Book Review

The Staphylococci in Human Disease

N Engl J Med 1998; 338:136-137January 8, 1998

Article

The Staphylococci in Human Disease
Edited by Kent B. Crossley and Gordon L. Archer. 682 pp., illustrated. New York, Churchill Livingstone, 1997. $115. ISBN: 0-443-07644-8

This comprehensive, highly readable, multiauthored book is a fitting prelude to the “genomic era” of the staphylococcus that is upon us. The complete genomic sequence of the Staphylococcus aureus 8325 chromosome (approximately 2.8 Mbp) has been elucidated and will soon be available to the research community. Some 1400 genes have been identified that specify proteins similar to those previously described in other organisms, and more than 1000 additional genes with unknown functions have yet to be deciphered. This book is therefore particularly timely. Crossley and Archer “have assembled most of the `stars' currently studying staphylococci and their infections” to update the burgeoning knowledge of these medically and commercially important microorganisms. This book covers the microbiology, epidemiology, molecular biology, and genetics of infections by staphylococci, as well as virulence, host defense, antibiotic resistance, diagnosis, treatment, and prevention. The book complements the previously published proceedings of the International Symposium on Staphylococci and Staphylococcal Infections (1966, 1973, 1976, 1981, 1985, 1991, and 1994), which are among the most important references for both clinical and basic-science investigators in this field. A related book, Molecular Biology of the Staphylococci, edited by Richard P. Novick and published in 1990 (New York: VCH), summarized the progress in our understanding of the biology and pathobiology of staphylococci as studied with modern tools of molecular biology; this book is also of great value, but it was not compiled specifically with the clinician in mind. The book by Crossley and Archer has largely remedied this problem.

This book has four sections: microbiology and pathogenesis, epidemiology, diseases, and treatment and prevention. There are 28 chapters. The main strength of the book is its comprehensive approach, combining current knowledge of the microbiology, genetics, and molecular biology of these important microorganisms with a clinical focus on the epidemiology, manifestations, diagnosis, and treatment of the infections they cause. There are outstanding discussions of the molecular basis of pathogenicity (clear and concise), laboratory procedures for epidemiologic analysis (critical and insightful), toxic shock syndrome and toxin-mediated syndromes (up to date and thorough), and vaccine-based strategies for prevention (provocative and enlightening). Fekety's chapter, which provides a historical perspective on staphylococcal diarrhea and enterocolitis, was particularly a pleasure to read.

The book has some weaknesses as well, although none are serious. Redundancies in a number of chapters could have been minimized — for example, the discussions of host defenses (in chapter 8) and infections in immunocompromised patients (in chapter 25), parenteral antibiotics (in chapter 26) and oral antibiotic therapy (in chapter 27), taxonomy (in chapter 5) and laboratory identification (in chapter 9), and ecology and habitat (in chapter 5) and staphylococcal skin carriage (in chapter 16). The relative lack of emphasis on and correlation between identified virulence factors and specific clinical syndromes (with the exception of bacteremia and endocarditis) is disappointing. A more critical appraisal of diagnostic tools for specific (especially deep-seated) infections would have been useful. The decision not to devote separate chapters to coagulase-negative staphylococci detracts somewhat from the importance of these prominent nosocomial pathogens, about which there remain considerable uncertainties and misconceptions regarding taxonomy, biology, and clinical significance.

Notwithstanding these minor deficiencies, the editors have done a superb job of compiling and organizing a vast and rapidly expanding body of knowledge and presenting it as a cohesive, informative, and highly readable reference source that will be invaluable to both practicing physicians and basic scientists with an interest in staphylococci and staphylococcal infections. I can recommend this book with great enthusiasm.

Anthony W. Chow, M.D.
University of British Columbia, Vancouver, BC V5Z 1M9, Canada