Bakgrund: Meticillinresistenta Staphylococcus aureus (MRSA) ökar drastiskt inom sjukvården både i Sverige och i hela världen. Bakterien sprids vanligast från patient till patient via vårdpersonal då restriktioner om basala hygienrutiner inte följs. Att bli smittad med MRSA kan leda till svåra konsekvenser för patienter i form av infektioner i operationssår, i implanterade proteser, på hjärtklaffar, i lungorna och på hjärnhinnor. Patienter med MRSA vårdas i isolering för att förebygga att MRSA sprids vidare, vilket kan orsaka lidande hos patienter.  Syfte: Denna uppsats syftar till att beskriva patienters upplevelser av MRSA-vård.  Metod: Nio vetenskapliga kvalitativa artiklar ligger till grund för denna litteraturöversikt. Artiklarna har analyserats och sammanställts och nya teman uppkom efter de likheter som framkom i deras resultatdelar.  Resultat: Resultatet visar att vårdandet förändrades efter MRSA-diagnos. Detta redovisas efter följande i sex teman och två subteman: Patienters kunskap om MRSA, Upplevelser av att bli smittad med MRSA, Patienters upplevelser av personalens kunskap och information, Upplevelser av personalens bemötande, Isolering med två subteman: Negativa upplevelser av isolering och Positiva upplevelser av isolering samt Oro för framtid.  Diskussion: Resultatet diskuteras utifrån Katie Erikssons teori om den lidande människan som teoretisk utgångspunkt och utifrån patientens perspektiv. Vårdpersonalen kan påverka hur vårdandet upplevs. Brister i kunskap om MRSA hos vårdpersonalen, deras bemötande och följsamheten till hygienrutiner orsakar vårdlidande hos patienter med MRSA. Sjuksköterskans roll är att förebygga/lindra lidandet hos patienter. / Background: Methicillin-resistant Staphylococcus aureus (MRSA) is increasing drastically in healthcare both in Sweden and worldwide. The bacteria is spread most commonly from patient to patient by health-care professionals when restrictions on basic hygiene is not followed. Becoming infected with MRSA can lead to severe consequences for the patients in terms of surgical site infection, the implanted prostheses, the heart valves, lungs, the meninges. Patients with MRSA are cared for in isolation to prevent MRSA from spreading further, which could cause distress in patients.  Aim: This paper aims to describe patients' experiences of MRSA care.  Methods: Nine scientific qualitative articles form the basis of this literature review. The articles were analyzed and compiled, and new themes emerged after the similarities that emerged from their performance parts.  Results: The result shows that caring changed after MRSA diagnosis. This is recognized by the following six themes and two subthemes: Patients' knowledge about MRSA, Experiences of becoming infected with MRSA, Patients experiences of staff knowledge and information, experiences of treatment by staff, isolation with two subthemes: Negative experiences of isolation and positive experiences of isolation and Concerns for the future.  Discussions: The results are discussed from the patient's perspective, with Katie Erikson's theory of the suffering person as a theoretical base. The nursing staff can affect how caring is experienced. Deficiencies in knowledge of MRSA in health care staff, their attitude and adherence to hygiene causes health suffering in patients with MRSA. The nurse's role is to prevent / alleviate the suffering of patients.

Methicillin-resistant Staphylococcus aureus (MRSA) is a pandemic human pathogen accounting for most of health-care associated infections throughout the world. However, in recent years, a more virulent strain of MRSA has emerged in the community defined as community-associated MRSA (CA-MRSA). These emerging strains of CA-MRSA are described to have different antibiotic susceptibility profiles, possess the SCCmec type IV element and usually produce the Panton-Valentine leukocidin (PVL) toxin. The majority of these CA-MRSA strains are associated with skin and soft tissue infections and necrotising pneumonia, with a 34% mortality rate. Identification and characterisation of MRSA isolates is mainly performed using phenotypic methods, which are time consuming. Little information exists on the prevalence and characteristics of MRSA isolates including antibiotic susceptibility patterns, PVL-producing CAMRSA strains, the SCCmec types and genotypes that might be circulating in the Steve Biko Academic Hospital. Identification and characterisation of MRSA isolates based on these criteria are important in controlling possible outbreaks in the clinical setting. In this study, 97 clinical MRSA isolates from the Steve Biko Academic Hospital, South Africa were collected between April 2006 to February 2007. These isolates were analysed and characterised using multiplex PCR (M-PCR), real-time PCR as well as staphylococcal protein A (spa) and hyper-variable region (HVR) typing. The aim of this study was to determine the antibiotic profiles, prevalence of MRSA isolates, the SCCmec types and the genotypes. Antibiotic susceptibility determination was performed using the disk diffusion susceptibility method as guidelined by the CLSI. Six distinct antibiotypes were identified with a total of 73%, 71%, 70% and 7% of MRSA isolates resistant to clindamycin, erythromycin, gentamicin and fusidic acid, respectively. The presence of Staphylococcus aureus specific 16S rRNA, the mecA and PVL genes was determined using a modified M-PCR assay. A total of 4% of the MRSA isolates possessed the PVL gene. Real-time PCR analysis also showed a 100% prevalence of the PVL gene in the same 4% MRSA isolates confirming the results of the first M-PCR assay. The second M-PCR was used to determine the SCCmec type prevalence and to distinguish between health-care associated MRSA (HA-MRSA) and CA-MRSA. SCCmec typing showed 67% of the isolates belonged to SCCmec type II and 14.4% SCCmec type III, both types belonging to HA-MRSA. A total of 4% of the MRSA isolates were CA-MRSA belonging to SCCmec type IVd. Genotyping results showed three distinct spa clusters whilst HVR showed six distinct clusters. Molecular-based assays proved to be useful tools to determine the prevalence and monitoring of MRSA outbreaks as well as to identify the SCCmec types, subtypes and genotypes of MRSA strains that might be circulating in the hospital. The determination of the different antibiotypes of MRSA can assist in the monitoring of the antibiotic resistant profile trends in the Steve Biko Academic Hospital, thus assisting with the correct implementation of antibiotic regimens for suspected MRSA infections. In an endeavour to assess the dissemination of MRSA strains especially PVL expressing CA-MRSA strains, it is of paramount importance to continuously monitor the emergence of these strains in clinical settings. Copyright / Dissertation (MSc)--University of Pretoria, 2010. / Medical Microbiology / unrestricted

ABSTRAKT Bakgrund: Den resistenta bakterien MRSA- Meticillinresistent Staphylococcus Aureus har kommit att bli ett globalt problem. Studier har påvisat att individer med MRSA som vårdas i isolering upplever förvirring över sitt sjukdomstillstånd då informationen om infektionen är bristfällig, som bland annat kan ge uttryck i rädsla samt oro hos patienter.   Syfte: Syftet med litteraturstudien är att belysa hur isolering upplevs av personer med MRSA.     Metod: Denna litteraturstudie baserades på tio vetenskapliga artiklar med kvalitativ ansats. Resultaten har analyserats och sammanställts till ett resultat.   Resultat: Det analyserade materialet presenteras i tre huvudkategorier och tio underkategorier. Huvudkategorierna omfattar: Att lida i utanförskap, Att leva i fångenskap och Att hantera sin situation.   Konklusion: Övervägande i resultatet var de negativa känslorna hos patienterna. Patienterna upplevde till stor del tristess, ensamhet och en känsla av fångenskap, medan ett fåtal föredrog att vara ensam och uppskattade isoleringen. För patienter kan deras upplevelse förbättras om det från deras perspektiv kommer fram fler studier om hur det är att vara isolerad med MRSA. Det är viktigt för patienternas välbefinnande att belysa kunskapsluckor som finns och att bedriva mer forskning med utgångspunkt hos patienterna. / ABSTRACT Background: The resistant bacterium MRSA Metacillinresistent Staphylococcus aureus has become a globalproblem. Studies have shown that individuals with MRSA who have been treated in isolation experiencing confusion over their illness when the information on the infection is poor, and it can express fear and anxiety in patients.   Aim: The purpose of this study is to explore how the isolation experienced by people with MRSA.   Method: This study was based on ten scientific articles with qualitative approach. The results have been analyzed and compiled to a result.   Results: Data is presented in three main categories and ten subcategories. Main categories include: Suffering in isolation, To live in captivity and To cope with the situation.     Conclusion:  Predominant in the results was the negative emotions of patients. Patients experienced largely boredom, loneliness and a sense of imprisonment, while a few preferred to be alone and appreciated the insulation. Patients can improve their experience of it from their perspective appears more studies on how it is to be insulated with MRSA. It is important for the patients well-being to highlight knowledge gaps and to conduct more research on the basis of the patients.

No description available.

Community-onset (CO) methicillin-resistant Staphylococcus aureus (MRSA) pneumonia is an evolving problem, and there is a great need for a reliable method to assess MRSA risk at hospital admission. A new MRSA prediction score classifies CO-pneumonia patients into low, medium, and high-risk groups based on objective criteria available at baseline. Our objective was to assess the effect of initial MRSA therapy on mortality in these three risk groups. We conducted a retrospective cohort study using data from the Veterans Health Administration. Patients were included if they were hospitalized with pneumonia and received antibiotics within the first 48 hours of admission. They were stratified into MRSA therapy and no MRSA therapy treatment arms based on antibiotics received in the first 48 hours. MRSA risk groups were analyzed separately. The primary outcome was 30-day patient mortality. Multivariable logistic regression was used to adjust for potential confounders. A total of 80,330 patients met inclusion criteria, of which 36% received MRSA therapy and 64% did not receive MRSA therapy. The majority of patients were classified as either low (51%) or medium (47%) risk, with only 2% classified as high-risk. In the high-risk group, unadjusted 30-day mortality was lower among patients who received initial MRSA therapy (40% versus 58%; p<0.0001). Likewise, multivariable logistic regression analysis also demonstrated that initial MRSA therapy was associated with a lower 30-day mortality in the high-risk group (adjusted odds ratio 0.57; 95% confidence interval 0.42-0.77). There was no benefit of initial MRSA therapy in the low or medium-risk groups. This study demonstrated improved survival with initial MRSA therapy in high-risk CO-pneumonia patients. The MRSA risk score should not replace clinical judgment, but it might be a useful tool to spare MRSA therapy for only those patients who are most likely to benefit. / text

Introduktion: Meticillin-resistenta Stafylokocker aureus (MRSA) utgör ett globalt hot tillika ett folkhälsoproblem. En åtgärd mot smittspridning av MRSA är vård i isolering vilken tidigare har visats sig ge upphov till psykisk påfrestning. Under vårdtiden är det av värde att vårdspersonalen förstår patientens känslor och upplevelser för att kunna möta dessa. Syfte: Syftet var att belysa patientens upplevelse av vård i isolering i samband med MRSA. Metod: Studien gjordes som en litteraturstudie baserad på tio vetenskapliga artiklar som kvalitetsgranskats. Artiklarna bearbetades induktivt där vitala delar markerades och översattes. Resultatet: Analysen genererade fyra teman: ”Patientens upplevelse av hur den fysiska miljön påverkar isolering”, ”Patientens upplevelse av information angående isolering”, ”Patientens självuppfattning i samband med isolering” samt ”Patientens upplevelse av förändrade relationer”. Den dominerande upplevelsen av isolering var negativ. Det framkom även att isoleringen kunde upplevas positiv i olika kontext. Slutsats: Isolering gav patienterna varierande känslor. För att minska förekomsten av psykisk stress hos den isolerade patientgruppen bör varje patient få utbildning som förklarar isoleringen och dess effekt. Målet med isoleringen bör vara att låta patienters fysiska hälsa förbättras utan att försämra deras mentala hälsa.

In dieser Arbeit wurde das in vitro Wachstumsverhalten ausgesuchter MRSA in Konkurrenz zu Bakterien der Standortflora unter Optimalbedingungen und unter Mangelbedingungen getestet. Es lässt sich für alle getesteten MRSA-Stämme zusammenfassend sagen, dass ihre klinische Prävalenz nicht mit dem Wachstum in vitro korreliert, d.h. das häufige Spa-Typen nicht besser unter unseren Versuchbedingungen gewachsen sind als seltene. In vitro konnte kein verdrängendes Wachstum des Methicillin sensiblen S. aureus gegenüber den resistenten Stämme beobachtet werden. Vielmehr gelingt es den MRSA-Stämmen, ein Wachstumsgemisch zu ihrem Vorteil zu beeinflussen, indem sie die getesteten anderen Mikroorganismen (S. epidermidis, S. cerivisiae) im Wachstum hemmen, mit Ausnahme von E. faecium. Die Arbeit beleuchtet die Schwierigkeiten der Identifizierung von probiotischen Arten zur Verdrängung eines MRSA. In Zukunft sollte vielleicht an der Optimierung von in vitro Systemen gearbeitet werden (in vitro Organkulturen) oder Tiermodelle verwendet werden. Den Transmissionsunterschieden und der Tenazität sind weiterhin Aufmerksamkeit zu widmen. Wie in der Literatur beschrieben ist es zum Verständnis des Wachstumsverhal-tens der resistenten Stämme wichtig zu wissen, auf welchen molekularbiologischen Grundlagen die Resistenz beruht, da eine einzelne Site-Mutation zusätzliche Resistenzen bedeuten und einen eventuellen Wachstumsnachteil wieder ausgleichen kann. Im Klinikalltag scheinen sich die MRSA-Stämme auszubreiten, die den Wachstumsnachteil bereits ausgeglichen haben, beziehungsweise deren Methicillinresistenz keinen Wachstumsnachteil bedeutet. / The competitive in vitro growth of selected MRSA-Clones in comparison to bacteria from the human skin and probiotic bacteria respectively are evaluated in this study. There was no proof of in vitro growth advantage for the common MRSA-Clones in comparison to the uncommonly found MRSA-Clones in clinical samples. This concludes that there must be a different reason for the spreading of the commonly found MRSA-Clones other than the growth rate. The competitive growth analysis with bacteria of the human skin (S. epidermidis, Methicillin susceptible S. aureus), E. faecium and probiotic bacteria (S. cerivisiae) showed, that none of the tested bacteria could decrease the growth rate of the MRSA-Clones in clinical relevant concentrations. Methicillin resistence shows a growth rate decrease for some MRSA-clones as described in the literature. By contrast, the results of this study reveal, that the clinical acquired MRSA-clones must have somehow compensated for the growth disadvantage.

Hintergrund: Zunehmend wird der Eigenschaft von Staphylococcus aureus als fakultativ intrazellulärem Erreger Bedeutung zugemessen. Ein direkter Nachweis der in vivo Relevanz von fakultativ intrazellulärem S. aureus bleibt allerdings bisher aus. Der Mechanismus zellulärer Invasivität ist bekannt und korreliert mit verschiedenen molekularen Markern (spa-Typ, SCCmec-Typ und pls/Pls). In dieser Studie wurde die Zuverlässigkeit und Ausweitbarkeit dieser Marker getestet. Des Weiteren wurde überprüft, ob sich die zelluläre Invasivität von kolonisierenden und Infektions-assoziierten MRSA-Isolaten unterscheidet und, ob die alleinige Bestimmung molekularer Marker in vitro die Virulenz eines Isolats in vivo abzuschätzen vermag. Methoden:Insgesamt wurden 109 MRSA-Isolate gesammelt, molekular charakterisiert (spa-Typ, BURP-Analyse, SCCmec-Typ, pls, agr-Typ, Hämolyseverhalten) und das Potential zellulärer Invasivität in vitro ermittelt. Die Assoziation eines Isolates mit einer Infektion in vivo wurde nachverfolgt (93 Kolonisierer versus 16 Infektions-assoziierte-Isolate). Zusätzlich wurde eine Referenzgruppe aus 13 S. aureus-Isolaten etabliert, die klinisch mit vergleichsweise invasiven Infektionen assoziiert waren (12 Osteomyelitis-Isolate und 1 Endokarditis-Isolat). Ergebnisse: Die bekannten molekularen Marker zellulärer Invasivität korrelieren zuverlässig in einer Population klinischer MRSA-Isolate und lassen sich auch auf bisher nicht bekannte (spa- und SCCmec-) Typen ausweiten. Das Hämolyseverhalten korrelierte nicht mit der zellulären Invasivität. Der agr-Typ wurde als weiterer molekularer Marker identifiziert. Die zelluläre Invasivität war unabhängig von der Etablierung einer Infektion in vivo (mediane Invasivität der Kolonisierer 100% versus 108% der Infektions-assoziierten Studienisolate und 110% der externen Referenzisolate). Des Weiteren waren die molekularen Marker spa- und agr-Typ nicht in der Lage, die Virulenz eines MRSA-Isolats in vivo abzuschätzen. Diskussion: Die zelluläre Invasivität klinischer MRSA-Isolate korreliert zuverlässig mit molekularen Markern. Allerdings vermögen weder die zelluläre Invasivität, noch mit ihr assoziierte molekulare Marker die Etablierung einer Infektion in vivo vorherzusagen. Beide scheinen also als Surrogat-Parameter zur Abschätzung der klinischen Virulenz eines Isolats ungeeignet. Zur Klärung der Frage, ob molekulare Marker zellulärer Invasivität in anderen Abschnitten der Pathogenese von S. aureus- Infektionen eine Rolle spielen, bedarf es weiterer Studien. / Background: Fibronectin-binding of S. aureus is reported to correlate with the propensity to cause invasive infections. Cellular invasion of S. aureus is Fn dependent and clusters with molecular markers (spa type, SCCmec, Pls). Here, we tested the hypothesis that cellular invasiveness and corresponding molecular markers predict the propensity to cause infections in a prospective cohort. Methods: 109 clinical MRSA isolates were characterized (agr, spa, BURP, SCCmec, pls) and cellular invasiveness was determined. Association with clinical infection was assessed (93 colonizing vs. 16 infecting isolates). Further 13 S. aureus isolates from patients with severe S. aureus infections served as an external comparison. Results: The agr type was identified as a new marker for invasiveness and known molecular markers were corroborated. Establishment of infection was independent from cellular invasiveness of MRSA (mean colonizing vs. infecting isolates 100% and 89%, respectively; external infecting isolates: 109%). Furthermore agr and spa types were unable to predict clinical behavior. Conclusion: Cellular invasiveness of MRSA isolates clusters reproducibly with molecular markers. However, cellular invasiveness and molecular markers cannot predict establishment of infection. This suggests that both criteria may not be used as surrogate parameters for the virulence potential of human MRSA isolates.

<p>Syftet med studien var att beskriva och jämföra vårdpersonalens kunskaper om MRSA och ESBL samt kunskaper om hygienrutiner inom primärvården före och efter en hygienutbildning.</p>

Syftet med studien var att beskriva och jämföra vårdpersonalens kunskaper om MRSA och ESBL samt kunskaper om hygienrutiner inom primärvården före och efter en hygienutbildning.