role of healthcare personnel in the maintenance and spread of methicillin-resistant Staphylococcus aureus. Journal of Infection and Public Health 1 (2): 78-100. doi:
  53. Marcel JP, Alfa M, Baquero F, Etienne J, Goossens H, Harbarth S, Hryniewicz W, Jarvis W, Kaku M, Leclercq R, Levy S, Mazel D, Nercelles P, Perl T, Pittet D, Vandenbroucke-Grauls C, Woodford N, Jarlier V (2008) Healthcare-associated infections: think globally, act locally. Clinical Microbiology and Infection 14 (10): 895-907. doi:
  54. Jaradat ZW, Ababneh QO, Sha’aban ST, Alkofahi AA, Assaleh D, Al Shara A (2020) Methicillin resistant Staphylococcus aureus and public fomites: a review. Pathogens and Global Health 114 (8): 426-450. doi:
  55. Huis A, Schouten J, Lescure D, Krein S, Ratz D, Saint S, Hulscher M, Greene MT (2020) Infection prevention practices in the Netherlands: results from a National Survey. Antimicrobial Resistance & Infection Control 9 (1): 1-7. doi: