Bakgrund Meticillinresistent Staphyloccus aureus är ett hälsoproblem som har en ökad spridning och är en aktuell hälsofråga som berör sjukvården. Anledningen till den ökade spridningen är bland annat dålig handhygien samt för lite kunskap inom ämnet. En strategi för minskning av spridningen av MRSA är att se till att patienten får eget rum för avskildhet. Sedan är det av vikt att patienter som bär MRSA får förmedla sina tankar och upplevelser för att få sina behov tillgodosedda. Syfte Syftet var att beskriva patienters upplevelse av meticillinresistent staphylococcus aureus på sjukhus. Metod Denna litteraturöversikt har fullföljts av nio kvalitativa vetenskapliga artiklar samt en kvantitativ vetenskaplig artikel. Artiklarna som använts har hämtats från databaserna CINAHL Complete och PubMed och utvärderas i enhet med Fribergs metod. Resultat Resultatet presenteras i två huvudteman: Känslan av att vara MRSA bärare och skam, samt stigma och kontakten med närstående. Upplevelsen av vård för MRSA bärare innebär isolering, förändringar i kontakten med vårdpersonal samt vårdpersonalens otillräckliga kunskaper inom ämnet. Diskussion Litteraturöversiktens resultat diskuteras med hjälp av Katie Erikssons teori som handlar om lidande med tre begrepp i fokus: Sjukdomslidande, Vårdlidande och Livslidande. Det som främst diskuteras är kunskapsbrist, isolering och vårdpersonals bemötande. / Background Methicillin-resistant Staphylococcus aureus (MRSA) is a concern in healthcare as it is becoming more widespread and is a current health issue that is commonly found in healthcare settings. The reason for the increased spread is, among other things, poor hand hygiene and too little knowledge on the subject. One strategy for reducing the spread of MRSA is to ensure that the patient has his or her room for privacy. Furthermore, it is essential that patients who carry MRSA are allowed to convey their thoughts and experiences in order to have their needs met. Aim The aim is to bring out the patient’s feelings about living with MRSA in hospital. Method This literature review has been completed by teen qualitative scientific articles. The articles used have been retrieved from the CINAHL Complete and PubMed databases and are assessed andevaluated following Friberg's method. Results The result depicts two main themes: are divided into subgroups. The feeling of being an MRSA carrier and the feeling of shame. As well as stigma and contact with relatives. The experience of the care of MRSA carriers who have themes: isolation, contact with health professionals and insufficient knowledge of the subject. Conclusion The results of the literature review are discussed on the basis of Katie Eriksson's theory of suffering with the following concepts in focus: disease suffering, care suffering and life suffering. The main findings discussed are lack of knowledge, isolation and the treatment of health care professionals.

Meticillinresistent Staphylococcus Aureus (MRSA) är en bakterie som är resistent mot olika typer av antibiotika. Spridningen av MRSA utgör ett hot mot modern medicin och möjligheten till en effektiv behandling och vård. Hälso- och sjukvårdspersonal bör arbeta förebyggande för att på så vis minska spridningen av MRSA, vilket är en viktig del av arbetet mot antibiotikaresistens. Hälso- och sjukvårdspersonalen är de som är i frontlinjen för att vårda patienter med MRSA, därmed fokuserar denna studie på deras upplevelser av att vårda dessa patienter. En litteraturöversikt genomfördes och resultatet visar att det finns kunskapsskillnader mellan hälso- och sjukvårdspersonal. Mängden kunskap påverkar även hälso- och sjukvårdspersonalens attityd av att vårda MRSA - smittade patienter. Det framkommer att hälso- och sjukvårdspersonalen är rädda för att bli smittade av MRSA, vilketupplevs skapa en barriär mellan hälso- och sjukvårdspersonal och patient. Denna rädsla kan prägla vården som ges vilket kan riskera att drabba patienterna negativt med en känsla av att vården distanseras som följd. Dessutom anses tidsbrist vara en faktor som gör det svårare att förebygga infektioner och kan leda till en bristande handhygien. Sammanfattningsvis medför en ökad kunskap om MRSA att hälso- och sjukvårdspersonalen känner sig säkrare och tryggare i sitt vårdande jämfört med de med lite kunskap, som ofta är rädda och kan överdriva användandet av handskar och desinfektionsmedel. / Methicillin Resistant Staphylococcus Aureus (MRSA) is a bacteria that is resistant to several forms of antibiotics. The spread of MRSA thus possess a threat to modern medicine and the possibility of effective treatment and care. To reduce the risk of MRSA spreading, healthcare professionals should work preventively, which is an important part of the work regarding antibiotic resistance. Due to the fact that healthcare professionals are those in the frontlines in the care of patients with MRSA, this study focuses on their experiences caring for said patients. Furthermore, a literature overview was used to perform this study. The result shows that there are differences in knowledge between the healthcare professionals. The amount of knowledge is also found to influence the attitude of healthcare professionals in caring for MRSA-infected patients. The results also showed that healthcare professionals were afraid of being infected by MRSA themselves. This fear could be reflected in their care which risked affecting the patients negatively with a feeling of isolation as a result. Furthermore, increased workload and lack of time was seen as a factor that made it more difficult to prevent infections and could lead to a poor execution of hand hygiene. In conclusion, Increased knowledge regarding MRSA made the healthcare workers more secure and comfortable in their care in comparison to those with little knowledge who were often scared and exaggerated their use of gloves and disinfection.

Bakgrund: MRSA är en antibiotikaresistent bakterie med hög virulens. Bakterien kan orsaka infektioner i kroppen som är svåra att bli av med på grund av resistensen. MRSA hanteras utifrån specifika riktlinjer som bland annat innebär att patienter inom slutenvård vårdas i isolering. Syfte: Syftet med litteraturstudien var att belysa upplevelser hos patienter med MRSA i vården. Metod: Litteraturstudien grundades på tio primärstudier med kvalitativ ansats som togs fram genom strategiska sökningar i tre databaser, CINAHL, PubMed och Sage Journals. Resultat: Analysen resulterade i fyra kategorier med fyra subkategorier. Kategorierna var Vårdpersonalens kunskap, Bemötande från vårdpersonal, Att vara isolerad och Att bli stigmatiserad. Patienterna med MRSA hade varierande upplevelser men övervägande var negativa upplevelser av vården där en stor bidragande orsak var kunskapsbrist hos vårdpersonalen. Upplevelserna av isolering samt stigmatisering frambringade känslor av bland annat rädsla, frustration och ilska. Vårdpersonalens användning av skyddskläder påverkade bemötandet mellan personal och patient negativt. Konklusion: Patienternas negativa upplevelser i vården påverkades delvis av vårdpersonalens bemötande och kunskap, att vara isolerad samt att bli stigmatiserad. För att kunna ge patienter med MRSA god omvårdnad krävs kompetenta sjuksköterskor samt annan vårdpersonal som besitter kunskap om MRSA och förståelse för patienter med bakterien. / Background: MRSA is an antibiotic-resistant bacterium with high virulence. The bacteria can cause infections in the body that are difficult to get rid of because of its resistance. MRSA is managed based on specific guidelines which, among other things, means that patients in inpatient care are cared for in isolation. Aim: The aim of this literature review was to shed light on the experiences of patients with MRSA in healthcare. Method: The literature review was based on ten primary studies with a qualitative approach that were sought out through strategic searches in three different databases, CINAHL, PubMed and Sage Journals. Results: The analysis resulted in four categories with four subcategories. The categories were The healthcare professionals' knowledge, Treatment from healthcare professionals, Being in isolation, and To be stigmatized. The patients with MRSA had varying experiences, with predominantly negative experiences of the care, where a major contributing reason was a lack of knowledge on the part of the care staff. The experiences of isolation and stigmatization produced feelings of, among other things, fear, frustration and anger. The healthcare staff's use of protective clothing negatively affected the interaction between staff and patient. Conclusion: The patients' negative experiences in care were affected by the care staff's lack of treatment and knowledge, as well as being isolated and being stigmatized. To be able to provide good nursing care to patients with MRSA, competent nurses and other healthcare personnel who possess knowledge of MRSA and an understanding of patients with the bacteria are required.

Bakgrund: Methicillin-resistent Staphylococcus aureus (MRSA) är en variant av gula stafylokocker som är resistenta mot meticillin vilket resulterar i att MRSA är svår behandlat. MRSA är infektioner som finns på bland annat huden och i slemhinnor, bakterien kan orsaka svåra livshotande infektioner. Vilket resulterar i ett stort lidande för patienten och höga samhällskostnader. Syfte: Syftet var att beskriva faktorer i sjuksköterskans omvårdnadsarbete som kan påverka smittspridningen av Methicillin-resistent Staphylococcus aureus (MRSA). Metod: Denna litteraturöversikt utgår från åtta kvalitativa och kvantitativa vetenskapliga artiklar som systematiskt söktes fram i databaserna PubMed och Cinahl Complete. Artiklarnas resultat tematiserades enligt Fribergs analysmodell. Resultat: Resultatet visade att sjuksköterskor behöver få mer kunskap genom upprepade utbildningar av MRSA och smittspridning samt ha en god handhygien för att påverka smittspridning. De hygienrutiner och riktlinjer som finns angående MRSA och smittspridning behöver utvecklas och förtydligas.  Sammanfattning: Sjuksköterskor behöver ta ansvar för sin yrkesmässiga utveckling genom att initiera utbildning för att kunna bidra till en säker vård. Sjuksköterskor behöver ta ansvar för att ständigt utvecklas och söka nya kunskaper. Kunskap och utbildning bidrar till evidensbaserad vård vilket kan förhindra smittspridning av MRSA. / Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a variant of staphylococcus aureus that is resistant to methicillin, which results in MRSA being difficult to treat. MRSA infections can be found on the skin and in mucous membranes of afflicted patients. Which results in great suffering for the patient and high societal costs. Aim: The aim of this study was to describe how nurse’s nursing care can affect spread of infection of Methicillin-resistant Staphylococcus aureus (MRSA). Method: This literature review is based on eight qualitative and quantitative scientific articles that were systematically searched in the databases PubMed and Cinahl Complete. The results of the articles were themed according to Friberg's analysis model. Results: The results showed that nurses need to gain more knowledge through repeated training on MRSA and the spread of infection and have good hand hygiene to affect spread of infection. The hygiene routines and guidelines that exist regarding MRSA and the spread of infection need to be developed and clarified. Summary: Nurses need to take responsibility for their professional development by initiating training in order to contribute to safe care. Nurses need to take responsibility for constantly developing and seeking new knowledge. Knowledge and education contribute to evidence-based care, which can prevent the spread of MRSA.

Made available in DSpace on 2014-07-29T15:30:34Z (GMT). No. of bitstreams: 1 AnaClaudiaOliveira.pdf: 1839747 bytes, checksum: 682694e3fdf66bf0d190f094c4aaa106 (MD5) Previous issue date: 2010-04-15 / Methicillin-resistant Staphylococcus aureus (MRSA) has been one of the most prevalent microorganisms that cause hospitals infections worldwide. Several studies show that this microorganism is often found colonizing health professionals. MRSA can cause skin infections from the severe pneumonia, with high resistance to different antimicrobial agents. This study aimed to evaluate morphometric changes in MRSA isolated from the saliva of health professionals, through the use of different concentrations of oxacillin and sodium chloride. The identification of morphological changes was assessed by growing the isolates in the following concentrations of Sodium Chloride and oxacillin: 2&#956;g, 4&#956;g and 6&#956;g and 2%, 4%, 6% and 7.5% and using the means of computerized morphometry. This technique was tested by microscopic computed by employing the software Image J 1.38 (HIH USA). Statistical analysis was performed using the Sigma Stat, version 2.03, and the differences between the groups were compared using the nonparametric Kruskal-Wallis (p <0.05). The 20 MRSA analyzed showed no alterations. The present study showed that Sodium Chloride and oxacilin at concentrations did not alter the development and morphology of MRSA. / Staphylococcus aureus meticilina resistentes (MRSA) têm sido um dos microorganismos causadores de infecções mais prevalentes nos hospitais em todo mundo. Vários estudos demonstram que estes germes são frequentêmente encontrados colonizando profissionais de saúde. MRSA podem causar desde infecções cutâneas a pneumonias graves, apresentando um perfil multirresistente frente aos antimicrobianos. Este estudo teve como objetivo avaliar alterações morfométricas em MRSA isolados da saliva de profissionais de saúde, mediante o emprego de diferentes concentrações de cloreto de sódio e oxacilina. A identificação de alterações morfológicas foi avaliada por meio do cultivo dos isolados nas seguintes concentrações de Cloreto de Sódio e oxacilina: 2&#956;g, 4&#956;g e 6&#956;g e 2%, 4%, 6% e 7,5% e da utilização da técnica de morfometria computadorizada, mediante o emprego do software Image J 1.38 (HIH USA). A análise estatística foi realizada empregando o programa Sigma Stat, versão 2.03, e as diferenças entre os grupos foram comparadas usando o teste não paramétrico de Kruskal-Wallis, (p<0,05). Os 20 MRSA analisados não apresentaram alterações morfológicas. O presente estudo observou que o Cloreto de Sódio e a oxacilina nas concentrações testadas não alteram o desenvolvimento e a morfologia dos MRSA.

Charles University in Prague, Faculty of Pharmacy in Hradec Králové Department of Biological and Medical Sciences Student: Bc. Lucie Polenová Supervisor: MUDr. Pavla Paterová Title of diploma thesis: Detection of methicillin - resistant Staphylococcus aureus (MRSA) in Hospital České Budějovice, a. s. and in University Hospital Hradec Králové The resistance of microbes to antibiotics belongs to worldwide health problems. Infections, which are caused by methicillin-resistant Staphylococcus aureus (MRSA), occur mainly in hospitals. It is because of incorrect and excesive consumption of antibiotics. Insufficient observance of hygienic-epidemiological measures helps to spread resistant strains. Background: The aim of the study was to determine the incidence of MRSA strains in two Czech hospitals - in Hospital České Budějovice, a.s. and in University Hospital Hradec Králové. To compare results with figures in the previous years and sort isolated strains by different characteristics in both hospitals. Methods: Results of the study are based on retrospective data analysis from electronic database. All data from hospitalized patients or outpatients during 1.1.2015 - 31.12.2015 with isolation of MRSA were counted. Processing and cultivation of isolates were made by standard microbiology measures. Strains,...

Staphylococcus aureus resistente à meticilina (MRSA, Methicillin-Resistant Staphylococcus aureus) é um dos principais responsáveis por infecções nosocomiais, sendo identificado também em infecções associadas à comunidade. Embora potentes fármacos anti-estafilocócicos estejam disponíveis, as infecções causadas por este patógeno continuam a apresentar significativa morbidade e mortalidade devido ao aparecimento de cepas com resistência a múltiplos fármacos, incluindo vancomicina e teicoplanina. Compostos 5-nitro-heterocíclicos com estrutura análoga à nifuroxazida, antimicrobiano utilizado em infecções gastrintestinais, têm apresentado satisfatória atividade in vitro frente a estas cepas multirresistentes, sendo importante e necessária a avaliação de sua biodisponibilidade oral como próximo estágio no desenvolvimento de um novo fármaco, visando à seleção eficiente e ao aprimoramento da estrutura molecular. Neste contexto, o presente estudo tem por objetivo empregar ensaios in vitro, utilizando células Caco-2, e métodos in silico, utilizando descritores moleculares VolSurf, a fim de analisar a permeabilidade de análogos à nifuroxazida com atividade antimicrobiana apresentando, principalmente, atividade potencial frente a cepas multirresistentes de S. aureus. Empregou-se o método de MTT (brometo de 3-(4,5-dimetiltiazol-2-il)-2,5-difenil tetrazólio) para a avaliação da citotoxicidade. Nos estudos de permeabilidade in vitro foram utilizadas membranas de células Caco-2 cultivadas em placas Transwel® por 21 dias. A quantificação das frações permeadas foi realizada por cromatografia a líquido de alta eficiência com detecção UV (CLAE-UV), com métodos validados de acordo com a Resolução 899/03. Os estudos in silico foram realizados por meio de análise exploratória, pelo método de consenso de análise de componentes principais (CPCA, Consensus Principal Component Analysis), e análise de regressão, por quadrados mínimos parciais (PLS, Partial Least Squares). As células Caco-2 apresentaram viabilidade adequada para a realização dos estudos de permeabilidade frente a todos os derivados da nifuroxazida, exceto o derivado MeTIO (5-nitro-2-tiofilideno 4-metilbenzidrazida). Os valores de permeabilidade aparente (Papp) obtidos para os análogos à nifuroxazida indicam que estes possuem alta permeabilidade. Os modelos obtidos por CPCA e PLS foram capazes de separar as moléculas em grupos de compostos de baixa, média e alta permeabilidade, sendo os análogos à nifuroxazida classificados como compostos de alta permeabilidade. Para os compostos em estudo, as propriedades determinantes da permeabilidade através de células Caco-2, de acordo com os modelos, seriam de natureza topológica e estérica, sendo possível a previsão externa qualitativa e quantitativa da permeabilidade através de células Caco-2. / Methicillin-resistant Staphylococcus aureus (MRSA) is one of the main pathogens responsible for nosocomial infections, also identified in community-associated infections. Although potent anti-staphylococcal drugs are available, infections caused by this bacteria continues to show significant morbidity and mortality due to the emergence of strains with resistance to multiple drugs, including vancomycin and teicoplanin. The 5-nitro-heterocyclic derivatives of nifuroxazide, which is an antimicrobial used to treat gastrointestinal infections, have shown satisfactory in vitro activity against multidrug-resistant strains of S. aureus. As a next step in the development of a new drug, it is important and necessary the evaluation of the oral bioavailability to achieve an efficient selection and refinement of the molecular structure. In this context, this study aims to develop in vitro assays through Caco-2 cells, and in silico approaches, using VolSurf molecular descriptors, in order to analyze the permeability of 5-nitro-heterocyclic compounds analogues to nifuroxazide with antimicrobial activity, especially showing promising activity against multidrug-resistant Staphylococcus aureus. The MTT (bromide 3-(4,5-dimethyltiazol-2-yl)-2,5-diphenyl tetrazolium) method was employed to perform the cytotoxicity evaluation. Caco-2 cell monolayers cultivated for 21 days in Transwel® plates were used for the in vitro permeability assays. The quantification of the permeated fractions was done by High Performance Liquid Chromatography with UV detection (HPLC-UV), with validated methods according to the Resolution 899/03. In silico studies were performed through exploratory analysis by consensus principal component analysis (CPCA) and regression analysis by partial least squares (PLS). Caco-2 cells showed suitable cell viability for the permeability studies against all nifuroxazide analogues except the MeTIO (5-nitro-2-thiophilydene 4-methylbenzidrazide). The nifuroxazide derivatives apparent permeability values (Papp) obtained indicate these are high permeable compounds. The models obtained by CPCA and PLS were able to separate the molecules into groups of low, medium and high permeabilities, and the nifuroxazide analogues were classified as high permeable substances. The identified properties for the permeability through Caco-2 cells to the studied compounds were topologic and sterical, and it is possible to perform qualitative and quantitative external predictions with these models for the permeability through Caco-2 cells.

Next-generation sequencing technology provides high-resolution data for epidemiological surveillance of bacterial pathogens on local and global scales. This approach has been used for many species including Methicillin Resistant Staphylococcus aureus (MRSA). In this thesis I demonstrate the utility of these data for understanding the spread of the globally disseminated clone MRSA ST239. I focus both on local and national-level epidemiology through sequence data of 71 isolates recovered from four hospitals representing three cities in Turkey; Istanbul (x2). Ankara and Izmir. I analyse whole genome sequence data from a further 33 ST239 isolates from global sources. These data were combined with previously published data for phylogenetic analysis based only on the core genome. I demonstrate how transmission events can be inferred from this approach on multiple levels; within hospital, between hospitals and between countries. The data pointed to a European origin of ST239, and independent introductions from Europe to Turkey, South America and East Asia. I also demonstrate how whole genome sequence data can be used to develop bespoke PCR assays, based on phage variation, for rapid local epidemiology. Finally, I consider how the sequence data might be used to explain variation in virulence potential, and describe the distribution and transfer of an important phage-borne virulence determinant, sasX, within Europe. Finally, I identified a single isolate with very strong biofilm forming ability likely due to the over-expression of the important adhesion SasG.

O sistema de saúde é desafiado diariamente por complicações infecciosas relacionadas à assistência, que constituem grave problema de saúde pública mundial, aumentando a morbidade e a mortalidade dos pacientes assistidos e elevando os custos hospitalares. O Staphylococcus aureus resistente à meticilina (MRSA), endêmico em várias instituições de saúde no mundo, é um dos principais agentes etiológicos de infecção relacionada à assistência à saúde. A colonização é um importante fator na patogênese das infecções causadas pelo MRSA, elevando o risco de uma infecção em portadores nasais desta bactéria. Além disso, sabe-se que pacientes colonizados ou infectados representam um importante reservatório desta bactéria. Atualmente, a descolonização dos portadores de MRSA é uma medida recomendada para o controle da disseminação desta bactéria. A mupirocina tem sido amplamente utilizada para a descolonização nasal, no entanto cepas de MRSA resistentes à mupirocina tem se tornado mais frequente na última década. Além disso, a formulação de mupirocina disponível no Brasil é inadequada para aplicação em mucosas, causando efeitos adversos intoleráveis. Uma vez que a sulfadiazina de prata é bastante ativa contra o MRSA in vitro, este estudo se propôs avaliar a efetividade da aplicação intranasal dessa substância para a descolonização de pacientes hospitalizados e colonizados por MRSA. Trata-se de um ensaio clínico randomizado, duplamente cego, controlado com placebo, cuja intervenção consistiu na terapia de descolonização nasal, com a aplicação intranasal de gel de sulfadiazina de prata a 1%, duas vezes por dia, associado a utilização de clorexidina degermante a 2% para o banho diário, por 5 dias consecutivos nos pacientes internados em um hospital terciário, com colonização nasal por MRSA, demonstrada por meio de cultura seletiva de swab nasal. O desfecho primário do estudo foi a identificação de swab nasal negativo para MRSA coletado imediatamente após o fim do tratamento. A comparação da taxa de descolonização nasal entre os grupos foi feita usando-se o teste do Qui quadrado, com correção de Person, e por meio de um modelo de regressão logística. Foram identificados 279 pacientes colonizados por MRSA, no entanto 156 apresentavam critérios de exclusão e 79 não estavam mais internados no momento da inclusão, sendo incluídos 44 pacientes. A mediana de idade dos incluídos foi de 57,5 anos. Após a randomização, restaram 22 pacientes em cada grupo. Oito pacientes não completaram o protocolo, e foram excluídos da análise. A descolonização nasal foi obtida em 10/16 pacientes (62,50%) no grupo controle e 10/20 (50,00%) no grupo experimental (p=0,453). A descolonização corporal global ocorreu em 8/16 (50,00%) no grupo controle e 9/20 (45,00%) no grupo experimental (p=0,765). Na análise multivariada, nenhuma das variáveis independentes incluídas, a saber sexo, idade, uso de sulfadiazina de prata, e uso de antimicrobianos sistêmicos com atividade anti-MRSA exibiu associação com o desfecho primário. Não houve diferença, entre os grupos, na incidência de infecções por MRSA após o término da terapia. Dois pacientes apresentaram irritação nasal no grupo experimental. De acordo com os nossos resultados, a sulfadiazina de prata a 1% não foi superior ao placebo para a descolonização de pacientes com colonização nasal por MRSA. / The health system is daily challenged by health-care associated infections, which constitute a global public health problem, increasing morbidity and mortality of assisted patients as well as hospital costs. The methicillin-resistant Staphylococcus aureus (MRSA), endemic in several facilities worldwide, is a major etiologic agent of health-care associated infections. MRSA colonization is a relevant risk factor in the pathogenesis of infections caused by MRSA. Moreover, it is known that colonized or infected patients represent an important reservoir of this pathogen. Currently, the decolonization of MRSA carriers is a recommended measure to control the spread of this pathogen. Mupirocin has been widely used for nasal decolonization, however MRSA strains resistant to mupirocin has become more common over the last decade. In addition, mupirocin formulation available in Brazil is inappropriate for application to mucosal causing intolerable side effects. Once silver sulfadiazine is active against MRSA in vitro, this study aimed to evaluate the effectiveness of intranasal application of this substance for decolonizing hospitalized patients harboring MRSA. This is a randomized, double-blind, placebo-controlled trial, which intervention consisted in intranasal application of silver sulfadiazine gel 1%, twice a day, associated with the use of chlorhexidine soap 2% for daily bath for 5 consecutive days in patients admitted to a tertiary hospital with nasal MRSA colonization, demonstrated by selective culture of nasal swab. The primary endpoint of the study was the identification of negative nasal swab for MRSA collected immediately after the end of treatment. Comparison of decolonization rate between groups was performed using Person\'s corrected chi square, and through a logistic regression model. From 279 patients colonized by MRSA identified, 156 met exclusion criteria and 79 were no longer in hospital at the time of inclusion, so 44 patients were included. The median age of those included was 57.5 years. After randomization, 22 patients remained in each group. Eight patients did not complete the protocol and were excluded from analysis. Nasal decolonization was achieved in 10/16 patients (62.50%) in the control group and 10/20 (50.00%) in the experimental group (p = 0.453). The global body decolonization occurred in 8/16 (50.00%) in the control group and 9/20 (45.00%) in the experimental group (p = 0.765). In multivariate analysis, none of the included independent variables, namely sex, age, use of silver sulfadiazine, and use of systemic antibiotics with anti-MRSA activity showed association with primary endpoint. There was no difference between groups in the incidence of MRSA infections after the end of therapy. Two patients had nasal irritation in the experimental group. According to our results, silver sulfadiazine 1% was not superior to placebo for decolonizing patients with nasal MRSA colonization.

Made available in DSpace on 2014-07-29T15:26:20Z (GMT). No. of bitstreams: 1 Tese Juliana Lamaro completa 2010.pdf: 383347 bytes, checksum: b303674ff0d9eef2f056b5d7aa6a4a91 (MD5) Previous issue date: 2009-04-15 / Objectives: (i) to assess the prevalence of Staphylococcus aureus and methicillin-resistant S. aureus (MRSA) nasal carriage in children attending day-care centers (DCC) in the municipality of Goiânia; (ii) to determine the potential risk factors related to S. aureus carriage and MRSA; (iii) to characterize MRSA isolates circulating in DCCs using molecular typing methods. Methods: Between August and December 2005, nasal swabs were collected from children who attended 62 DCCs. Clinical and socio-demographic information associated with the acquisition of S. aureus and MRSA were obtained through questionnaires applied to parents or guardians. The swabs were processed following the standard methods for identification and isolation of S. aureus. Amplification femB gene by polymerase chain reaction (PCR) was used to confirm the specie. The presence of mecA gene was detected by PCR and the positive isolates were identified as MRSA. Susceptibility to MRSA was determined by disk diffusion method. MRSA molecular typing was performed by PFGE, MLST, spa typing and SCCmec multiplex PCR. Results: 371 (31.1%) out of the 1.192 collected swabs were positive for S. aureus and 14 (1.2%) were identified as MRSA. The factors independently associated with risks for nasal colonization by S. aureus were children higher than two years of age (OR = 1.83, 95% CI 1.27-2.65) and previous DCC attendance (OR = 1.48; 95% CI 1.01-2.16). Mother s high degree of education was a protective factor for S. aureus carriage (OR = 0.43, 95% CI 0.23-0.80). A multidrug resistant dominant MRSA lineage was identified comprising 8 out of the 14 MRSA isolates. This cluster was characterized as SCCmec type IIIA, ST239 and spa type t037 sharing 82.7% genetic similarity with the Brazilian clone. One MRSA strain was classified as SCCmec type V and ST1120. This strain showed features of CA-MRSA although it has been recovered from a healthy child who presented risk factors for HA-MRSA acquisition. The remaining MRSA strains showed a diverse genetic background. Conclusions: Children attending DCCs are often colonized with S. aureus and although the prevalence of MRSA was low, they can represent potential vectors of spread of resistant pathogens to the community. The detection of a MRSA lineage circulating within DCCs suggests a two-way flow spread of MRSA between hospitals and community. / Objetivos: (i) avaliar a prevalência de portador nasal de Staphylococcus aureus e S. aureus resistentes à meticilina (MRSA) em crianças que frequentam centros municipais de educação infantil (CMEIs) no município de Goiânia; (ii) determinar os potenciais fatores de risco relacionados com a colonização nasal pelo S. aureus e por MRSA; (iii) caracterizar os isolados de MRSA circulantes nos CMEIS utilizando métodos de tipagem molecular. Material e Métodos: De agosto e dezembro de 2005, swabs nasais foram coletados de crianças menores de cinco anos de idade atendidas em 62 CMEIs do município. Informações clínicas e sócio-demográficas associadas à aquisição de S. aureus e MRSA foram obtidas por meio de questionários aplicados aos pais ou responsáveis. Os swabs foram processados seguindo metodologia padronizada para identificação e isolamento de S. aureus. A confirmação da espécie foi realizada pela amplificaçao do gene femB por reação em cadeia da polimerase (PCR). A presença do gene mecA foi detectada por PCR e os isolados positivos foram identificados como MRSA. O perfil de suscetibilidade para estes isolados foi determinado pelo método de disco difusão. A tipagem molecular dos MRSA foi realizada pelas técnicas de PFGE, MLST, spa typing e SCCmec multiplex PCR. Utilizou-se regressão logística para o cálculo do odds ratio e respectivos intervalos de 95% de confiança. Resultados: Entre os 1.192 swabs coletados, 371 (31,1%) foram positivos para S. aureus e 14 (1,2%) foram identificados como MRSA. Os fatores independentemente associados ao portador nasal de S. aureus foram: crianças acima de dois anos de idade (OR=1,83; IC95% 1,27-2,65) e ter frequentado outra creche (OR= 1,48; IC95% 1,01-2,16). Alto grau de escolaridade da mãe foi um fator protetor para a colonização por S. aureus (OR=0,43; IC95% 0,23-0,80). Uma linhagem genética predominante foi identificada compreendendo 8 dos 14 MRSA isolados. Esta linhagem apresentou perfil de multirresistência, SCCmec tipo IIIA, ST239 e spa type t037, compartilhando 82,7% de similaridade genética com o Clone MRSA Brasileiro. Uma cepa MRSA foi classificada como SCCmec tipo V e ST1120. Esta cepa apresentou características genéticas de MRSA associados à comunidade embora tenha sido recuperada de criança com fatores de risco para aquisição de MRSA relacionado ao serviço de saúde. As demais cepas MRSA apresentaram composição genética bastante diversa. Conclusões: A prevalência de crianças de creches colonizadas pelo S. aureus é alta. Embora a prevalência para MRSA tenha sido baixa nessas crianças, elas representam vetores potenciais de disseminação de MRSA para comunidade. A detecção de uma linhagem de MRSA circulando nos CMEIs e associada a serviços de saúde pode estar sinalizando uma rota de transmissão cruzada destes microrganismos entre hospitais e comunidade.