Bakgrund: Resistenta bakterier (ESBL och MRSA) ökar runtom i Europa och anses vara ett hot mot människors hälsa. Det finns en kunskapslucka bland sjuksköterskor vad gäller smittvägar för dessa bakterier och hur omvårdnad bör ges till smittade patienter. Syfte: Att undersöka resistenta bakteriers smittvägar och vilka åtgärder i omvårdnaden av patienter som kan bryta dessa smittvägar. Metod: Vetenskapliga artiklar söktes fram i databaserna PubMed och Cinahl. Kvalitetsgranskning utfördes och därefter analyserades totalt 34 kvantitativa vetenskapliga artiklar. Analysen, som utfördes i enlighet med metod beskriven av Friberg (2012), mynnade ut i fyra kategorier efter att meningsenheter och huvudsakligt innehåll grupperats. Resultat: Huvudresultatet visade att resistenta bakterierna kan spridas via föremål och ytor i patientrum och på avdelningar samt via patienten och/eller sjuksköterskan, där händerna spelar störst roll. Åtgärder för minskad smittspridning innefattar bland annat desinficering av ytor, föremål och händer. Diskussion: Bristande handhygien, från hälso- och sjukvårdspersonalens sida, verkar vara en central faktor för smittspridning av resistenta bakterier. Detta skulle kunna bero på bristande kunskap om dessa bakterier, överbeläggningar eller tidsbrist. Slutsats: Sjuksköterskan är oumbärlig i arbetet för minskad smittspridning av resistenta bakterier. Sjuksköterskan behöver kunskap om smittvägar och hur de kan brytas för att kunna förmedla detta vidare till övrig personal. Detta för att säkerställa att samtliga på arbetsplatsen arbetar för samma mål.

Staphylococci are important opportunistic pathogens often found in the microflora of skin and mucosal surfaces of the upper respiratory tract of man and animals. The coagulase-positive species such as Staphylococcus aureus are capable of causing invasive (eg furuncles and bacteraemia) and non-invasive (food poisoning and toxic shock syndrome) conditions in humans. In animals, S. intermedius and S. aureus have been implicated in a variety of conditions including pyoderma in dogs, mastitis in cows and skin infections in horses with S. intermedius being responsible for more than 95% of staphylococcal infections in dogs. The emergence of antibiotic-resistant bacteria, in humans, animals and the environment, has become a cause for concern following the introduction of antimicrobial agents in clinical practice. Staphylococcal species, in particular, have developed or acquired antibiotic-resistance determinants to almost all the antimicrobial agents in clinical use today. In recent years there has been an increase in reports of the isolation of antibiotic-resistance staphylococci especially methicillin-resistant staphylococci (MRS), from cats and dogs. Cats and dogs are in close contact with humans, especially in advanced countries and therefore the possibility for transfer of antibiotic-resistant staphylococci from these animals to humans or vice versa may exist. The aims of this study were; to determine the species distribution and antibiotic sensitivity of staphylococci obtained from cats and dogs, to investigate the molecular basis of resistance and to examine the genetic relatedness of specific resistant isolates. Many studies have shown that S. intermedius and S. simulans (S. felis) are the predominante species on healthy dogs and cats, respectively, and lesions in these animals are caused by S. aureus and S. intermedius. In this study, a diverse range of coagulase-negative staphylococci was isolated from healthy animals but staphylococci from skin lesions of cats and dogs were identified mainly as S. intermedius as reported in the literature. A limited number of resistant isolates (~20%) were observed in this study and were mostly isolated from dogs. Investigations into the molecular basis of resistance to beta-lactam, macrolide and tetracycline antibiotics were carried out. The resistant isolates were analysed by polymerase chain reaction (PCR) and DNA sequencing techniques. MRS were analysed for the presence of the mecA gene and the staphylococcal cassette chromosome mec (SCCmec). The recombinase genes, cassette chromosome recombinase (ccr) on SCCmec elements were also examined. The SCCmec elements detected were as diverse as those reported in human staphylococcal strains. Comparative analysis of nucleotide and amino acid sequences of mecA and ccr gene complexes revealed that the genes are conserved among MRS of cat and dog orgin. Multilocus sequence typing (MLST) of methicillin-resistant S. aureus (MRSA) and S. epidermidis isolates showed that, the MRSA were of human origin but the S. epidermidis isolates were unique to cats and dogs. In addition, the blaZ gene which codes for ??-lactamases production, the erm genes responsible for erythromycin resistance and the tet genes which encode tetracycline resistances, were found to be identical to those observed in humans and other animal staphylococci and demonstrated similar diversity. The study has provided important information about the molecular basis of resistance in beta-lactamase producing staphylococci as well as the molecular epidemiology of MRS of cat and dog origin and identifies the risk of spread of MRS between humans and pets and vice versa. These findings should form part of a larger surveillance study on staphylococci of cat and dog origin for a better understanding of the epidemiology of antibiotic-resistance genes for improved management and control of resistant staphylococci in the community and in health care settings. / PhD Doctorate

The Problem: Novel community-acquired, non-multiresistant strains of oxacillin- (methicillin-) resistant Staphylococcus aureus (ORSA) have emerged in many parts of the globe. Little is known of the clinical features, the epidemiology, and the antibiotic treatment of these strains. Materials and Methods: A retrospective chart review was performed on patients presenting to Emergency Departments or Dermatology Clinics with staphylococcal infections. Patients were stratified into three groups, non-multiresistant ORSA (NORSA), multiresistant ORSA (MORSA) and oxacillin-susceptible S. aureus, and clinical comparisons made. Strains of NORSA and MORSA were typed using antibiograms, phage typing and pulsed-field gel electrophoresis. Antimicrobial studies were performed to compare different methods of detecting resistance to oxacillin and to non-beta-lactams. Time-kill studies were performed with one drug to explore killing kinetics. The interaction between drug combinations was examined using disk approximation and time-kill methodologies. A single point pharmacodynamic analysis was performed. Results: There was an increase in infections with NORSA, MORSA and OSSA. NORSA strains appeared to be more virulent than OSSA and MORSA strains. NORSA was strongly associated with skin and soft tissue infections and with Polynesians. Most of the NORSA strains were related to New Zealand ????Western Samoan Phage Pattern???? (WSPP) isolates, and unrelated to community-acquired, non-multiresistant MRSA strains from Western Australia. Two patients were found to have British EMRSA-15 strains. NORSA strains were unrelated to MORSA strains. Resistance to rifampicin, fusidic acid, ciprofloxacin and trimethoprim emerged in the time-kill assays. Combinations of antibiotics, particularly with ciprofloxacin, often showed antagonism. Gentamicin, fusidic acid, clindamycin, teicoplanin, vancomycin, and linezolid were predicted to perform well. Ciprofloxacin, erythromycin, doxycycline, flucloxacillin and quinupristin/dalfopristin were predicted to fail. Conclusions: WSPP strains of New Zealand and EMRSA-15 strains from Britain exist in South Western Sydney. These organisms are virulent, and increasing in incidence in several areas of Australia. Antimicrobial treatment of infections with these strains is problematic and requires further study.

Universiẗat, Diss., 2006--Giessen.

Freie Universiẗat, Diss., 2005--Berlin. / Dateiformat: zip, Dateien im PDF-Format.

Diss. (sammanfattning) Uppsala : Sveriges lantbruksuniv., 2004. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2005. / Härtill 4 uppsatser.

Thesis (Ph.D.). / Written for the Dept. of Food Science and Agricultural Chemistry, Macdonald College of McGill University. Title from title page of PDF (viewed 2008/08/04). Includes bibliographical references.

Thesis (Ph. D.)--University of Texas at Austin, 2008. / Vita. Includes bibliographical references.