Direkter Tierkontakt gehört zu den wirkungsvollsten Elementen des Besuchererlebnisses in Zoologischen Gärten. In Streichelzoos hat der Zoobesucher unkontrollierten und unmittelbaren Kontakt mit kleinen Wiederkäuern und insbesondere mit Ziegen. Diese Anlagen können ein Zoonoserisiko darstellen, da Ziegen asymptomatische Träger von verschiedenen zoonotischen Krankheitserregern sein können und in der Vergangenheit bereits Übertragungen auf den Menschen nach Kontakt mit Streicheltieren nachgewiesen wurden. Es sollte das Vorkommen ausgewählter zoonotischer Pathogene (Shigatoxin-produzierende Escherichia coli (STEC), Coxiella burnetii, Campylobacter spp., Arcobacter spp., Salmonella spp., Yersinia spp., Enterobacteriaceae mit beta-Laktamasen mit breitem Wirkungsspektrum (ESBL), Methicillin-resistente Staphylococcus aureus (MRSA) und Dermatophyten) bei klinisch gesunden Ziegen in Streichelzoos Zoologischer Gärten in Deutschland untersucht werden. Aus 21 Herden in 14 tiergärtnerischen Einrichtungen in Deutschland wurden 300 klinisch gesunde Ziegen im Rahmen tierärztlicher Routineuntersuchungen beprobt. Der Nachweis von STEC und Salmonella spp. wurde aus Rektaltupfern über die Anzucht auf GCG-Agar versucht. Für Escherichia coli verdächtige Kulturen wurden auf Blutagar überführt und auf ausgewählte Virulenzgene per PCR untersucht. In der Folge wurde eine Serotypisierung vorgenommen. Nach Coxiella burnetii wurde in Vaginaltupfern der 230 weiblichen Tieren der Studie mittels einer real-time PCR (qPCR) gesucht. Campylobacter spp. und Arcobacter spp. aus Rektaltupfern wurden nach Isolation über Selektivnährböden unter mirkoaerophilen Bedingungen jeweils per Multiplex-PCR und qPCR auf Artebene bestimmt. Rektaltupfer wurden nach einer Kälteanreicherung mit folgender Anzucht auf Selektivnährböden auf Yersinia spp. untersucht. Nach Anzucht über einen ESBL-Selektivagar auf Basis von Rektaltupfern wurden verdächtige Kolonien mit einem VITEK-System artbestimmt und auf mögliche Antibiotikaresistenzen untersucht. Beta-Lactamase-Gene wurden mittels PCR identifiziert. Das aus Nasentupfern stammende Untersuchungsmaterial zum MRSA-Nachweis wurde nach Anreicherung einer Kultur auf einem Selektivnährboden zugeführt. Eventuelle Kolonien wurden auf einen Blutagar transferriert und danach per MALDI-TOF massenspektrometrisch untersucht. Positive Proben wurden durch PCR-Microarray untersucht. Mit einer modifizierten Mackenzie-Brush- Methode gewonnene Hautschuppen wurden über einen Pilzagar und einen selektiven Dermatophytenagar untersucht. Demographische Korrelationen zum Auftreten von Campylobacter spp. wurden mit einem exakten Test nach Fisher evaluiert. Campylobacter spp. wurden bei 22,7 %, STEC bei 20,0 % und Arcobacter spp. bei 1,7 % der 300 getesteten Ziegen nach der Kultur aus Rektaltupfern und der folgenden PCR nachgewiesen. Die Prävalenz von Campylobacter spp. war bei juvenilen höher als bei adulten Tieren (53,0 % gegenüber 14.1 %; p<0,0001). Ein Isolat der Art Escherichia fergusonii trug phänotypisch Hinweise auf eine ESBL, die durch den Nachweis des Gens blaCTX-M-1 bestätigt wurde. Aus den Nasentupfern von 20,7 % der beprobten Ziegen konnte Staphylococcus aureus kultiviert werden, darunter auch ein mecC-positiver MRSA. Weder Salmonella spp. noch Yersinia spp. fanden sich in der Stichprobe und auch der Nachweis von Dermatophyten gelang bei einer häufigen Überwucherung durch ubiquitäre Pilze (19,3 %) nicht. Unter den 230 weiblichen Ziegen der Studie gab es bei zwei Tieren positive PCR- Signale für Coxiella burnetii, die nach ausgiebiger Nachbeprobung und epidemiologischer Prüfung als falsch-positiv gewertet werden mussten. Grundsätzlich muss vom Vorhandensein einiger Zoonoseerreger in Ziegenbeständen in Streichelzoos ausgegangen werden, da Campylobacter spp. und STEC regelmäßig in der Stichprobe auftraten. Damit sollte das Risiko der Übertragung zoonotischer Bakterien von Ziegen auf Zoobesucher beim Betrieb entsprechender Anlagen Berücksichtigung finden. Angemessene Informationen und Einrichtungen zum Waschen der Hände und zur Handdesinfektion sollten in jedem Fall zur Verfügung gestellt werden. Zum genaueren Verständnis des vermehrten Auftretens von Campylobacter spp. bei jungen Ziegen sind weitere Untersuchungen notwendig. Die Identifikation von asymptomatischen Ziegen mit einer Dermatophyteninfektion bedarf einer modifizierten Technik.:1 Einleitung 1 2 Literaturübersicht 3 2.1 Geschichte und tiergärtnerische Bedeutung des Streichelzoos 3 2.2 Ausgewählte Zoonoseerreger bei Ziegen 4 2.2.1 Shigatoxin-bildende Escherichia coli 4 2.2.1.1 Erreger 4 2.2.1.2 Bedeutung bei der Ziege 5 2.2.1.3 Bedeutung beim Menschen 5 2.2.2 Coxiella burnetii 5 2.2.2.1 Erreger 5 2.2.2.2 Bedeutung bei der Ziege 6 2.2.2.3 Bedeutung beim Menschen 7 2.2.3 Campylobacter spp. 7 2.2.3.1 Erreger 7 2.2.3.2 Bedeutung bei der Ziege 8 2.2.3.3 Bedeutung beim Menschen 8 2.2.4 Arcobacter spp. 9 2.2.4.1 Erreger 9 2.2.4.2 Bedeutung bei der Ziege 9 2.2.4.3 Bedeutung beim Menschen 10 2.2.5 Salmonella spp. 10 2.2.5.1 Erreger 10 2.2.5.2 Bedeutung bei der Ziege 11 2.2.5.3 Bedeutung beim Menschen 11 2.2.6 Yersinia spp. 12 2.2.6.1 Erreger 12 2.2.6.2 Bedeutung bei der Ziege 12 2.2.6.3 Bedeutung beim Menschen 13 2.2.7 beta-Laktamasen mit breitem Wirkungsspektrum 13 2.2.7.1 Erreger 13 2.2.7.2 Bedeutung bei der Ziege 14 2.2.7.3 Bedeutung beim Menschen 14 2.2.8 Methicillin-resistente Staphylococcus aureus 15 2.2.8.1 Erreger 15 2.2.8.2 Bedeutung bei der Ziege 15 2.2.8.3 Bedeutung beim Menschen 16 2.2.9 Dermatophyten 16 2.2.9.1 Erreger 16 2.2.9.2 Bedeutung bei der Ziege 17 2.2.9.3 Bedeutung beim Menschen 17 3 Veröffentlichung 19 3.1 Stellungnahme zum Eigenanteil an den Arbeiten an der Publikation 19 3.2 Publikation 20 4 Diskussion 31 5 Zusammenfassung 35 6 Summary 37 7 Literaturverzeichnis 39 8 Danksagung

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Bacterial resistance to antibiotics has become a worldwide health problem, resulting in untreatable infections and escalating healthcare costs. Wastewater treatment plants are a critical point of control between anthropogenic sources of pathogens, antibiotic resistant bacteria (ARBs), antibiotic resistance genes (ARGs), and the environment through discharge of treated effluent and land application of biosolids. Recent studies observing an apparent resuscitation of pathogens and pathogen indicators and the widening realization of the importance of addressing environmental reservoirs of ARGs all lead toward the need for improved understanding of ARG fate and pathogen inactivation kinetics and mechanisms in sludge stabilization technologies. This research has investigated the fate of two pathogens, methicillin-resistant Staphylococcus aureus (MRSA) and Escherichia coli, and various ARGs under pasteurization, anaerobic digestion, biosolids storage, and land application conditions. Pathogen die-off occurs at a rate specific to each pathogen and matrix in ambient and mesophilic temperature environments. Viable but nonculturable (VBNC) states are initiated by thermal treatments, such as thermophilic digestion and possibly pasteurization, and allow the persistence of pathogen cells and any ARGs contained therein through treatment and into the receiving environment where resuscitation or transformation could occur. Raw sludge ARG content does affect digester effluent quality, although the predominant mechanisms of ARG persistence may be different in mesophilic versus thermophilic digestion. In both thermophilic and mesophilic digestion, a correlation was observed between raw sludge and digester ARGs associated with Class 1 integrons, possibly as a result of horizontal gene transfer. ARB survival was shown to contribute to ARG content in mesophilic digestion, but not thermophilic digestion. Thermophilic digestion may achieve a higher ARG reduction because of reduced microbial diversity compared to mesophilic digestion. However, it is evident that horizontal gene transfer still does occur, particularly with highly mobile integrons, so that complete reduction of all ARGs would not be possible with thermophilic digestion alone. Surprisingly, the experiments that introduced various concentrations of antibiotic sulfamethoxazole and antimicrobial nanosilver did not induce enhanced rates of horizontal gene transfer. Finally, ARG concentrations in biosolids increased during cold temperature storage suggesting that there is a stress induction of horizontal gene transfer of integron-associated ARGs. / Ph. D.

Background: Antimicrobial-resistant infections result in hospital stays costing between $18,000 and $29,000. As of 2009, Centers for Medicare and Medicaid Services no longer upgrade payments for hospital-acquired infections. Hospital epidemiologists monitor and document rates of individual resistant microbes in antibiogram reports. Overall summary measures capturing resistance within a hospital may be useful. Objectives: We applied four techniques (L1- and L2-principal component analysis (PCA), desirability functions, and simple summary) to create summary measures of resistance and described the four summary measures with respect to reliability, proportion of variance explained, and clinical utility. Methods: We requested antibiograms from hospitals participating in the University HealthSystem Consortium for the years 2002–2008 (n=40). A clinical team selected organism-drug resistant pairs (as resistant isolates per 1,000 patient days) based on 1) virulence, 2) complicated or toxic therapies, 3) transmissibility, and 4) high incidence with increasing levels of resistance. Four methods were used to create summary scores: 1) L1- and L2-PCA: derived multipliers so that the variance explained is maximized; 2) desirability function: transformed resistance data to be between 0 and 1; 3) simple sum: each resistance rate was added and divided by the square root of the total number of microbes summed. Simple correlation analyses between time and each summary score evaluated reliability. For each year, we calculated the proportion of explained variance by dividing each summary score’s variance by the variance in the original data. Clinical utility was checked by comparing the trends for all of the individual microbe’s resistance rates to the trends seen in the summary scores for each hospital. Results: Proportion of variance explained by L1- and L2-PCA and the simple sum was 0.61, 0.62, and 0.29 respectively. Simple sum and L1- and L2-PCA summary scores best followed the trends seen in the individual antimicrobial resistance rates; trends in desirability function scores deviated from those seen in individual trends of antimicrobial resistance. L1- and L2-PCA summary scores were more influenced by MRSA rates, and the simple sum score was less influenced. Pearson correlation coefficients revealed good reliability through time. Conclusion: Deriving summary measures of antimicrobial resistance can be reliable over time and explain a high proportion of variance. Infection control practitioners and hospital epidemiologists may find the inclusion of a summary score of antimicrobial resistance beneficial in describing the trends of overall resistance in their yearly antibiogram reports.

The overall aim of the present thesis was to investigate experiences of living with multidrug-resistant bacteria (MDRB), using methicillin-resistant Staphylococcus aureus (MRSA) colonization as an illustration, and to develop and validate a tool to describe healthcare personnel’s attitudes towards patients with MDRB. A further objective was to study MRSA-colonized persons’ and healthcare personnel’s experiences of patient-professional interactions and responsibilities for infection prevention. Four empirical studies were conducted. A total of 18 MRSA-colonized persons and 20 healthcare personnel were interviewed regarding their experiences, and a total of 726 RNs responded the MDRB Attitude Questionnaire. The findings revealed the difficulties associated with living with MRSA colonization, which was described as something uncertain, and as an indefinable threat that has to be managed in both everyday life and in contacts with healthcare. Interactions with healthcare personnel were described as unprofessional owing to personnel’s inappropriate behaviour and insufficient information provision. According to the personnel, achieving adequate patient-professional interactions required having knowledge and experiences of MRSA. They also experienced difficulties in providing tailored information to patients. The MRSA-colonized persons described their unwanted responsibility to inform healthcare personnel about the colonization, but also felt responsible for limiting the spread of infection to others. Furthermore, responsibility for infection control was regarded as shared between healthcare personnel and patients. The personnel described such responsibility as a natural part of their daily work, although it was not always easy to adhere to hygiene precautions. The MRSA-colonized persons felt that healthcare personnel have insufficient knowledge of the bacteria and of hygiene precautions. The MDRB Attitude Questionnaire showed that registered nurses do have knowledge deficiencies. The MDRB Attitude Questionnaire has adequate psychometric properties. In conclusion, MRSA colonization constitutes a psychological strain for carriers, and interactions with healthcare personnel resulted in feelings of stigmatization. The present thesis indicates that there is a need to improve healthcare personnel’s knowledge, behaviour and emotional response in relation to patients with MDRB, in order to ensure patient safety and address patients’ needs. The heads of department is responsible for such improvements, and the MDRB Attitude Questionnaire is useful in identifying areas in need for improvement.

<i>Staphylococcus aureus</i> is a ubiquitous organism causing world-wide morbidity and mortality. This species readily develops resistance to antimicrobial agents. Current dosing strategies are based, in part, on minimum inhibitory concentrations (MICs). This susceptibility test fails to detect the presence of first-step resistant mutants often present in large heterogeneous populations of infecting bacteria. Dosing strategies based on MIC results may, in fact, allow for the selective proliferation of resistant subpopulations. The mutant-prevention concentration (MPC) is the drug concentration at which all first-step resistant mutants will be eradicated along with the susceptible cells. Determination of the mutant-selection window (MSW) is possible using MIC and MPC data. When considered together with achievable drug concentrations in human bodily sites, the MSW helps determine which antimicrobials are likely to select for resistance. MIC and MPC testing on clinical isolates of methicillin-susceptible (MSSA) and -resistant (MRSA) S. aureus was performed. Characterization via the polymerase chain reaction, sequencing, and electron microscopy (EM) was done on selected organisms recovered from MPC studies (MPC-recovered). MIC and MPC testing was performed on organisms isolated sequentially from patients with recurring S. aureus infections. Pulsed field gel electrophoresis was performed on these sequential isolates. Based on the MIC and the MPC values, the most potent agents for systemic MSSA and MRSA infections are gemifloxacin and vancomycin, respectively. Re-testing MPC-recovered populations by the MIC showed increased MIC results compared to the parent populations. Macrolide-resistance genes were discovered in S. aureus MPC-recovered populations; in contrast, parental isolates lacked these resistance determinants. EM revealed an increase in cell wall thickness of a vancomycin MPC-recovered population compared to its parental population. Moxifloxacin and vancomycin had the lowest and narrowest MSWs for systemic MSSA and MRSA infections, respectively, compared to the other agents tested. Sequential isolates showed no change in MIC and MPC values. The data presented provides evidence for the application of the MPC test to S. aureus organisms. The MPC data is significant when determining appropriate dosing strategies aimed at preventing resistance.

<i>Staphylococcus aureus</i> is a ubiquitous organism causing world-wide morbidity and mortality. This species readily develops resistance to antimicrobial agents. Current dosing strategies are based, in part, on minimum inhibitory concentrations (MICs). This susceptibility test fails to detect the presence of first-step resistant mutants often present in large heterogeneous populations of infecting bacteria. Dosing strategies based on MIC results may, in fact, allow for the selective proliferation of resistant subpopulations. The mutant-prevention concentration (MPC) is the drug concentration at which all first-step resistant mutants will be eradicated along with the susceptible cells. Determination of the mutant-selection window (MSW) is possible using MIC and MPC data. When considered together with achievable drug concentrations in human bodily sites, the MSW helps determine which antimicrobials are likely to select for resistance. MIC and MPC testing on clinical isolates of methicillin-susceptible (MSSA) and -resistant (MRSA) S. aureus was performed. Characterization via the polymerase chain reaction, sequencing, and electron microscopy (EM) was done on selected organisms recovered from MPC studies (MPC-recovered). MIC and MPC testing was performed on organisms isolated sequentially from patients with recurring S. aureus infections. Pulsed field gel electrophoresis was performed on these sequential isolates. Based on the MIC and the MPC values, the most potent agents for systemic MSSA and MRSA infections are gemifloxacin and vancomycin, respectively. Re-testing MPC-recovered populations by the MIC showed increased MIC results compared to the parent populations. Macrolide-resistance genes were discovered in S. aureus MPC-recovered populations; in contrast, parental isolates lacked these resistance determinants. EM revealed an increase in cell wall thickness of a vancomycin MPC-recovered population compared to its parental population. Moxifloxacin and vancomycin had the lowest and narrowest MSWs for systemic MSSA and MRSA infections, respectively, compared to the other agents tested. Sequential isolates showed no change in MIC and MPC values. The data presented provides evidence for the application of the MPC test to S. aureus organisms. The MPC data is significant when determining appropriate dosing strategies aimed at preventing resistance.

O Staphylococcus aureus é bactéria espécie não específica que, além de potencial patogenicidade, evoluiu em mecanismos de resistência a antimicrobianos. O S. aureus meticilina resistente (MRSA) antes restrito a infecções nosocomiais, dispersou-se na comunidade e nos animais de companhia e para produção de alimento. Na conduta para o controle da transmissão, além do uso de antibióticos, a ação sobre os agentes causais nas fontes de contaminação exige atenção, sendo decisiva e crítica a escolha de desinfetantes e antisépticos. A busca por recursos frente a agentes patogênicos resistentes a antimicrobianos convencionais e a demanda por insumos sanitários aplicáveis em modelos sustentáveis de produção agropecuária, motivam a investigação de extrações vegetais que apresentem atividade antibacteriana. O objetivo deste estudo foi avaliar a atividade bactericida de desinfetantes convencionais sobre isolados MRSA, testar a hipótese da possibilidade de resistência cruzada entre grupos químicos antibióticos (beta-lactâmicos) e desinfetantes e também avaliar a atividade bactericida de extrações das inflorescências de Achyrocline satureioides (Lam.) DC. (Asteraceae) (“macela”), planta medicinal, de uso popular e tradicional, nativa na região sul do Brasil, sobre os mesmos inóculos. A técnica de referência foi o “Teste de Suspensão na Avaliação Quantitativa da Atividade Bactericida de Desinfetantes e Antissépticos Químicos”. Nos testes com os desinfetantes hipoclorito de sódio (HS), iodofór (I) e quaternário de amônio (QAC - cloreto de cetil trimetilamônio), quatro concentrações de cada grupo químico foram confrontadas com 21 MRSA, em tempos de contato de cinco, 15 e 30 minutos e densidade populacional inicial dos inóculos de 107UFC/mL. Observou-se que os grupos químicos nas menores concentrações HS 25 ppm, I 12,5 ppm e QAC 125 ppm, apresentaram atividade bactericida frente a todos os isolados no menor tempo de contato. A proporção usada da A. satureioides foi de 5 g:100 mL de solvente e as densidades iniciais dos inóculos confrontados foram 107, 106 e 105 UFC/mL. A atividade da forma decocto foi verificada frente a 51 isolados MRSA, em tempos de contato de uma, oito e 24 h. Vinte e um deles também foram submetidos ao extrato hidroetanólico hidratado (EH), obtido de maceração hidroetanólica 70º GL, desalcoolizada e hidratada ao volume inicial, nos tempos de contato de cinco e 30 minutos e de uma até quatro horas. Por Cromatografia Liquida de Alta Eficiência (CLAE) foi confirmada, no acesso da planta, a presença dos marcadores fitoquímicos quercetina, luteolina e 3-Ometilquercetina. As extrações da A. satureioides apresentaram atividade antibacteriana frente a todos os isolados MRSA. O EH mostrou atividade de inativação em menor tempo. Tomando como exemplo a 1 h de contato, na maior densidade do inóculo, 19% dos isolados estavam inativados, enquanto que no decocto não foi observada inativação. Em 4 horas de contato com o EH 85,7% dos isolados, na maior densidade desafio, estavam inativados e 100% dos isolados sofreram redução da densidade populacional. O decocto demonstrou maior atividade bactericida entre 8h e 24 horas, inativando 100% dos isolados até as 24 h. Concluiu-se que, controlados os conhecidos fatores limitantes da atividade bactericida, o hipoclorito de sódio o iodofor e o quaternário de amônio são adequados para controlar os MRSA nas fontes de contaminação em ambientes de saúde humana ou nos de saúde e de produção animal. Para os isolados resistentes aos antibióticos beta-lactâmicos confrontados não foi observada relação de resistência com os desinfetantes. A atividade bactericida das soluções de Achyrocline satureioides frente aos isolados MRSA e ao microrganismo de referência Staphylococcus aureus ATCC 6538 sugere seu potencial uso, diretamente nas formas avaliadas ou em formulações, em procedimentos de higiene, tanto nas fontes de infecção de ambientes de saúde humana quanto nos de saúde e de produção animal. / The bacterium Staphylococcus aureus is a speciea not specific and potential pathogenicity, which has evolved mechanisms for antimicrobial resistance. S. aureus methicillin resistant (MRSA) once restricted to nosocomial infections, dispersed in the community and in companion animals and production. In order to control the transmission, besides the use of antibiotics, the action on the causative agents in the sources of contamination requires attention, being decisive and critical the choice of disinfectants and antiseptics. The search for resources against pathogens resistant to conventional antibiotics and the demand for health inputs applicable in sustainable agriculture production motivated the investigation of plant extractions that have antibacterial activity. The aim of this study was to evaluate the bactericidal activity of conventional disinfectants on MRSA isolates, testing the hypothesis of the possibility of cross-resistance between chemical groups antibiotics (beta-lactams) and disinfectants and also assess the bactericidal activity of extractions of inflorescences Achyrocline satureioides (Lam.) Dc. (Asteraceae) ("macela"), a medicinal plant with a popular and traditional use, native from southern Brazil on the same isolates. The reference technique was the "Suspension Test in Quantitative Evaluation of Bactericidal Activity of Chemical Disinfectants and Antiseptics." In tests with disinfectant sodium hypochlorite (HS), iodophor (I) and quaternary ammonium (QAC-cetyl trimethylammonium chloride), four concentrations of each chemical group were confronted with 21 MRSA on contact time of five, 15 and 30 minutes. The population density of the initial inoculum was 107UFC/mL. It was observed that the chemical groups at lower concentrations HS 25 ppm, and 12.5 ppm I 125 ppm QAC showed bactericidal activity against all isolates in less contact time. The proportion used of A. satureioides was 5 g: 100 mL of solvent and the initial densities of the inocula confronted were 107, 106 and 105 CFU / mL. The activity of decoction form was checked against 51 MRSA isolates, in times of a contact, eight and 24 h. Twenty-one of them also underwent hydroethanolic extract hydrate (EH) obtained by maceration hydroethanol 70 º GL, dealcoholised hydrated and the initial volume, the contact time of five and 30 minutes and one to four hours. By High performance liquid chromatography (HPLC) was confirmed in the access plan, the presence of markers phytochemicals quercetin, luteolin and 3-O-methylquercetin. The extractions of A. satureioides showed antibacterial activity against all MRSA isolates. The EH showed activity inactivation in less time. Taking as an example the 1 hr of contact, the greater density of the inoculum, 19% of the isolates were inactive, whereas the decoction did not show inactivation. In 4 hours of contact with the EH 85.7% of isolates in higher density challenge were inactivated and 100% of isolates reduced population density. The decoction showed greater bactericidal activity between 8 and 24 hours, inactivating 100% of isolates until 24 h. It was concluded that, controlling for known factors affecting the bactericidal activity, the sodium hypochlorite and quaternary ammonium iodophor are suitable for controlling MRSA in the sources of contamination in healthcare environments or in human health and animal production. For the isolates resistant to beta-lactam antibiotics confronted no relationship was observed resistance to disinfectants. The bactericidal activity of solutions Achyrocline satureioides against of MRSA isolates and reference microorganism Staphylococcus aureus ATCC 6538 suggests its potential use, directly into forms or formulations evaluated in hygiene procedures, both in the sources of infection in healthcare environments as in human health and animal production.

Made available in DSpace on 2014-12-17T14:13:43Z (GMT). No. of bitstreams: 1 FranciscoCSJ.pdf: 1235219 bytes, checksum: 99fd9a9cd6382f5c2247c17ecd9cce0b (MD5) Previous issue date: 2009-10-09 / Staphylococcus aureus resistente ? meticilina (MRSA) ? um dos principais agentes de infec??es associadas a servi?os de sa?de em todo o mundo. No Brasil, h? a predomin?ncia de um clone de MRSA multirresistente denominando clone epid?mico brasileiro (CEB). Entretanto, novos clones n?omultirresistentes com alta virul?ncia t?m sido descritos em infec??es comunit?rias e hospitalares. O objetivo desse estudo foi realizar a caracteriza??o fenot?pica e genot?pica de cepas de MRSA isoladas na cidade do Natal/RN. Inicialmente avaliamos 60 amostras de S. aureus quanto a resist?ncia ? meticilina atrav?s de diferentes t?cnicas fenot?picas, utilizando a detec??o do gene mecA por PCR como padr?o. O antibiograma de todas as cepas foi realizado utilizando 12 antimicrobianos conforme descrito pelo CLSI. As cepas de MRSA foram caracterizadas geneticamente atrav?s da tipagem do cassete cromoss?mico estafiloc?cico mec (SCCmec) e da eletroforese em campo el?trico alternado (PFGE). Dos 60 S. aureus estudados, 45 foram resistentes ? meticilina. Observamos que para algumas cepas de MRSA os testes de triagem em ?gar com 6&#956;g/mL de oxacilina e difus?o em meio s?lido com oxacilina-1&#956;g apresentaram dificuldades na sua interpreta??o. No entanto, todas as 45 amostras de MRSA, foram facilmente detectadas pelos testes com o disco de cefoxitina-30&#956;g e pesquisa da PBP2a. A an?lise molecular das cepas de MRSA mostrou 8 padr?es distintos de PFGE (A-H), com predomin?ncia do padr?o A (73%), relacionado ao CEB. Estas carreavam o SCCmec tipo IIIA, e apresentaram uma consider?vel variedade de subtipos (A1-A16). Cinco cepas de MRSA portando SCCmec IV tamb?m foram xiv identificadas, tr?s delas relacionadas geneticamente ao clone USA800 (Padr?o B). Destas cinco, tr?s (2 padr?o F e 1 padr?o B) foram altamente suscept?veis as drogas testadas, entretanto, dois outros isolados, padr?o B, apresentaram multirresist?ncia. As amostras restantes pertenciam a padr?es de PFGE distintos dos clones internacionais predominantes em nosso continente. Para realiza??o deste projeto de pesquisa, a metodologia exigiu a intera??o com pesquisadores de ?reas como: infectologia, microbiologia e biologia molecular. Portanto, esta disserta??o apresentou um car?ter de multidisciplinaridade e transdiciplinaridade no seu desenvolvimento

O Staphylococcus aureus é bactéria espécie não específica que, além de potencial patogenicidade, evoluiu em mecanismos de resistência a antimicrobianos. O S. aureus meticilina resistente (MRSA) antes restrito a infecções nosocomiais, dispersou-se na comunidade e nos animais de companhia e para produção de alimento. Na conduta para o controle da transmissão, além do uso de antibióticos, a ação sobre os agentes causais nas fontes de contaminação exige atenção, sendo decisiva e crítica a escolha de desinfetantes e antisépticos. A busca por recursos frente a agentes patogênicos resistentes a antimicrobianos convencionais e a demanda por insumos sanitários aplicáveis em modelos sustentáveis de produção agropecuária, motivam a investigação de extrações vegetais que apresentem atividade antibacteriana. O objetivo deste estudo foi avaliar a atividade bactericida de desinfetantes convencionais sobre isolados MRSA, testar a hipótese da possibilidade de resistência cruzada entre grupos químicos antibióticos (beta-lactâmicos) e desinfetantes e também avaliar a atividade bactericida de extrações das inflorescências de Achyrocline satureioides (Lam.) DC. (Asteraceae) (“macela”), planta medicinal, de uso popular e tradicional, nativa na região sul do Brasil, sobre os mesmos inóculos. A técnica de referência foi o “Teste de Suspensão na Avaliação Quantitativa da Atividade Bactericida de Desinfetantes e Antissépticos Químicos”. Nos testes com os desinfetantes hipoclorito de sódio (HS), iodofór (I) e quaternário de amônio (QAC - cloreto de cetil trimetilamônio), quatro concentrações de cada grupo químico foram confrontadas com 21 MRSA, em tempos de contato de cinco, 15 e 30 minutos e densidade populacional inicial dos inóculos de 107UFC/mL. Observou-se que os grupos químicos nas menores concentrações HS 25 ppm, I 12,5 ppm e QAC 125 ppm, apresentaram atividade bactericida frente a todos os isolados no menor tempo de contato. A proporção usada da A. satureioides foi de 5 g:100 mL de solvente e as densidades iniciais dos inóculos confrontados foram 107, 106 e 105 UFC/mL. A atividade da forma decocto foi verificada frente a 51 isolados MRSA, em tempos de contato de uma, oito e 24 h. Vinte e um deles também foram submetidos ao extrato hidroetanólico hidratado (EH), obtido de maceração hidroetanólica 70º GL, desalcoolizada e hidratada ao volume inicial, nos tempos de contato de cinco e 30 minutos e de uma até quatro horas. Por Cromatografia Liquida de Alta Eficiência (CLAE) foi confirmada, no acesso da planta, a presença dos marcadores fitoquímicos quercetina, luteolina e 3-Ometilquercetina. As extrações da A. satureioides apresentaram atividade antibacteriana frente a todos os isolados MRSA. O EH mostrou atividade de inativação em menor tempo. Tomando como exemplo a 1 h de contato, na maior densidade do inóculo, 19% dos isolados estavam inativados, enquanto que no decocto não foi observada inativação. Em 4 horas de contato com o EH 85,7% dos isolados, na maior densidade desafio, estavam inativados e 100% dos isolados sofreram redução da densidade populacional. O decocto demonstrou maior atividade bactericida entre 8h e 24 horas, inativando 100% dos isolados até as 24 h. Concluiu-se que, controlados os conhecidos fatores limitantes da atividade bactericida, o hipoclorito de sódio o iodofor e o quaternário de amônio são adequados para controlar os MRSA nas fontes de contaminação em ambientes de saúde humana ou nos de saúde e de produção animal. Para os isolados resistentes aos antibióticos beta-lactâmicos confrontados não foi observada relação de resistência com os desinfetantes. A atividade bactericida das soluções de Achyrocline satureioides frente aos isolados MRSA e ao microrganismo de referência Staphylococcus aureus ATCC 6538 sugere seu potencial uso, diretamente nas formas avaliadas ou em formulações, em procedimentos de higiene, tanto nas fontes de infecção de ambientes de saúde humana quanto nos de saúde e de produção animal. / The bacterium Staphylococcus aureus is a speciea not specific and potential pathogenicity, which has evolved mechanisms for antimicrobial resistance. S. aureus methicillin resistant (MRSA) once restricted to nosocomial infections, dispersed in the community and in companion animals and production. In order to control the transmission, besides the use of antibiotics, the action on the causative agents in the sources of contamination requires attention, being decisive and critical the choice of disinfectants and antiseptics. The search for resources against pathogens resistant to conventional antibiotics and the demand for health inputs applicable in sustainable agriculture production motivated the investigation of plant extractions that have antibacterial activity. The aim of this study was to evaluate the bactericidal activity of conventional disinfectants on MRSA isolates, testing the hypothesis of the possibility of cross-resistance between chemical groups antibiotics (beta-lactams) and disinfectants and also assess the bactericidal activity of extractions of inflorescences Achyrocline satureioides (Lam.) Dc. (Asteraceae) ("macela"), a medicinal plant with a popular and traditional use, native from southern Brazil on the same isolates. The reference technique was the "Suspension Test in Quantitative Evaluation of Bactericidal Activity of Chemical Disinfectants and Antiseptics." In tests with disinfectant sodium hypochlorite (HS), iodophor (I) and quaternary ammonium (QAC-cetyl trimethylammonium chloride), four concentrations of each chemical group were confronted with 21 MRSA on contact time of five, 15 and 30 minutes. The population density of the initial inoculum was 107UFC/mL. It was observed that the chemical groups at lower concentrations HS 25 ppm, and 12.5 ppm I 125 ppm QAC showed bactericidal activity against all isolates in less contact time. The proportion used of A. satureioides was 5 g: 100 mL of solvent and the initial densities of the inocula confronted were 107, 106 and 105 CFU / mL. The activity of decoction form was checked against 51 MRSA isolates, in times of a contact, eight and 24 h. Twenty-one of them also underwent hydroethanolic extract hydrate (EH) obtained by maceration hydroethanol 70 º GL, dealcoholised hydrated and the initial volume, the contact time of five and 30 minutes and one to four hours. By High performance liquid chromatography (HPLC) was confirmed in the access plan, the presence of markers phytochemicals quercetin, luteolin and 3-O-methylquercetin. The extractions of A. satureioides showed antibacterial activity against all MRSA isolates. The EH showed activity inactivation in less time. Taking as an example the 1 hr of contact, the greater density of the inoculum, 19% of the isolates were inactive, whereas the decoction did not show inactivation. In 4 hours of contact with the EH 85.7% of isolates in higher density challenge were inactivated and 100% of isolates reduced population density. The decoction showed greater bactericidal activity between 8 and 24 hours, inactivating 100% of isolates until 24 h. It was concluded that, controlling for known factors affecting the bactericidal activity, the sodium hypochlorite and quaternary ammonium iodophor are suitable for controlling MRSA in the sources of contamination in healthcare environments or in human health and animal production. For the isolates resistant to beta-lactam antibiotics confronted no relationship was observed resistance to disinfectants. The bactericidal activity of solutions Achyrocline satureioides against of MRSA isolates and reference microorganism Staphylococcus aureus ATCC 6538 suggests its potential use, directly into forms or formulations evaluated in hygiene procedures, both in the sources of infection in healthcare environments as in human health and animal production.