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.

>Magister Scientiae - MSc / The aim of this study was to compare the trough plasma levels of Aspen-Vancomycin® (AV); and Sandoz-Vancocin CP® (SV) in premature infants with suspected Methicillin Resistant Staphylococcus aureus (MRSA) infection. The study was designed as a prospective, double blind, randomised trial involving male and female premature infants admitted in the Neonatal Intensive care Unit (NICU) at Netcare Blaauwberg and N1-city Hospitals for treatment of suspected MRSA-infection between April 2012 and June 2013. The inclusion criteria were: 29-35 weeks postmenstrual age (PMA), informed and written consent from parents of each premature infant enrolled in the study. Blood samples (0.3-0.4ml) were collected for renal function test and vancomycin trough levels determination. Blood samples for vancomycin trough level assay were collected thirty minutes prior to the administration of the third dose of vancomycin. Statistical analysis was performed and estimation was made giving an indication of how many infants will be needed to make the study statistically significant. Wilcoxon Two-Sample test was performed to determine the p-values and Spearman correlation coefficients were used to determine the correlation between trough levels and variables. P-values < 0.05 were considered significant. A total of 19 premature infants met with study criteria, 10 (5 females and 5 males) received AV and 9 (6 females and 3 males) receive d SV. There was no statistical significant difference between the demographic (GA, BW, PMA, PNA, weight at trial entry, height at trial entry) and biological (albumin, serum creatinine concentration and glomerular filtration rate) parameters of the premature infants in the AV and SV group. There were no statistical significant difference between trough level 1 of AV and SV, although trough level 1 had a lower trend in the SV group (p=0.118). No AV trough level 1 was below the minimum effective concentration (<5μg/ml). It was found that 30% of AV trough level 1 was within the therapeutic range (5-10μg/ml) and 70% of AV trough level 1, were above minimum toxic concentration (>10mg/l). It was found that 22.2% of SV trough level 1 was below minimum effective concentration, 44.4% of SV trough level 1 was within therapeutic range and 33.3% of trough level 1 was above minimum toxic concentration. No correlation was found between trough level 1 and the demographic and biological parameters of the premature infants in the AV group. SV had a positive correlation with GA, BBW, PMA and a negative correlation with PNA

Methicillin-resistant staphylococcus aureus (MRSA) has become resistant to antibiotics. The purpose of this quantitative, retrospective cohort study was to examine the relationship between length of hospitalization and invasive MRSA infection rates among different racial and ethnic groups in the 8 service planning areas (SPAs) of Los Angeles County. Cane, O'Connor, and Michie's theoretical domain framework was used. Secondary data from the Healthcare-Associated (HA) Infections Program of the California Department of Public Health were analyzed. For the first research question, a Pearson correlation analysis was conducted to assess the relationships between length of hospitalization and invasive HA-MRSA infection rates and counts. Length of hospital stay was not correlatedwith HA-MRSA infection rates; however, it was strongly and positively correlated with HA-MRSA infection counts. For the second research question, a one-way ANOVA was conducted on the infection count rate data, with SPA as the between-subjects factor. The results were statistically significant, indicating that HA-MRSA infection counts varied among the 8 SPAs. The findings might help medical professionals better understand the risk factors associated with MRSA infections. In doing so, findings may relieve some of the burden on the U.S. health care system and improve the overall quality of life of the patients involved.

No description available.

No description available.

Optical sensor systems that integrate Long-Period-Gratings (LPG) as the detection arm have been proven to be highly sensitive and reliable in many applications. With increasing public recognition of threats from bacteria-induced diseases and their potential outbreak among densely populated communities, an intrinsic, low-cost biosensor device that can perform quick and precise identification of the infection type is in high demand to respond to such challenging situations and control the damage those diseases could possibly cause. This dissertation describes the development of a biosensor platform that utilizes polymer thin films, known as ionic self-assembled multilayer (ISAM) films, to be the sensitivity- enhancing medium between an LPG fiber and specific, recognition layer. With the aid of cross- linking reactions, monoclonal antibodies (IgG) or DNA probes are immobilized onto the surface of the ISAM-coated fiber, which form the core component of the biosensor. By immersing such biosensor fiber into a sample suspension, the immobilized antibody molecules will bind the specific antigen and capture the target cells or cell fragments onto the surface of the fiber sensor, resulting in increasing the average thickness of the fiber cladding and changing the refractive index of the cladding. This change occurring at the surface of the fiber results in a decrease of optical power emerging from the LPG section of the fiber. By comparing the transmitted optical power before and after applying the sample suspension, we are able to determine whether or not certain bacterial species have attached to the surface of the fiber, and as a consequence, we are able to determine whether or not the solution contains the targeted bacteria. This platform has the potential for detection of a wide range of bacteria types. In our study, we have primarily investigated the sensitivity and specificity of the biosensor to methicillin- resistant Staphlococcus aureus (MRSA). The data we obtained have shown a sensitive threshold at as low as 102 cfu/ml with pure culture samples. A typical MRSA antibody-based biosensor assay with MRSA sample at this concentration has shown optical power reduction of 21.78%. In a detailed study involving twenty-six bacterial strains possessing the PBP2a protein that enables antibiotic resistance and sixteen strains that do not, the biosensor system was able to correctly identify every sample in pure culture samples at concentration of 104 cfu/ml. Further studies have also been conducted on infected mouse tissues and clinical swab samples from human ears, noses, and skin, and in each case, the system was in full agreement with the results of standard culture tests. However, the system is not yet able to correctly distinguish MRSA and non-MRSA infections in clinical swab samples taken from infected patient wounds. It is proposed that nonspecific binding due to insufficient blocking methods is the key issue. Other bacterial strains, such as Brucella and Francisella tularensis have also been studied using a similar biosensor platform with DNA probes and antibodies, respectively, and the outcomes are also promising. The Brucella DNA biosensor is able to reflect the existence of 3 Brucella strains at 100 cfu/ml with an average of 12.2% signal reduction, while negative control samples at 106cfu/ml generate an average signal reduction of -2.1%. Similarly, the F. tularensis antibodies biosensor has shown a 25.6% signal reduction to LVS strain samples at 100 cfu/ml, while for negative control samples at the same concentration, it only produces a signal reduction of 0.05%. In general, this biosensor platform has demonstrated the potential of detecting a wide range of bacteria in a rapid and relatively inexpensive manner. / Ph. D.

No description available.

Depuis quelques années et dans plusieurs pays, un nouveau type de Staphylococcus aureus résistant à la méthicilline (SARM), le séquence type (ST) 398, a été fréquemment retrouvé chez les porcs et chez les fermiers en contact avec ces porcs. Au Canada, très peu d’informations sont disponibles concernant le SARM d’origine porcine. Une première étude dans notre laboratoire a permis de récolter 107 isolats de SARM provenant de deux abattoirs porcins du Québec. Le présent travail vise à caractériser les gènes de virulence et de résistance aux antibiotiques de ces SARM, d’étudier leur formation de biofilm en relation avec la spécificité du groupe agr et de vérifier la localisation plasmidique et la transférabilité de ces gènes à des souches de SARM d’origine humaine. Plusieurs souches ont démontré différents patrons phénotypiques de résistance aux antibiotiques. Vingt-quatre souches représentatives de ces isolats ont été soumises à une caractérisation plus approfondie par une étude génotypique en utilisant une biopuce à ADN et un grand nombre de gènes de virulence a été détecté codant pour des entérotoxines staphylococcales, des leucocidines, des hémolysines, des auréolysines, des facteurs d’immunoévasion, des superantigènes, des facteurs d’adhésion et des facteurs impliqués dans la formation de biofilm. Des gènes de résistance envers les aminoglycosides, les macrolides, les lincosamides, les tétracyclines et les biocides ont été également détectés par biopuce et leur localisation plasmidique a par la suite été déterminée. La transférabilité de ces gènes de souches porcines à des souches de SARM d’origine humaine a été démontrée par conjugaison bactérienne; ainsi le transfert horizontal de certains gènes de résistance aux antibiotiques et de virulence a été observé. Ces travaux de recherche apportent une meilleure connaissance de la résistance aux antibiotiques et de la virulence des SARM d’origine porcine et de leur potentiel de contribution à l’émergence de certaines résistances et facteurs de virulence chez le SARM d’origine humaine. / In recent years and in several countries, a new type of methicillin-resistant Staphylococcus aureus (MRSA), the sequence type (ST) 398, has been frequently found in pigs and in farmers in contact with these pigs. In Canada, little information is available concerning MRSA from pigs. A previous study in our laboratory identified 107 MRSA isolates from two pig slaughterhouses in Quebec. This study was conducted to determine antimicrobial resistance and virulence genes of MRSA from abattoir pig, to study their biofilm formation in relation with agr specificity groups and to evaluate horizontal transfer of genes to a MRSA of human clinical origin. Different phenotypic patterns of antimicrobial resistance were observed in these MRSA and a representative subset of these isolates was selected for further characterization. Twenty-four porcine MRSA were characterized by a DNA microarray, the StaphyType of CLONDIAG. Our results demonstrated that the MRSA strains from the abattoirs contain several antimicrobial resistance genes responsible for macrolide and tetracycline resistance and virulence genes encoding staphylococcal enterotoxins, hemolysins, leukocidins, aureolysin, superantigens, immunoevasion, adhesion, and biofilm development. This study presents the first evidence that horizontal transfer of some of these genes can occur between MRSA of porcine and human origin. We also report for the first time biofilm formation in Livestock Associated-MRSA of porcine origin associated with agr group II. It is possible that biofilm formation favors colonization, persistence as well as zoonotic potential. This research provides a better understanding of antimicrobial resistance and virulence of MRSA from pigs and their potential contribution to the emergence of some resistance and virulence factors in MRSA of human origin.

Le Staphylococcus aureus résistant à la méthicilline (SARM) est un pathogène important qui a été identifié comme agent d‟infection chez les animaux d‟élevage et les travailleurs exposés à ces animaux. Au Canada, très peu d‟informations sont disponibles concernant les SARMs d‟origine porcine. L‟objectif de cette étude était de déterminer la prévalence des SARMs provenant de porcs à l‟abattoir, de caractériser leur résistance aux antibiotiques ainsi que d‟évaluer le niveau de séroconversion des porcs envers le S. aureus chez les animaux porteurs ou non du SARM. Un total de 107 isolats ont été identifiés positifs aux SARMs sur 660 échantillons. La prévalence de SARMs à l‟abattoir A était de 30,8% et de 23,8% à l‟abattoir B. La susceptibilité aux antibiotiques a été déterminée en utilisant la méthode de micro-dilution de Sensititre. Tous les isolats ont démontré une sensibilité envers la ciprofloxacine, la gatifloxacine, la gentamicine, la lévofloxacine, le linézolide, la quinupristine/dalfopristine, la rifampicine, la streptomycine, le triméthoprime/sulfaméthoxazole et la vancomycine. De la résistance a été observée envers la daptomycine (0,93%), l‟érythromycine (29%), la clindamycine (29%), la tétracycline (98,1%). De plus, 30% des SARMs isolés étaient résistants à plus de deux antibiotiques autres que les β-lactamines. Par typage, deux clones prédominants ont été obtenus ainsi que deux types de SCCmec (type V et possiblement un nouveau type comprenant les cassettes III et IVb). 15 clones ont été identifiés par typage MLVA, comprenant les clones prédominants VI (40.1%; 43/107) et XI (17.7%; 19/107). Deux souches de SARMs ont été caractérisées par biopuce à ADN et des gènes d‟antibiorésistance, de typage (SCCmec et MLST) et de virulence ont été identifiés. Sans considération pour le site de colonisation, les porcs SA-/MRSA- (n=34) et les porcs SA+ (n=194) montrent, respectivement, des taux de séroconversion de 20.6% et 32.5%. Les porcs colonisés par un SARM à un site de iv prélèvement et non colonisés par un SA à l‟autre site (n=18) montrent une séroconversion (5.6%) significativement (P < 0.05) plus faible comparativement aux porcs colonisés par SA à un ou deux sites de prélèvement et n‟ayant pas de SARM. Nos résultats démontrent que les porcs provenant d‟abattoir peuvent être colonisés par des SARMs multi-résistants aux antibiotiques. De plus, ces SARMs sont possiblement capable de coloniser leurs hôtes sans stimuler la production d‟anticorps et ce par l‟atténuation de la réponse immunitaire ou par la colonisation de porcs qui sont moins immunocompétents. / Methicillin-resistant Staphylococcus aureus (MRSA) found in food producing animals is a major public health concern. Transmission to humans has been reported and MRSA represents a reservoir of antimicrobial resistance genes. Little is known on how MRSA successfully establishes colonization and how it is able to persist in the host. This study was conducted to determine the occurrence and the antimicrobial resistance profile of MRSA from abattoir pigs and their level of seroconversion toward S. aureus (SA). A total of 107 isolates were identified as MRSA from 660 samples. Antimicrobial susceptibilities were determined by broth microdilutions. Fifteen clones were identified by MLVA with clones VI (40.1%; 43/107) and XI (17.7%; 19/107) being the most predominant. All MRSA isolates were pvl-, tst-, eta- and etb-negative. Most isolates were SCCmec type V (70.1%; 75/107). All MRSA isolates were susceptible to ciprofloxacin, gatifloxacin, gentamicin, levofloxacin, linezolid, quinupristin/dalfopristin, rifampin, streptomycin, trimethroprim/sulfamethoxazole and vancomycin. However, resistance was observed toward clindamycin (29%), daptomycin (0.9%), erythromycin (29%) and tetracycline (98.1%). Multi-resistance was confirmed in MRSA since 28% of all isolates were resistant toward three antimicrobials other than β-lactams. The effect of MRSA carriage on seroconversion was examined to see whether the host responded differently to MRSA or SA colonization. The presence of SA-specific antibodies in pig serums was measured for each animal using indirect ELISA and a mixture of two widespread SA antigens (IsdH [HarA] and IsdB). Regardless of the colonization site, SA-/MRSA- pigs (n=34) and SA+ pigs (n=194) showed 20.6% and 32.5% seroconversion, respectively. Notably, pigs colonized by MRSA at one body site and no SA at the other sampling site (n=18) showed a significantly lower (5.6%) seroconversion (P < 0.05) compared to pigs colonized by SA at one or both vi sites without MRSA. The findings of the study show that the nares and axillae of abattoir pigs can harbor MRSA strains with multiple antimicrobial resistances. In addition, these MRSA were possibly able to colonize the host either without stimulating antibody production, by attenuating the immune response or by colonizing pigs that are less immunocompetent. This may explain the success of MRSA colonization and persistence in pigs. Further studies are required to better elucidate MRSA colonization in abattoir pigs and their public health risk.

Antibiotic resistant pathogens, such as methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant enterococci (VRE), are an increasing burden on healthcare systems. Hospital acquired infections with these organisms leads to higher morbidity and mortality compared with the sensitive strains of the same species and both VRE and MRSA are on the rise worldwide including in Australian hospitals. Emerging community infectious diseases are also having an impact on hospitals. The Severe Acute Respiratory Syndrome virus (SARS Co-V) was noted for its propensity to spread throughout hospitals, and was contained largely through social distancing interventions including hospital isolation. A detailed understanding of the transmission of these and other emerging pathogens is crucial for their containment. The statistical inference and mathematical models used in this thesis aim to improve understanding of pathogen transmission by estimating the transmission rates of contagions and predicting the impact of interventions. Datasets used for these studies come from the Princess Alexandra Hospital in Brisbane, Australia and Shanxi province, mainland China. Epidemiological data on infection outbreaks are challenging to analyse due to the censored nature of infection transmission events. Most datasets record the time on symptom onset, but the transmission time is not observable. There are many ways of managing censored data, in this study we use Bayesian inference, with transmission times incorporated into the augmented dataset as latent variables. Hospital infection surveillance data is often much less detailed that data collected for epidemiological studies, often consisting of serial incidence or prevalence of patient colonisation with a resistant pathogen without individual patient event histories. Despite the lack of detailed data, transmission characteristics can be inferred from such a dataset using structured HiddenMarkovModels (HMMs). Each new transmission in an epidemic increases the infection pressure on those remaining susceptible, hence infection outbreak data are serially dependent. Statistical methods that assume independence of infection events are misleading and prone to over-estimating the impact of infection control interventions. Structured mathematical models that include transmission pressure are essential. Mathematical models can also give insights into the potential impact of interventions. The complex interaction of different infection control strategies, and their likely impact on transmission can be predicted using mathematical models. This dissertation uses modified or novel mathematical models that are specific to the pathogen and dataset being analysed. The first study estimates MRSA transmission in an Intensive Care Unit, using a structured four compartment model, Bayesian inference and a piecewise hazard methods. The model predicts the impact of interventions, such as changes to staff/patient ratios, ward size and decolonisation. A comparison of results of the stochastic and deterministic model is made and reason for differences given. The second study constructs a Hidden Markov Model to describe longitudinal data on weekly VRE prevalence. Transmission is assumed to be either from patient to patient cross-transmission or sporadic (independent of cross-transmission) and parameters for each mode of acquisition are estimated from the data. The third study develops a new model with a compartment representing an environmental reservoir. Parameters for the model are gathered from literature sources and the implications of the environmental reservoir are explored. The fourth study uses a modified Susceptible-Exposed-Infectious-Removed (SEIR) model to analyse data from a SARS outbreak in Shanxi province, China. Infectivity is determined before and after interventions as well as separately for hospitalised and community symptomatic SARS cases. Model diagnostics including sensitivity analysis, model comparison and bootstrapping are implemented.