Introdução: Staphylococcus aureus é um importante patógeno responsável por diversas infecções no ambiente hospitalar com elevada morbi-mortalidade. Os profissionais de saúde, sobretudo os de enfermagem, apresentam elevado risco de colonização por meio do contato direto com indivíduos suscetíveis ou pelo contato com fômites em suas atividades laborais. Com isso, esses profissionais podem disseminar esses microrganismos tanto no ambiente hospitalar como na comunidade. Objetivo: Avaliar a colonização por Staphylococcus aureus em profissionais de enfermagem e a adesão às precauções-padrão. Metodologia: Trata-se de um estudo transversal realizado em clínica médica e em unidades especializadas em prestação de cuidados a pessoas com HIV/aids de um hospital escola do município de Ribeirão Preto. A população foi composta por 100 profissionais de enfermagem que prestam cuidados direto aos pacientes dessas unidades. Foram coletadas amostras de saliva, de secreção nasal e um swab do telefone celular dos profissionais. A coleta ocorreu no período de abril de 2014 a fevereiro de 2015, em três momentos, nos meses zero, quatro e oito. A obtenção dos dados demográficos, profissionais e individuais foi feita por meio de um questionário estruturado. Para avaliar a adesão dos profissionais às precauções-padrão, foram aplicadas dez escalas psicométricas do tipo Likert, já traduzidas e validadas para o português. As amostras coletadas foram encaminhadas e processadas pelo Laboratório de Microbiologia e Sorologia do referido hospital. Resultados: Dos 100 profissionais de enfermagem, 43,0% estavam colonizados por Staphylococcus aureus nas amostras de saliva e/ou de secreção nasal; 36,0% eram Staphylococcus aureus sensível à oxacilina e 7,0% resistente à oxacilina. A prevalência foi de 32,0% na secreção nasal, 1,0%, na saliva e 11,0%, nas amostras de saliva e de secreção nasal. Observou-se que 93,0% dos Staphylococcus aureus apresentaram resistência à penicilina, 43,0%, à eritromicina e 39,5%, à clindamicina. Nenhuma das amostras coletadas da base do telefone celular dos profissionais apresentou Staphylococcus aureus. Os profissionais apresentaram escores médios altos para a Escala de Adesão às Precauções-padrão e Escala de Personalidade de Risco. Não houve diferença significante ao comparar a média dos escores das escalas entre o grupo de colonizados e não colonizados. Armazenamento da escova dental em compartimento fechado/protegido (RP=2,07; IC95%=1,07-3,80) foi um fator de risco para a colonização. Enquanto que, o conhecimento sobre as PP (RP=0,53; IC95%=0,44-0,64) e participação em treinamento sobre as PP (RP=0,52; IC95%=0,43-0,64) apresentaram-se como um fator de proteção para a não colonização. Conclusão: A cavidade nasal foi um importante sítio de colonização quando comparada à cavidade oral, sendo um sítio relevante e indicado para a coleta em estudos que investigam a prevalência de colonização por Staphylococcus aureus. O conhecimento sobre precauções-padrão e a participação em treinamentos foram fatores associados à proteção para a não colonização. No entanto, um dos fatores determinantes para a adesão às precauções-padrão é a percepção de suscetibilidade do profissional de adquirir e disseminar esses microrganismos / Introduction: Staphylococcus aureus is an important pathogen responsible for several infections in hospitals with high morbidity and mortality rates. Health professionals, especially nurses, are at increased risk of colonization through direct contact with susceptible individuals or by contact with fomites in their work activities. As a consequence, these professionals can disseminate these microorganisms both in the hospital and in the community. Objective: To assess colonization by Staphylococcus aureus in nursing professionals and the adherence to standard precautions. Methods: This cross-sectional study was carried out in an outpatient clinic and in specialized units that provide care to people with HIV/Aids, in a teaching hospital of Ribeirão Preto. The population consisted of 100 nursing professionals who provide direct care to patients of these units. Samples of saliva, nasal secretions and a swab from the mobile phone of professionals were collected. The collection took place from April 2014 to February 2015 on three occasions, in months zero, four and eight. A structured questionnaire was used to obtain demographic, occupational and personal data. To assess the adherence of professionals to standard precautions, ten Likert-type psychometric scales, translated and validated for Portuguese, were applied. The collected samples were forwarded to and processed by the Microbiology and Serology Laboratory of the hospital. Results: Of the 100 nursing professionals, 43% were colonized with Staphylococcus aureus in saliva samples and/or nasal secretions; 36% were oxacillin-sensitive Staphylococcus aureus and 7.0% oxacillin-resistant. The prevalence was 32% in nasal secretion, 1% in saliva and 11% in saliva samples and nasal discharge. It was observed that 93% of Staphylococcus aureus were penicillin-resistant strains, 43% resistant to erythromycin and 39.5% to clindamycin. None of the samples collected from the base of the mobile phone of the professionals presented Staphylococcus aureus. Professionals had high mean scores for the Compliance with Standard Precautions Scale and the Risk Personality Scale. There was no significant difference when comparing the average scores of scales between the colonized and non-colonized groups. Storing the toothbrush in a closed/protected space (PR=2.07; CI95%=1.07-3.80) was a risk factor for colonization. Knowledge of the SP (PR=0.53, CI95%=0.44-0.64) and participation in training on SP (PR=0.52, CI95%=0.43-0.64) were a protective factor for non- colonization. Conclusion: The nasal cavity was an important colonization site compared to the oral cavity, the nasal site is relevant and recommended for collection in studies investigating the prevalence of colonization for Staphylococcus aureus. Knowledge of the standard precautions and participation in training on standard precautions were protective factors for non-colonization. However, one of the determining factors for adherence to standard precautions is the perceived susceptibility of professional to acquire and disseminate these microorganisms

Introdução: Staphylococcus aureus é um importante patógeno responsável por diversas infecções no ambiente hospitalar com elevada morbi-mortalidade. Os profissionais de saúde, sobretudo os de enfermagem, apresentam elevado risco de colonização por meio do contato direto com indivíduos suscetíveis ou pelo contato com fômites em suas atividades laborais. Com isso, esses profissionais podem disseminar esses microrganismos tanto no ambiente hospitalar como na comunidade. Objetivo: Avaliar a colonização por Staphylococcus aureus em profissionais de enfermagem e a adesão às precauções-padrão. Metodologia: Trata-se de um estudo transversal realizado em clínica médica e em unidades especializadas em prestação de cuidados a pessoas com HIV/aids de um hospital escola do município de Ribeirão Preto. A população foi composta por 100 profissionais de enfermagem que prestam cuidados direto aos pacientes dessas unidades. Foram coletadas amostras de saliva, de secreção nasal e um swab do telefone celular dos profissionais. A coleta ocorreu no período de abril de 2014 a fevereiro de 2015, em três momentos, nos meses zero, quatro e oito. A obtenção dos dados demográficos, profissionais e individuais foi feita por meio de um questionário estruturado. Para avaliar a adesão dos profissionais às precauções-padrão, foram aplicadas dez escalas psicométricas do tipo Likert, já traduzidas e validadas para o português. As amostras coletadas foram encaminhadas e processadas pelo Laboratório de Microbiologia e Sorologia do referido hospital. Resultados: Dos 100 profissionais de enfermagem, 43,0% estavam colonizados por Staphylococcus aureus nas amostras de saliva e/ou de secreção nasal; 36,0% eram Staphylococcus aureus sensível à oxacilina e 7,0% resistente à oxacilina. A prevalência foi de 32,0% na secreção nasal, 1,0%, na saliva e 11,0%, nas amostras de saliva e de secreção nasal. Observou-se que 93,0% dos Staphylococcus aureus apresentaram resistência à penicilina, 43,0%, à eritromicina e 39,5%, à clindamicina. Nenhuma das amostras coletadas da base do telefone celular dos profissionais apresentou Staphylococcus aureus. Os profissionais apresentaram escores médios altos para a Escala de Adesão às Precauções-padrão e Escala de Personalidade de Risco. Não houve diferença significante ao comparar a média dos escores das escalas entre o grupo de colonizados e não colonizados. Armazenamento da escova dental em compartimento fechado/protegido (RP=2,07; IC95%=1,07-3,80) foi um fator de risco para a colonização. Enquanto que, o conhecimento sobre as PP (RP=0,53; IC95%=0,44-0,64) e participação em treinamento sobre as PP (RP=0,52; IC95%=0,43-0,64) apresentaram-se como um fator de proteção para a não colonização. Conclusão: A cavidade nasal foi um importante sítio de colonização quando comparada à cavidade oral, sendo um sítio relevante e indicado para a coleta em estudos que investigam a prevalência de colonização por Staphylococcus aureus. O conhecimento sobre precauções-padrão e a participação em treinamentos foram fatores associados à proteção para a não colonização. No entanto, um dos fatores determinantes para a adesão às precauções-padrão é a percepção de suscetibilidade do profissional de adquirir e disseminar esses microrganismos / Introduction: Staphylococcus aureus is an important pathogen responsible for several infections in hospitals with high morbidity and mortality rates. Health professionals, especially nurses, are at increased risk of colonization through direct contact with susceptible individuals or by contact with fomites in their work activities. As a consequence, these professionals can disseminate these microorganisms both in the hospital and in the community. Objective: To assess colonization by Staphylococcus aureus in nursing professionals and the adherence to standard precautions. Methods: This cross-sectional study was carried out in an outpatient clinic and in specialized units that provide care to people with HIV/Aids, in a teaching hospital of Ribeirão Preto. The population consisted of 100 nursing professionals who provide direct care to patients of these units. Samples of saliva, nasal secretions and a swab from the mobile phone of professionals were collected. The collection took place from April 2014 to February 2015 on three occasions, in months zero, four and eight. A structured questionnaire was used to obtain demographic, occupational and personal data. To assess the adherence of professionals to standard precautions, ten Likert-type psychometric scales, translated and validated for Portuguese, were applied. The collected samples were forwarded to and processed by the Microbiology and Serology Laboratory of the hospital. Results: Of the 100 nursing professionals, 43% were colonized with Staphylococcus aureus in saliva samples and/or nasal secretions; 36% were oxacillin-sensitive Staphylococcus aureus and 7.0% oxacillin-resistant. The prevalence was 32% in nasal secretion, 1% in saliva and 11% in saliva samples and nasal discharge. It was observed that 93% of Staphylococcus aureus were penicillin-resistant strains, 43% resistant to erythromycin and 39.5% to clindamycin. None of the samples collected from the base of the mobile phone of the professionals presented Staphylococcus aureus. Professionals had high mean scores for the Compliance with Standard Precautions Scale and the Risk Personality Scale. There was no significant difference when comparing the average scores of scales between the colonized and non-colonized groups. Storing the toothbrush in a closed/protected space (PR=2.07; CI95%=1.07-3.80) was a risk factor for colonization. Knowledge of the SP (PR=0.53, CI95%=0.44-0.64) and participation in training on SP (PR=0.52, CI95%=0.43-0.64) were a protective factor for non- colonization. Conclusion: The nasal cavity was an important colonization site compared to the oral cavity, the nasal site is relevant and recommended for collection in studies investigating the prevalence of colonization for Staphylococcus aureus. Knowledge of the standard precautions and participation in training on standard precautions were protective factors for non-colonization. However, one of the determining factors for adherence to standard precautions is the perceived susceptibility of professional to acquire and disseminate these microorganisms

This thesis is an investigation of methods to remediate methicillin-resistant Staphylococcus pseudintermedius (MRSP) biofilms through conventional and microfluidic-based in vitro assays. MRSP biofilm related infections are a major concern for veterinary clinicians as they may complicate remediation by the immune system or antimicrobials. Novel antimicrobials that have been found to reduce biofilm growth in other staphylococci were assessed in both mono- and combination therapy against MRSP biofilm. Quantitative assay results (p < 0.05) suggest fosfomycin alone and in combination with clarithromycin can significantly reduce biofilm formation. Morphological examination using scanning electron microscopy and atomic force microscopy further demonstrated the effectiveness of fosfomycin alone on biofilm formation on orthopaedic screws and mica sheets. Fabricated microfluidic assays were utilized to assess multiple concentrations of antimicrobial therapy against pre-formed biofilm under physiologically relevant conditions in a quick and repeatable manner. Results demonstrated the usefulness of microfluidic platforms in determining minimum biofilm eradication concentrations.

Thesis (M.S.)--University of Alabama at Birmingham, 2006. / Title from first page of PDF file (viewed Feb. 19, 2009). Includes bibliographical references (p. 35-44).

Thesis (M.S.)--University of Missouri-Columbia, 2008. / The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file. "December 2008" Includes bibliographical references.

Methicillin-resistant Staphylococcus aureus (MRSA) are reported worldwide as a high prevalence of pathogens in the etiology of infections, both nosocomial and community. This study aimed to determine the prevalence of MRSA in the University Hospital of Santa Maria (HUSM), 2007-2011, as well as evaluating the sensitivity to vancomycin front of MRSA isolates collected from May to December 2011. We analyzed retrospectively the clinical data of all patients diagnosed with MRSA infections between January 2007 and December 2011. During this period, 1,852 samples of S. aureus foram isolated in HUSM, and 616 (33.3%) were resistant to oxacillin. There was a significant reduction in the prevalence rates of this pathogen which rose from 43.4% in 2007 to 33.9% in 2008, 30.4% in 2009, 28.1% in 2010 and 27.5% in 2011. Infections were more prevalent in male patients, aged 41 to 70 years, hospitalized in Medical clinic (16.28%), Adult Intensive Care Unit (15.13%), First Aid Post (13%), Adult Emergency Care (12.67%) and Surgery Clinic (12.5%). A greater isolation of MRSA in blood samples (16.9%), followed by tracheal aspirates (16.5%), urine (10.4%), sputum (8.7%), surgery wound secretion (8.1%) and lower limb secretion (7.8%). As for the determination of susceptibility to vancomycin, 125 samples from S. aureus were collected prospectively from May to December 2011, which 31 (24.8%) were MRSA. The minimum inhibitory concentration (MIC) of vancomycin was determined using a conventional methodology manual broth microdilution. The MIC most frequent among all S. aureus were the 1μg/mL, presented by 53.6% of the strains, whereas among MRSA, there was a higher frequency of MIC of 2 mg/mL (48.4%). Therefore all isolates belonging to this study were sensitive to this antimicrobial of choice for infections caused by MRSA strains. Thus, given the high rates of morbidity and mortality associated with these infections, this study demonstrated the importance of recognizing the prevalence and profile of susceptibility to vancomycin of MRSA so that effective measures for the treatment and control of MRSA to take effect. / Staphylococcus aureus resistentes à meticilina (MRSA) são relatados mundialmente como patógenos de elevada prevalência na etiologia de infecções, tanto nosocomiais como comunitárias. Este trabalho teve por objetivo determinar a prevalência dos MRSA no Hospital Universitário de Santa Maria (HUSM), de 2007 a 2011, bem como avaliar o perfil de sensibilidade frente à vancomicina de isolados de MRSA, coletados de maio a dezembro de 2011. Analisaram-se retrospectivamente, dados clínicos de todos os pacientes diagnosticados com infecções por MRSA entre janeiro de 2007 e dezembro de 2011. Durante este período, 1.852 amostras de S. aureus foram isoladas no HUSM, sendo que 616 (33,3%) foram resistentes à oxacilina. Houve uma redução significativa nas taxas de prevalência deste patógeno que passou de 43,4% em 2007 para 33,9% em 2008, 30,4% em 2009, 28,1% em 2010 e 27,5% em 2011. As infecções foram mais prevalentes em pacientes do sexo masculino, com idades entre 41 e 70 anos, internados na Clínica Médica (16,28%), Unidade de Terapia Intensiva adulto (15,13%), Ambulatório (13%), Pronto Atendimento adulto (12,67%) e Clínica Cirúrgica (12,5%). Houve maior isolamento dos MRSA em amostras de sangue (16,9%), seguido de secreção traqueal (16,5%), urina (10,4%), escarro (8,7%), secreção de ferida operatória (8,1%) e de membro inferior (7,8%). Já para a determinação da sensibilidade à vancomicina, foram coletadas prospectivamente 125 amostras de S. aureus de maio a dezembro de 2011, das quais 31 (24,8%) foram MRSA. A concentração inibitória mínima (CIM) da vancomicina foi determinada através de metodologia convencional manual de microdiluição em caldo. A CIM mais frequente dentre todos os S. aureus foi a de 1μg/mL, apresentada por 53,6% das cepas, enquanto que dentre os MRSA, houve maior frequência da CIM de 2 μg/mL (48,4%). Portanto todos os isolados pertencentes ao presente estudo foram sensíveis a este antimicrobiano de escolha para infecções causadas por cepas MRSA. Desta forma, diante das altas taxas de morbidade e mortalidade associadas a estas infecções, este estudo demonstrou a importância do reconhecimento da prevalência e do perfil de sensibilidade à vancomicina dos MRSA, para que medidas eficazes para o tratamento e controle dos MRSA sejam efetivadas.

Thesis (PhD)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Numerous studies conducted internationally have identified and described several endemic methicillin-susceptible Staphylococcus aureus (MSSA) clones. However, only some of these clones are associated with methicillin resistance (CC5, CC8, CC22, CC30 and CC45). To date, studies reporting on the population structure of S. aureus isolated in South Africa represent limited demographic areas, focus on methicillin-resistant S. aureus (MRSA) only and have displayed little emphasis on virulence. This study was undertaken to elucidate the population structure of S. aureus isolated from specific clinical sources at Tygerberg hospital, and to investigate specific host-pathogen interactions of representative isolates. Consecutive non-repetitive clinical S. aureus isolates were collected over one year (September 2009/2010) with patient demographics and limited clinical information. Strains were typed by PFGE and molecular markers (spa, multi-locus sequence typing (MLST), agr, Staphylococcal Chromosome Cassette mec and Panton-Valentine leukocidin (PVL)). Representative isolates were selected and investigated for the presence of virulence genes, adherence (to immobilised fibronectin [Fn], fibrinogen [Fg], collagens IV [CnIV] and VI [CnVI]), cellular invasion and cell death induction. Statistical association were determined between all in vitro results and methicillin-resistance, clonality, patient HIV status and bacterial PVL status. Fifteen percent of the isolates (n = 367) were MRSA. Forty four present of isolates were PVL+. agr I-IV and SCCmec I-V were identified. The MSSA population was diverse: ST22 (dominant), ST1865 and ST121 were PVL+. ST45, ST1863 and ST15 were PVL-. PVL- MRSA were diverse: ST612-MRSA-IV (dominant), ST5-MRSA-I, ST239-MRSA-III, ST36-MRSA-II and ST22-MRSA-IV. The genes fnbA/B (fibronectin-binding protein A/B), clfA/B (clumping factor A/B), eap (extracellular adherence protein), nuc (nuclease), coa (coagulase) and hld (delta toxin) were detected in all representative isolates. The CC8 and CC6 isolates adhered strongly to all ligands (100-700% of control, ligand dependent), while isolates of CC45, CC22 and CC88 adhered strongly only to Fg and Fn. The CC30, CC15, and CC12 isolates adhered extremely strongly to CnIV (>300%) and CC8, CC15, and C6 to CnVI (>200%). Isolates from CC30, CC8, CC15, CC6, CC12, CC97, CC88 and CC45 were highly invasive (>100%). ST121 was non-invasive (>50%). Isolates of CC5, CC30 and CC121 were non-cytotoxic (<50%), while isolates of CC22, CC8, CC15, CC45 and CC88 were very cytotoxic (>70%). No significant difference was observed in adherence or cell death induction of MRSA vs. MSSA clones or between isolates from HIV+ vs. HIV- persons. PVL- isolates displayed higher cellular invasiveness than PVL+ isolates. The presence of ST612-MRSA-IV, ST22-MRSA-V and ST8-MRSA-V points to local SCCmec acquisition, as we found MSSA isolates with the same spa types. Numerous MSSA clones were prevalent, but do not appear to have a major common genetic background with MRSA. PVL was highly prevalent among MSSA, indicating acquisition of PVL genes independently of SCCmec. The abilities to adhere to specific immobilised ligands in vitro were diverse and grouped with the genetic background, while the vast majority of isolates were invasive and induced significant cell death. We can conclude that the population of S. aureus at Tygerberg hospital is composed of a vast number of MSSA and MRSA clones, which display varying patters of adherence to selected ligands and of which, the majority clones are invasive and cytotoxic. / AFRIKAANSE OPSOMMING: Talle internasionale studies het verskeie endemiese metisillien vatbare Staphylococcus aureus (MSSA) klone geïdentifiseer en beskryf. Slegs 'n paar van hierdie klone word geassosieer met metisillien weerstandigheid (Klonale kompleks (KK) 5, KK8, KK22, KK30 en KK45). Studies oor die bevolking struktuur van S. aureus geïsoleer in Suid-Afrika is tot dusver beperk tot demografiese gebiede, fokus slegs op metisillien-weerstande S. aureus (MRSA) en het min klem op virulensie geplaas. Hierdie studie is onderneem om die bevolking struktuur van S. aureus, geïsoleer vanaf spesifieke kliniese bronne, in die pasiëntpopulasie van Tygerberg-hospitaal te ondersoek en om ondersoek in te stel na spesifieke gasheer-patogeen interaksies van verteenwoordigende isolate. Opeenvolgende, nie-herhalende en suiwer kliniese S. aureus isolate is versamel oor ´n periode van een jaar (September 2009/2010), tesame met pasiënt demografiese- en beperkte kliniese inligting. Stamme is deur PFGE en molekulêre merkers (spa, MLST, agr, SCCmec en PVL) beskryf. Verteenwoordigende isolate is gekies en ondersoek vir die teenwoordigheid van virulensie gene, aanhegting ( aan geïmmobiliseerde fibronektien [Fn], fibrinogeen [Fg], kollageen IV [CnIV] en kollageen VI [CnVI]), sellulêre indringing en die induksie van seldood. Statistiese assosiasies is bepaal tussen alle in vitro resultate en methicillin-weerstandigheid, klonaliteit, pasiënt MIV status en bakteriese PVL status. Fyftien persent van die isolate (n = 367) was MRSA. Vier-en-veertig van die isolate was PVL+. agrI-IV en SCCmec I-V is geïdentifiseer. Die MSSA bevolking was divers: ST22 (dominant), ST1865 en ST121 PVL +. ST45, ST1863 en ST15 was PVL+. PVL- MRSA was divers: ST612-MRSA-IV (dominant), ST5-MRSA-I, ST239-MRSA-III, ST36-MRSA-II en ST22-MRSA-IV. Die gene fnbA/B (fibronektien A/B), clfA/B (klontings faktor A/B), eap (ekstrasellulêre aanhegtings protein), nuc (nukease), coa (koagulase) en hld (delta toksien) was aangetref in alle verteenwoordigende isolate. Isolate van KK8 en KK6 het sterk aan alle ligande (100-700% van kontrole, ligand-afhanklike) aangeheg, terwyl isolate van KK45, KK22 en KK88 slegs sterk aand fibronektien en fibrinogeen aangeheg het. Isolate van KK30, KK15, en KK12 het baie sterk aan CnIV (> 300%) aangeheg en KK8, KK15, en KK6 and CnVI (> 200%). Isolate van KK30, KK8, KK15, KK6, KK12, KK97, KK88 en KK45 was hoogs indringend (> 100%). ST121 was nie-indringende (> 50%). Isolate van KK5, KK30 en KK121 was nie-sitotoksiese (<50%), terwyl isolate van KK22, KK8, KK15, KK45 en KK88 baie sitotoksies was (> 70%). Geen betekenisvolle verskil is waargeneem in die aanhegting of seldood induksie van MRSA teenoor MSSA klone of tussen isolate van MIV+ teenoor MIV- persone nie. PVL- isolate het hoër sellulêre indringing as PVL+ isolate vertoon. Die teenwoordigheid van ST612-MRSA-IV, ST22-MRSA-V en ST8-MRSA-V verwys na die plaaslike verwerwing van SCCmec, aangesien ons MSSA isolate beskryf het met dieselfde spa-tipes. Talle MSSA klone was algemeen, maar het nie 'n beduidende genetiese agtergrond met MRSA vertoon nie. PVL was baie algemeen onder MSSA isolate en die PVL gene is dalk onafhanklik van SCCmec verkry. Die vermoë om aan spesifieke geïmmobiliseer ligande in vitro aan te heg was divers en groepeer met die genetiese agtergrond, terwyl die meerderheid van die isolate indringend was en kon betekenisvolle sel dood veroorsaak. Ons kan aflei dat die bevolking van S. aureus by die Tygerberg hospitaal saamgestel is uit 'n groot aantal van MSSA en MRSA klone, wat verskillende patrone van aanhegting aan geselekteerde ligande vertoon en waarvan die meeste klone indringende en sitotoksies is. / DFG/NRF International Research and Training Group (IRTG) 1522 “HIV and associated infectious diseases in Southern Africa” / National Research Foundation / Medical Research Council, Medi-Clinic / Harry Crossley Fund (Stellenbosch University) / Stellenbosch University

Introdução: A problemática referente à conduta com profissionais na área de saúde colonizados por Staphylococcus aureus sensíveis e resistentes à metilcilina está em grande evidência, por ser este um importante patógeno causador de doenças com alta morbi-mortalidade.(LOWY, 1998). Atualmente as infecções por Staphylococcus aureus não respondem mais ao tratamento com os antimicrobianos anteriormente utilizados (CDC, 2006). O Staphylococcus aureus, resistente à meticilina (MRSA), vem se disseminando nos serviços de saúde e tem sido uma das causas de infecções com maior dificuldade de tratamento (CDC,1999). A maioria das infecções ocorre em pessoas colonizadas com o micro-organismo, sendo o carreador de longo tempo um fator de risco mais fortemente associado com infecção subsequente (WERTHEIM et al, 2005a). Objetivos: Avaliar a colonização e o perfil de susceptibilidade dos Staphylococcus aureus isolados na saliva da equipe de enfermagem atuante nas unidades de terapia intensiva, clínica médica, clínica cirúrgica e gineco-obstétrica de uma instituição de saúde de grande porte do interior paulista. Determinar a prevalência de portadores de Staphylococcus aureus resistentes à meticilina e à mupirocina, levando em consideração o tempo de atuação profissional, jornada no hospital e tempo de contato com os pacientes desse hospital. Métodos: Foram coletadas três amostras da saliva de 351 indivíduos, correspondendo a 94,1% dos profissionais da equipe de enfermagem com intervalo de dois meses entre as coletas. As amostras foram semeadas em agar manitol salgado e colônias típicas de Staphylococcus aureus foram identificadas pela coloração de Gram, produção de catalase, coagulase, Dnase, fermentação do manitol e o perfil de susceptibilidade determinado pelo teste de difusão de disco. Resultados: A prevalência entre os trabalhadores foi de 144 (41,0%) sendo 25 (7,1%) caracterizados como resistentes e 104 (29,6%) como sensíveis à meticilina (MSSA) 15 (4,3%) não foram recuperados para o antibiograma. Os carreadores transitórios representaram 81,2% e os persistentes 18,8%. A resistência à mupirocina foi de 73,1% entre os MRSA e 9,3% nos MSSA. Os resultados evidenciaram que os enfermeiros e técnicos de enfermagem constituem a categoria profissional mais susceptível à colonização por MRSA. O tempo na instituição não teve uma forte correlação com a colonização do profissional, pois trabalhadores com menor tempo na instituição também tiveram alta incidência de colonização. Discussão: Ao considerarmos outros fatores envolvidos como o setor de trabalho, fica evidenciado um panorama de risco para a segurança do paciente. Conclusão: Constatamos, na cavidade bucal, um potencial reservatório e fonte de disseminação de Staphylococcus aureus nos serviços de saúde, bem como um fator de risco de infecção para o trabalhador e, portanto, a necessidade de estudos específicos e intervenções para a prevenção e controle de MRSA, considerando principalmente a condição de setores especiais. / Introduction: The problem of how to manage health professionals colonized by methicillin sensitive and resistant Staphylococcus aureus is very evident, as this important pathogen causes different diseases with high morbidity and mortality rates (LOWY, 1998). Today, infections by Staphylococcus aureus no longer respond to treatment with formerly used antibiotics (CDC, 2006). Methicillin resistant Staphylococcus aureus is spreading across health services and has been one of the infection causes most difficult to treat (CDC, 1999). Most infections affect people colonized by the microorganism. Long-term carriers are a risk factor more strongly associated with subsequent infection (WERTHEIM et al, 2005a). Aims: To assess the colonization and susceptibility profile of Staphylococcus aureus isolated in the saliva of nursing teams active at the intensive care, medical clinic, surgical clinic and gynecological-obstetrical units of a large health institution in the interior of São Paulo State, Brazil. To determine the prevalence of nursing professionals carrying methicillin and mupirocin resistant Staphylococcus aureus, in view of their length of professional activity, work hours at the hospital and time of contact with hospital patients. Methods: Three saliva samples were collected from 351 individuals, corresponding to 94.1% of nursing team professionals, with a two-month interval between the collections. The samples were seeded in mannitol salt agar and typical colonies of S. aureus were identified through Gram stain; catalase, coagulase and Dnase production; mannitol fermentation and susceptibility profile determined by the disk diffusion test. Results: Prevalence levels among workers corresponded to 144 (41,0%) colonized by S aureus, 25 (7,10%) of whom were characterized as MRSA and 104 (29.6%) as methicillin sensitive Staphylococcus aureus, while 15 (4.3%) were not recovered for the antibiogram. Transitory carriers represented 81,2% and persistent carriers 18,8%. Mupirocin resistance was 73.1% among MRSA and 9.3% among MSSA. Results evidenced that nursing technicians and nurses were the professional category most susceptible to MRSA. No strong correlation was found between length of professional activity at the institution and colonization, as professionals working less time at the institution also displayed high colonization ratios. Discussion: These results are relevant for the study institution. When considering other factors involved in professional categorization and the work site, a picture of risk for patient safety is evidenced. Conclusion: Workers\' oral cavity is a potential reservoir and source of dissemination of S. aureus in health services, as well as a risk factor for infection. Hence, specific studies and MRSA prevention and control interventions are needed, mainly when considering the condition of special sectors.

Abstract not available

The dissertation investigates the S. aureus carriage cases in Vilnius adult population. The aim of the study – to determine the extent of S. aureus carriage of selected adult population and hospitalized patients in Vilnius and evaluate potential risk factors of its carriage as well as antimicrobial resistance of isolated strains and, prevailing genetic elements of the resistance and virulence. It was found that more S. aureus carriers detected in the community group than in hospitalized patients group. Greater isolated S. aureus strains resistance to antibiotics has been found in hospitalized patients group. Methicillin-resistant S. aureus were not isolated in the community group. Greater part of isolated S. aureus strains in community group was susceptible to all analyzed antimicrobial drugs. S. aureus strains resistant to erythromycin and clindamycin contained different genes in studied groups’: ermC dominated in community group, ermA – in hospitalized patients group. In terms of the incidence of tetracycline resistance genes in isolated S. aureus strains, tetK genes were dominant in MSSA and MRSA in both community and hospitalized patients groups. Our results demonstrate that PVL-positive S. aureus strains were more commonly isolated from community than from hospitalized patients group. 15% of spa types circulated in both studied groups. The spa types t4995 – t4999, t5001 – t5005 detected in this study were added into the Ridom StaphTypeTM database. Lithuania currently is... [to full text] / Disertacijoje nagrinėjama S. aureus nešiojimo atvejai suaugusiųjų populiacijoje Vilniaus mieste. Darbo tikslas – nustatyti S. aureus nešiojimo mastą pasirinktoje suaugusiųjų populiacijoje visuomenės bei hospitalizuotų ligonių grupėse Vilniaus mieste ir įvertinti S. aureus nešiojimo potencialius rizikos veiksnius, taip pat išskirtų padermių atsparumą kai kurioms antimikrobinėms medžiagoms, pagrindinius atsparumo ir virulentiškumo genetinius elementus. Nustatyta, kad daugiau S. aureus nešiojimo atvejų aptikta visuomenės grupėje nei hospitalizuotų ligonių. Didesnis S. aureus padermių atsparumas tirtiems antibiotikams buvo hospitalizuotų ligonių grupėje. Visuomenės grupėje meticilinui atsparių S. aureus neišskirta. Didesnė S. aureus dalis, išskirta visuomenės grupėje, buvo jautri visiems tirtiems antimikrobiniams vaistams. Atsparumą eritromicinui ir klindamicinui tirtose grupėse kodavo skirtingi genai: visuomenės grupėje vyravo ermC, hospitalizuotų ligonių grupėje – ermA. Atsparumą tetraciklinui koduojantis tetK genas vyravo abiejose tirtose grupėse. Visuomenės grupėje nustatyta daugiau PVL teigiamų S. aureus padermių nei hospitalizuotų ligonių grupėje. Septintadalis nustatytų spa tipų cirkuliuoja tiek visuomenės, tiek hospitalizuotų ligonių grupėse. Šio tyrimo metu spa tipai t4995 – t4999, t5001 – t5005 pirmą kartą nustatyti Lietuvoje ir įtraukti į Ridom StaphTypeTM duomenų bazę. Nustatyta statistiškai reikšminga asociacija tarp viršutinių kvėpavimo takų S. aureus kolonizacijos... [toliau žr. visą tekstą]