Ökning av multiresistenta bakterier som MRSA och ESBL kan ses i Sverige. För att förebygga att dessa mikroorganismer sprids är det viktigt att basala hygienrutiner följs samt att personalen har kunskap om MRSA och ESBL.   Studiens syfte var att se vilken kunskap det fanns hos läkare och sjuksköterskor inom primärvården, gällande MRSA och ESBL, samt att undersöka följsamhet hos personalen gällande hygienrutiner. En tvärsnittsstudie gjordes där tre vårdcentraler valdes ut. 45 enkäter delades ut totalt. Fyra personer valde att inte delta.   Skiftande kunskaper kunde ses gällande smittspridning, mikrobiologiska egenskaper och behandling av bärarskap av MRSA och ESBL.   Kunskaper om hygienförebyggande åtgärder var goda och deltagarna svarade att engångsförkläde ska användas vid patientnära vård samt att noggrann handhygien ska utföras för att minska smittspridningen. Trots kunskap om vikten av noggrann handhygien var det cirka 25 % av deltagarna som utförde handdesinfektionen felaktigt. För övrigt var följsamheten god.   Studiens slutsats är att kunskaper i hygienförebyggande åtgärder samt följsamhet av basala hygienrutiner är relativt goda.

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Background: Staphylococcus aureus (SA) infections are common and important within the hospital environment. The case fatality rate of invasive Staphylococcus aureus (SA) infections is between 20-40%. Whether the infection is due to methicillin resistant SA (MRSA) or methicillin sensitive SA (MSSA) may determine outcomes. Literature to date is inconclusive regarding whether antimicrobial resistance in SA affects patient outcomes. Host factors, infection-host interactions, and treatment-related factors may also influence case fatality. Objectives: The purpose of this study was to determine if patients with MRSA invasive infections were more likely to die than those with MSSA invasive infections, and what factors were associated with death. Methods: A retrospective matched case control study was designed, comparing cases of MRSA with controls of MSSA invasive disease from hospitals participating in the Canadian Nosocomial Infection Surveillance Program (CNISP). Two analyses were run: the first, to identify the variables associated with MRSA vs. MSSA infections, and the second, to determine the variables associated with death in invasive Staphylococcal aureus (S. aureus) infections. Backward logistic regression analysis was used for the MRSA vs. MSSA analysis and a hierarchical logistic regression model for assessment of risk factors for death. Results: In the logistic regression MRSA model the variables: recent prior use of antibiotics, Charlson Comorbidity Index score > 2 and not having received appropriate empiric antibiotics were associated with MRSA vs. MSSA infections. The hierarchical model identified older age, higher CCI scores, immunosuppression, bloodstream infection, septic shock, neurological dysfunction and not receiving appropriate empiric antibiotic as associated with death. MRSA infection was not more likely to be associated with increased mortality than MSSA infection. Those with a resistant infection (MRSA) however, were less likely to receive appropriate empiric antibiotic treatment. Conclusions: Appropriate empiric antibiotics are the most important and only modifiable risk factor identified. Elderly patients who are on immunosuppressive drugs and have chronic comorbid conditions need to be monitored and screened more often since they are more at risk for death than others.

Background: Staphylococcus aureus (SA) infections are common and important within the hospital environment. The case fatality rate of invasive Staphylococcus aureus (SA) infections is between 20-40%. Whether the infection is due to methicillin resistant SA (MRSA) or methicillin sensitive SA (MSSA) may determine outcomes. Literature to date is inconclusive regarding whether antimicrobial resistance in SA affects patient outcomes. Host factors, infection-host interactions, and treatment-related factors may also influence case fatality. Objectives: The purpose of this study was to determine if patients with MRSA invasive infections were more likely to die than those with MSSA invasive infections, and what factors were associated with death. Methods: A retrospective matched case control study was designed, comparing cases of MRSA with controls of MSSA invasive disease from hospitals participating in the Canadian Nosocomial Infection Surveillance Program (CNISP). Two analyses were run: the first, to identify the variables associated with MRSA vs. MSSA infections, and the second, to determine the variables associated with death in invasive Staphylococcal aureus (S. aureus) infections. Backward logistic regression analysis was used for the MRSA vs. MSSA analysis and a hierarchical logistic regression model for assessment of risk factors for death. Results: In the logistic regression MRSA model the variables: recent prior use of antibiotics, Charlson Comorbidity Index score > 2 and not having received appropriate empiric antibiotics were associated with MRSA vs. MSSA infections. The hierarchical model identified older age, higher CCI scores, immunosuppression, bloodstream infection, septic shock, neurological dysfunction and not receiving appropriate empiric antibiotic as associated with death. MRSA infection was not more likely to be associated with increased mortality than MSSA infection. Those with a resistant infection (MRSA) however, were less likely to receive appropriate empiric antibiotic treatment. Conclusions: Appropriate empiric antibiotics are the most important and only modifiable risk factor identified. Elderly patients who are on immunosuppressive drugs and have chronic comorbid conditions need to be monitored and screened more often since they are more at risk for death than others.

Regensburg, Univ., Diss., 2009.

Bakgrund: MRSA-smittade patienter blir allt vanligare inom den svenska hälso- och sjukvården och dessutom saknas viss kunskap och förståelse för omvårdnaden och den specifika isoleringsvård som patienter smittade med MRSA behöver. Patienter som är i behov av isoleringsvård upplever ofta sin vårdtid som negativ eftersom de är en utsatt grupp inom sjukvården. Syfte: Syftet med studien var att belysa MRSA-smittade patienters upplevelser av isolering på sjukhus. Metod: Litteraturstudien baserades på sju vetenskapliga artiklar med en kvalitativ design. Artiklarnas resultat analyserades enligt Graneheim och Lundmans tolkning av Krippendorff’s analys för kvalitativa studier. Resultat: Analysen resulterad i fyra kategorier som bildar resultatet; ”Känslor förknippade med isolering” som beskrev de olika känslorna som patienterna upplevde under sin isolering; ”Stigmatisering från sjukvårdspersonal” beskrev patienternas upplevelser av att bli undvikta och åsidosatta;” Okunskap kring MRSA-smitta” bidrog till att patienterna upplevde sin vårdtid som dålig; Samt kategorin ”Behov av stöd och information” där det beskrevs hur detta kan bidra till en bättre vårdupplevelse för patienterna. Slutsats: Då MRSA är ett problem som ökar i den svenska hälso- och sjukvården och då allt fler patienter är i behov av isoleringsvård så krävs det en ökad kunskap och förståelse från sjukvårdspersonalen. En ökad kunskap kring infektionssjukdomar, isolering och vad detta innebär för patienterna skulle underlätta för sjukvårdspersonalen att utföra en god och personcentrerad omvårdnad.

Made available in DSpace on 2014-06-11T19:30:29Z (GMT). No. of bitstreams: 0 Previous issue date: 2005-12-13Bitstream added on 2014-06-13T20:21:07Z : No. of bitstreams: 1 braoios_a_dr_arafcf.pdf: 1217984 bytes, checksum: 5239ef0501af6f189fd2b422aad8dc7d (MD5) / Universidade Estadual Paulista (UNESP) / Staphylococcus aureus é um dos principais agentes de infecção humana, especialmente em indivíduos hospitalizados. Cepas MRSA (Methicillin Resistant Staphylococcus aureus) constituem um grave problema em hospitais de todo o mundo, aumentando a morbidade e mortalidade de indivíduos infectados. A vancomicina é uma das únicas opções terapêuticas. No entanto, o uso excessivo desse antibiótico pode selecionar cepas resistentes, agravando ainda mais o problema. Trabalhadores hospitalares podem carrear S. aureus nas narinas anteriores e pele e, assim, constituem um importante elo na epidemiologia das infecções nosocomiais. Nesse trabalho foram coletadas amostras das mãos e narinas de 100 trabalhadores do Hospital Universitário Dr. Domingos Leonardo Cerávolo da Universidade do Oeste Paulista - UNOESTE, em Presidente Prudente (SP). Desse total, 68% não eram portadores de S. aureus, 27% carreavam S. aureus sensível a meticilina, 4% carreavam MRSA e 1% carreava BORSA (Borderline Oxacillin Resistant Staphylococcus aureus). No mesmo período (julho a dezembro de 2002), 54,3% das infecções estafilocócicas em pacientes internados nessa Instituição tinham como agente MRSA. A técnica da PCR (Polymerase Chain Reaction) Multiplex para a detecção do gene femA (gene espécie-específico), mecA (resistência à meticilina) e ileS-2 (resistência à mupirocina) foi comparada com o método da difusão com discos e provas convencionais de identificação. Os resultados da PCR Multiplex apresentaram completa concordância com os resultados obtidos com os testes fenotípicos convencionais. Para verificar a relação genética entre as 30 cepas MRSA, 5 isoladas de trabalhadores e 25 de pacientes, foram realizadas a antibiotipagem e tipagem molecular através da técnica RAPD (Random Amplified Polymorphic DNA). Pela antibiotipagem as cepas MRSA foram... . / Staphylococcus aureus is considered as a major infeccious disease agent in human, especially in hospitalized people. Methicillin-resistant strains (MRSA) constitute a serious problem in hospitals around the world, increasing the morbity and mortality rate of infected people. Usually, vancomycin is the only therapeutic choice for the treatment of MRSA infections. However, excessive use of this antibiotic can select resistant strains, aggravating the problem. Health workers can carry S. aureus in the anterior nares and skin, constituting an important link for the epidemiology of nosocomial infections. In this study, samples of the hands and nares of one hundred workers from the University Hospital Dr. Domingos Leonardo Cerávolo , at Presidente Prudente, SP, Brazil, were assessed. Among the one hundred workers, 68% did not carry S. aureus, methicillin-susceptible S. aureus was found in 27/100 (27%) of those people; MRSA in 4/100 (4%) and BORSA (Borderline Resistant Staphylococcus aureus) was found in 1 (1%) health worker. In the same period (July to December of 2002), 54,3% of the staphylococcal infections in hospitalized patients were caused by MRSA. Multiplex PCR assay for the detection of femA (species-specific gene), mecA (methicillin resistance gene) and ileS-2 (mupirocin resistance gene) was compared to the disk diffusion susceptibility test and conventional identification test methods. The Multiplex PCR technic results were in complete agreement with the results obtained from conventional methods. Genetic relationship among the 30 MRSA strains, five isolated from workers and twenty five from patients, was established by antibiotyping and molecular typing by RAPD. On the basis of the antibiotyping, the 30 strains were grouped into four clusters (A to D), of a which 87% were grouped into antibiotype A. According to the profile of RAPD, eight clusters... (Complete abstract, click electronic address below).

Dissertação (mestrado)—Universidade de Brasília, Faculdade de Medicina, 2008. / Submitted by Ângela Christina (angelchris@bce.unb.br) on 2009-05-05T20:46:16Z No. of bitstreams: 1 2008_GustavoBalduinoLeite_reduzida.pdf: 1263249 bytes, checksum: c55f741f929e8ef09635062edaafb6dc (MD5) / Approved for entry into archive by Guimaraes Jacqueline(jacqueline.guimaraes@bce.unb.br) on 2009-05-06T15:48:42Z (GMT) No. of bitstreams: 1 2008_GustavoBalduinoLeite_reduzida.pdf: 1263249 bytes, checksum: c55f741f929e8ef09635062edaafb6dc (MD5) / Made available in DSpace on 2009-05-06T15:48:42Z (GMT). No. of bitstreams: 1 2008_GustavoBalduinoLeite_reduzida.pdf: 1263249 bytes, checksum: c55f741f929e8ef09635062edaafb6dc (MD5) Previous issue date: 2008-10 / Staphylococcus aureus é um patógeno associado a altas taxas de mortalidade e morbidade, capaz de produzir infecções em diversos tecidos do corpo humano. Sua capacidade em adquirir resistência à antibióticos e de sobreviver em diferentes condições ambientais o torna um perigoso agente infeccioso no ambiente hospitalar. O objetivo deste estudo foi realizar um levantamento da ocorrência de indivíduos portadores assintomáticos de S. aureus suscetíveis (MSSA) ou resistente a meticilina (MRSA) no âmbito do Hospital Universitário de Brasília (HUB) e na comunidade e, o desenvolvimento de procedimentos moleculares para identificação de MSSA e de MRSA. No total foram coletadas 327 amostras nasais e sub-ungueais de profissionais e alunos vinculados ao HUB. Essas amostras foram divididas em três grupos: Alunos (medicina, enfermagem e odontologia), Equipe Médica (enfermeiros, auxiliares e técnicos de enfermagem e médicos) e Técnicos (funcionários que não possuem contato com pacientes). Também foram coletadas 48 amostras de pacientes previamente identificadas como MRSA pelo HUB e 136 amostras de indivíduos sem contato com o ambiente hospitalar (comunidade). Todas as amostras foram submetidas a crescimento em meios de cultura seletivos e diferenciais e testadas quanto a produção de coagulase para a identificação de S. aureus. Os isolados foram então submetidos ao teste de susceptibilidade à oxacilina e vancomicina. Os isolados de comunidade e de pacientes foram submetidos a ensaios de PCR para confirmação dos resultados bioquímicos através de iniciadores específicos para os genes que codificam proteína A, coagulase e nuclease termoestável, específicos de S. aureus, e mecA, presente em MRSA. A porcentagem de portadores de S. aureus encontrada na comunidade foi de 17,64%, e nos grupos relacionados ao ambiente hospitalar de 56,02%, sendo que: Alunos 69,64%; Equipe Médica 47,54% e Técnicos 51,02%. A diferença de portadores de cada grupo e o grupo comunidade foi significativa (P 0,001), o que indica que indivíduos sem contato com o ambiente hospitalar possui menos tendência de estar colonizado por S. aureus. Em relação a MRSA, a porcentagem de portadores na comunidade foi de 1,47%, e entre os indivíduos relacionados ao ambiente hospitalar 37,95%. Nos alunos a freqüência foi de 53,57%, equipe médica 22,95% e técnicos 38,77%. Dentro do grupo técnicos destaca-se os funcionários da lavanderia, onde 52,2% foram caracterizados como portadores de MRSA. A diferença dos grupos associados ao hospital e o grupo comunidade foi significativa (P 0,001). Apenas dois isolados de pacientes não confirmaram a caracterização prévia, sendo considerados Staphylococcus coagulase negativo resistente à oxacilina. Todos os isolados de comunidade e pacientes identificadas como Staphylococcus aureus e como MRSA nos testes bioquímicos também foram positivos nos ensaios de PCR. Os três isolados de pacientes caracterizadas como Staphylococcus coagulase negativo resistente à oxacilina foram positivos apenas na amplificação do gene mecA, confirmando os resultados nos testes bioquímicos. Nenhuma amostra apresentou resistência à vancomicina. Nossos resultados sugerem uma alta freqüência de portadores de MRSA no ambiente hospitalar, contrariamente ao observado na comunidade. O número de portadores de MRSA entre alunos e funcionários da lavanderia levanta a questão do possível papel que estes indivíduos podem estar desempenhando na disseminação dessas cepas resistentes pelo hospital, no entanto essa pergunta só poderá ser respondida através de estudos específicos. Os ensaios moleculares demonstraram o potencial dessa metodologia no diagnóstico rápido de infecções por MRSA, o que possibilita não só um tratamento mais eficiente como uma redução na disseminação dessas cepas. / _________________________________________________________________ ABSTRACT / Staphylococcus aureus is a pathogen associated with high rates of mortality and morbidity, capable of producing infections in various tissues of the human body. His ability to acquire resistance to antibiotics makes it a dangerous infectious agent in the hospital environment. The purpose of this work was to survey the incidence of asymptomatic carriers of S. aureus resistant (MRSA) and susceptive (MSSA) to methicillin in the University Hospital of Brasília (HUB), and the development of procedures for molecular identification of MSSA and MSRA strains. In total 327 samples were collected nasal and sub-nail of individuals related to the HUB. These samples were divided into three groups: students (medicine, nursing and dentistry), medical staff (nurses, nursing assistants and doctors) and the Technical Group (employees who do not have contact with patients). Were also collected 48 samples from patients previously identified as MRSA by HUB and 136 samples from individuals without contact with the hospital environment (community). All samples were inoculated into the culture medium and Baird Parker, and colonies with phenotypic characteristics of S. aureus were tested for fermentation of mannitol and coagulation of rabbit’s plasma to confirm the identification. Samples confirmed as S. aureus were then subjected to the test of susceptibility to oxacillin and vancomycin. Samples from community and patients were also subjected to PCR confirmation of the biochemical results through DNA fragment amplification using specific primers for genes that encodes protein A, coagulase and the thermal-stable nuclease, all specific to S. aureus, and mecA, which is present in MRSA. The rate of S. aureus carriers found in the community was 17.64%, and the total of groups related to the hospital was 56.02%, of which: Students 69.64%; Technicians 51.02% and Medical Staff 47.54%. The difference in carriers of each group and in the community group was significant (P 0001), which indicates that individuals without contact with the hospital have fewer chances to be colonized by S. aureus. For MRSA, the rate of carriers in the community was 1.47%, and among individuals related to the hospital was 37.95%, while in the Students group the rate was 53.57%, in the Medical Staff group was 22.95% and in the Technicians group was 38.77%. Inside the Technicians group, 52,2% of the workers in hospital’s laundry were colonized with MRSA. The difference between the groups associated with the hospital and the community group was significant (P 0001). Only two samples of patients did not confirm the prior characterization made by HUB and was considered Staphylococcus coagulase negative oxacillin resistant. All samples of community and patients identified as Staphylococcus aureus and MRSA in biochemical tests were also positive in the PCR test. The three samples of patients characterized as Staphylococcus coagulase negative oxacillin resistant was positive only for the amplification of the mecA gene, confirming the results in biochemical tests. No sample proved resistant to vancomycin. Our results suggest a high rate of MRSA carriers among hospital workers and students. The number of MRSA carriers among students and worker of the laundry raise the question about the rule of these individuals over the dissemination of MRSA through the hospital wards. Further studies focused on that matter would be necessary to answer this question. The molecular experiments showed the potential of this methodology on a fast diagnosis of MRSA infections, what would not just help the treatment, but should avoid the disseminations of those clones.

abstract: The prevalence of antibiotic resistant bacterial pathogens has increased since the introduction of penicillin in the 1940s. Insufficient development of novel antibacterial agents is leaving us with a failing arsenal of therapies to combat these pathogenic organisms. We have identified a clay mineral mixture (designated CB) that exhibits in vitro antibacterial activity against a broad spectrum of bacterial pathogens, yet the antibacterial mechanism of action remains unknown. Antibacterial susceptibility testing of four different clay samples collected from the same source revealed that these natural clays had markedly different antibacterial activity. X-ray diffraction analyses of these minerals revealed minor mineralogical differences across the samples; however, ICP analyses demonstrated that the concentrations of many elements, Fe, Co, Cu, Ni, and Zn in particular, vary greatly across the four clay mixture leachates. Supplementation of a non-antibacterial leachate containing lower concentrations of Fe, Co, Ni, Cu, and Zn to final ion concentrations and a pH equivalent to that of the antibacterial leachate resulted in antibacterial activity against E. coli and MRSA, confirming the role of these ions in the in vitro antibacterial clay mixture leachates. The prevailing hypothesis is that metal ions participate in redox cycling and produce ROS, leading to oxidative damage to macromolecules and resulting in cellular death. However, E. coli cells showed no increase in DNA or protein oxidative lesions and a slight increase in lipid peroxidation following exposure to CB-L. Supplementation of CB-L with ROS scavengers eliminated oxidative damage in E. coli, but did not rescue the cells from killing, indicating that in vitro killing is due to direct metal toxicity and not to indirect oxidative damage. Finally, we ion-exchanged non-antibacterial clays with Fe, Co, Cu, and Zn and established antibacterial activity in these samples. Treatment of MRSA skin infections with both natural and ion-exchanged clays significantly decreased the bacterial load after 7 days of treatment. We conclude that 1) in vitro clay-mediated killing is due to toxicity associated directly with released metal ions and not to indirect oxidative damage and 2) that in vivo killing is due to the physical properties of the clays rather than metal ion toxicity. / Dissertation/Thesis / Ph.D. Microbiology 2014

Class of 2013 Abstract / Specific Aims: The purpose of this study was to assess risk factors that are associated with inpatient charges and mortality rates with methicilin-resistant Staphylococcus aureu (MRSA), Aspergillus, and Candida in children with leukemia. The hypotheses is MRSA and opportunistic fungal infections are associated with higher inpatient charges and worse outcomes relative to those without. Children with leukemia are especially at risk due to underdeveloped and compromised immune systems. The rational is that identifying the risk factors that affect mortality and inpatient charges of these infections should add to the current knowledge of treating and preventing these infections in immune compromised patients. Methods: Retrospective cohort study using the Agency for Healthcare Research Quality (AHRQ) KIDS 2009 database. Inclusion criteria was defined as 17 years of age or younger and a ICD-9 code for an active infection with MRSA, Aspergillus, or Candida. Regression analysis's were performed to identify factors that had an impact on mortality, length of stay, and direct patient charges. Main Results: Values that were significant (p≤0.05) for predicting an increase in mortality were Age (year), MRSA, Aspergillus, Candida, and Deyo-Charlson comorbidity scores. Significant predictors of increased Inpatient Charges (p≤0.05) was Age (year), MRSA, Aspergillus, Candida, Female Sex, Deyo-Charlson comorbidity scores, Urban Hospitals, and the Southern Region. Significant predictors of Increased Length of Stay (p≤0.05) MRSA, Aspergillus, Candida, Female Sex, Deyo-Charlson, Urban Hospitals, Teaching Hospitals, and the Southern Region. Conclusion: Although uncommon in leukemia cases involving pediatrics or young adults, statistically significant and large risks of higher mortality, length of stay, and inpatient charges were noted in cases involving MRSA, aspergillus, and candida. Increasing Deyo-Charlson comorbidities scores were also consistently important predictors for poor outcomes in these leukemia patients and, with certain outcomes, increasing age and female sex.