Σκοπός της παρούσας ερευνητικής εργασίας ήταν η επιδημιολογική μελέτη των λοιμώξεων από πηκτάση-αρνητικούς σταφυλοκόκκους (CNS) σε ασθενείς με προσθετικά υλικά, όπως ενδαγγειακούς καθετήρες και η σύγκριση με στελέχη που προκαλούν βακτηριαιμία. Συνολικά μελετήθηκαν 168 Staphylococcus epidermidis και 58 S. haemolyticus από βακτηριαιμίες (BSIs, 100 στελέχη) και εντοπισμένες λοιμώξεις σχετιζόμενες με την εφαρμογή προσθετικών υλικών (PDAIs, 126 στελέχη) από ασθενείς του Πανεπιστημιακού Γενικού Νοσοκομείου Πατρών (ΠΓΝΠ) και του Νοσοκομείου Παίδων Πεντέλης (ΝΠΠ). Η πλειοψηφία των στελεχών (89.8%) ήταν ανθεκτικά στην methicillin (MR-CNS) και πολυανθεκτικά (90.7%). Βιομεμβράνη συνέθεταν τα 106/226 στελέχη, ενώ 208 παρήγαγαν β-λακταμάση. Τα γονίδια σύνθεσης προσκολλητινών aap, fnbA και bap βρέθηκαν σε συχνότητα 40.3%, 35.8% και 20.4% αντίστοιχα. Οι S. epidermidis έφεραν τα γονίδια atlE και fbe σε ποσοστά 88.1% και 81%, αντίστοιχα. Από τα γονίδια σύνθεσης τοξινών, συχνότερο ήταν το γονίδιο της τοξίνης τοξικής καταπληξίας tst (8.4%) ενώ τα γονίδια που κωδικοποιούν τις εντεροτοξίνες sea, sec βρέθηκαν μόνο σε μικρό ποσοστό στελεχών S. epidermidis και S. haemolyticus (5.3% και 3.1% του συνολικού πληθυσμού αντίστοιχα). Κανένα στέλεχος δεν έφερε τα γονίδια σύνθεσης των εντεροτοξινών seb και sed. Ο πληθυσμός των στελεχών S. epidermidis έδειξε μεγάλη γενετική ποικιλομορφία, με 67 PFGE τύπους, μεταξύ των οποίων δύο κύριοι τύποι (a, b) με 50 και 36 στελέχη αντίστοιχα. Έλεγχος με MLST ανέδειξε τρεις κύριους κλώνους (ST2, ST5 και ST16) που ανήκαν στο ίδιο κλωνικό σύμπλεγμα (Clonal Complex 2). Τα στελέχη του PFGE τύπου a παρουσίασαν υψηλότερα ποσοστά αντοχής στα αντιμικροβιακά clindamycin, ciprofloxacin, fusidic acid, SXT και στις αμινογλυκοσίδες, ενώ τα στελέχη του τύπου b έφεραν συχνότερα το γονίδιο aap (p=0.049). Τα στελέχη S. haemolyticus παρουσίασαν μικρότερη γενετική ποικιλομορφία, με έναν κύριο PFGE τύπο (h), που περιελάμβανε 44/58 στελέχη (75.9% του συνολικού πληθυσμού). Τα στελέχη CNS από BSIs ήταν συχνότερα ανθεκτικά στην methicillin (p<0.001) και στα υπόλοιπα αντιμικροβιακά (p<0.05), ενώ υπερείχαν και στην παραγωγή biofilm (p=0.003). Αντιθέτως, οι CNS από PDAIs έφεραν συχνότερα τα γονίδια των προσκολλητινών aap (p=0.006) και bap (p=0.045). Σε ένα δεύτερο σκέλος της παρούσας ερευνητικής εργασίας μελετήθηκε ένας πληθυσμός S. lugdunensis από το ΠΓΝΠ (37 στελέχη) και το ΝΠΠ (1 στέλεχος). Ο S. lugdunensis κατέχει ιδιαίτερη θέση μεταξύ των CNS, καθώς μπορεί να μιμηθεί την παθογόνο δράση του S. aureus και να προκαλέσει σοβαρές λοιμώξεις. Είκοσι δύο S. lugdunensis απομονώθηκαν από ασθενείς με λοιμώξεις δέρματος και μαλακών μορίων (Skin and Soft Tissue Infections: SSTIs), εννέα από εν τω βάθει λοιμώξεις (Deep Sited Infections: DSIs), συμπεριλαμβανομένων τριών στελεχών από ασθενείς με βακτηριαιμία, και επτά στελέχη από λοιμώξεις σχετιζόμενες με προσθετικά υλικά, κυρίως ενδαγγειακούς καθετήρες, (PDAIs). Όλα τα στελέχη ήταν ευαίσθητα στην methicillin (MS-CNS), στις αμινογλυκοσίδες (kanamycin, gentamicin), καθώς και στα: ciprofloxacin, rifampicin, teicoplanin, vancomycin, linezolid και daptomycin, ενώ μόνο τέσσερα στελέχη ήταν πολυανθεκτικά. Οι S. lugdunensis της συλλογής μας έδειξαν μικρή γενετική ποικιλομορφία. Τα 38 στελέχη ταξινομήθηκαν σε επτά κλώνους, με δύο κύριους PFGE τύπους (C και D), οι οποίοι περιελάμβαναν 22 και εννέα στελέχη αντίστοιχα. Τα 26 από τα 38 στελέχη έφεραν το οπερόνιο ica, ενώ συνολικά 14 ήταν biofilm-θετικά. Δεν παρατηρήθηκε συσχέτιση της παρουσίας του ica με κάποιο κλώνο, αλλά ούτε και με την παραγωγή βιομεμβράνης. Οι S. lugdunensis από PDAIs ήταν συχνότερα biofilm-θετικοί σε σχέση με τα στελέχη από SSTIs και DSIs, ενώ ο κύριος κλώνος C παρήγαγε biofilm σε μεγαλύτερο ποσοστό από τον D, δεύτερο σε συχνότητα κλώνο. Το γονίδιο fbl ανιχνεύθηκε σε όλα τα στελέχη S. lugdunensis που εξετάστηκαν, επιβεβαιώνοντας την φαινοτυπική ταυτοποίηση σε επίπεδο είδους. Ο επόμενος κατά σειρά συχνότητας παράγοντας παθογένειας που ανιχνεύθηκε ήταν το γονίδιο atlL, το οποίο βρέθηκε σε 36 από τα 38 στελέχη (94.7%). Ακολουθούν οι παράγοντες vwbl και slush, που βρέθηκαν σε 31 (81.6%) και 15 (39.5%) S. lugdunensis, αντίστοιχα. Τα στελέχη από εν τω βάθει λοιμώξεις (DSIs) έφεραν σε μεγαλύτερο ποσοστό τα γονίδια vwbl και slush σε σχέση με αυτά από PDAIs και SSTIs . Ο κλώνος C υπερείχε στην παρουσία του ermC, ενώ τα στελέχη που ανήκαν στον κλώνο D έφεραν σε μεγαλύτερο ποσοστό τα γονίδια vwbl και slush. / Coagulase-negative staphylococci (CNS), especially Staphylococcus epidermidis and S. haemolyticus, have emerged as opportunistic pathogens in patients with low immune response or indwelling medical devices. In the present study, bloodstream (BSIs) and prosthetic-device associated infections (PDAIs) CNS isolates were compared in terms of biofilm formation, antimicrobial resistance, clonal distribution, adhesin and toxin genes carriage. A collection of 226 CNS (168 S. epidermidis and 58 S. haemolyticus) recovered from BSIs (100) and PDAIs (126) of different patients in the Patras tertiary-care University General Hospital (UGHP) and Pentelis Paediatric Hospital in Athens (PPHA), was tested for biofilm formation, antimicrobial susceptibility, mecA, ica operon, adhesin (aap, bap, fnbA, atlE, fbe) and toxin (tst, sea, seb, sec, sed) genes carriage. All CNS were classified into pulsotypes by PFGE, whereas S. epidermidis strains were assigned to sequence types by MLST. In total, 106 isolates (46.9%) produced biofilm, whereas 150 (66.4%) carried ica operon. Most isolates carried mecA and were multidrug resistant (90.7%). The adhesin encoding genes aap, fnbA and bap were identified in 40.3%, 35.8% and 20.4% of the total population, respectively. Genes encoding AtlE and Fbe were found in 88.1% and 81% of S. epidermidis isolates, respectively. CNS recovered from BSIs prevailed in biofilm formation (P=0.003), resistance to antimicrobials and mecA carriage (P<0.001) as compared to isolates derived from PDAIs. CNS from PDAIs carried more frequently aap and bap genes (P=0.006 and P=0.045, respectively). No statistically significant difference in toxin genes carriage was identified (P>0.05). Even though PFGE showed genetic diversity, especially among S. epidermidis, analysis of representative strains from the main PFGE types by MLST, revealed three major clones (ST2, ST5, ST16). A clonal relationship was found concerning antimicrobial susceptibility, ica and aap gene carriage, reinforcing the aspect of clonal expansion in hospital settings. Pathogenesis of BSIs is associated with biofilm formation and high-level antimicrobial resistance, whereas PDAIs are related to the adhesion capability of CNS. In the second part of this study we analyzed a collection of S. lugdunensis isolates recovered from different inpatients hospitalized in UGHP (37 isolates) and PPHA (one isolate) during a six-year period (2008-2013). S. lugdunensis has emerged as a significant human pathogen with distinct clinical and microbiological characteristics. A collection of 38 S. lugdunensis was tested for biofilm formation, antimicrobial susceptibility, clonal distribution, virulence factors (ica operon, fbl, atlL, vwbl, slush) and antibiotic resistance genes (mecA, ermC) carriage. The majority (22) was isolated from skin and soft tissue infections (SSTIs), nine from deep-sited infections (DSIs), including three bacteraemias and seven from PDAIs. All isolates were oxacillin-susceptible, mecA-negative and fbl-positive. The higher resistance rate was detected for ampicillin (50%), followed by erythromycin and clindamycin (18.4%). Fourteen isolates (36.8%) produced biofilm, 26 carried ica operon, but no relation between ica carriage and biofilm formation was identified. Biofilm formation was more frequent in isolates recovered from PDAIs. Thirty six strains (94.7%) carried atlL, 31 (81.6%) vwbl, whereas, slush was detected in fifteen (39.5%). PFGE revealed low level of genetic diversity: strains were classified into seven pulsotypes, with two major clones C and D including 22 and nine strains, respectively. Type C strains, recovered from all infection sites, prevailed in biofilm formation and ermC carriage, whereas, type D strains, associated with SSTIs and DSIs, carried more frequently vwbl, slush or both genes. Despite susceptibility to antimicrobials, clonal expansion and carriage of virulence factors combined with biofilm-producing ability render this species an important pathogen that should not be ignored.

Coagulase negative staphylococci (CoNS) are the most prevalent bacterial contaminants of platelet concentrates (PCs), and have been implicated in severe and fatal transfusion reactions. Of this group, Staphylococcus epidermidis is most frequently identified. The preliminary objective of this thesis was to confirm that S. epidermidis could form biofilms under platelet storage conditions. This was achieved using a modified crystal violet staining assay to detect plastic-adherent bacterial cells and examination of attachment processes by scanning electron microscopy. A collection of CoNS isolated from PCs obtained from reportedly healthy donors was then assessed for biofilm-forming potential at the genetic and phenotypic level. Despite the presumable commensal origin of these isolates, a high proportion of S. epidermidis strains displayed a biofilm positive phenotype. The threat of S. epidermidis biofilm formation during platelet storage identified herein signifies that any alterations made to platelet storage protocols should be evaluated with consideration of this risk. The advent of platelet additive solutions (PASs) as an alternative to plasma for PC storage provides a relevant example, since little is known about the effect of PAS on contaminant bacteria, and vice versa. Growth and biofilm formation by S. epidermidis and the Gram-negative bacterium Serratia liquefaciens were measured in PAS- or plasma-PCs over 5 days, simulating standard platelet storage conditions, after initial inoculation with low, clinically relevant bacterial concentrations. Assays for platelet quality were performed simultaneously. Only S. liquefaciens exhibited a slower doubling time in plasma-PCs than in PAS-PCs. Biofilm formation by both species was reduced during storage in PAS-PCs, increasing bacteria availability for detection. Although S. liquefaciens adversely affected platelet quality in both media, S. epidermidis contamination did not. Ultimately, culture-based detection remains the earliest indicator of bacterial presence in PAS-PCs. Lastly, since formation of platelet-bacteria aggregates is largely based on receptor-ligand interactions, it was postulated that biofilm formation by contaminant bacteria could be abrogated by receptor shielding. Methoxypoly(ethylene glycol) was applied to covalently modify the platelet surface using a process termed ‘PEGylation’. It is herein demonstrated that PEGylation of PCs inoculated with S. epidermidis results in significantly reduced bacterial binding and biofilm formation during platelet storage.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Os Staphylococcus coagulase-negativos (SCN) são encontrados na pele e mucosas de seres humanos e outros animais, já que algumas espécies são parte constituinte da microbiota normal destes mesmos sítios, e podem constituir um reservatório para SCN. A espécie Staphylococcus epidermidis, é reconhecida como grande oportunista e agente de graves infecções nosocomiais e comunitárias, além de associado com infecções em pacientes submetidos a implantes com dispositivos médicos, e a espécie Staphyloccus haemolyticus é a segunda espécie mais isolada de hemoculturas humanas, sendo uma das espécies que apresenta elevada resistência aos antimicrobianos. O presente estudo teve como objetivo principal investigar a presença de SCN em fômites (estetoscópios, termômetros e esfigmomanômetros) no ambiente hospitalar, identificar as espécies S. haemolyticus e S. epidermidis e correlacionar seus perfis de resistência aos antimicrobianos com a capacidade de produção de biofilme. A técnica de multiplex-mPCR foi empregada na determinação das espécies e a fenotipagem foi realizada pelos testes fenotípicos convencionais. Os perfis de resistência aos antimicrobianos foram verificados através do teste de disco-difusão, determinação da CIM (oxacilina e vancomicina), determinação da CBM e presença do gene mecA. A capacidade de produção de biofilme foi investigada pelos testes do Ágar Vermelho do Congo e ensaios de aderência em superfícies abióticas (poliestireno e vidro) na presença e ausência de oxacilina e vancomicina, além da PCR para o gene icaAD. Os resultados demonstraram que pelos testes bioquímicos convencionais, a espécie mais encontrada foi S. epidermidis (43,5%). Após a confirmação pela técnica de PCR, 29 amostras (82%) foram identificadas como S. epidermidis, e 6 amostras (18%) foram identificadas como S. haemolyticus. Todas as amostras foram multirresistentes, oxacilina resistentes e vancomicina sensíveis, sendo que apenas 5 amostras S. epidermidis (17,2%) foram tolerantes a oxacilina. A presença do gene mecA foi detectada em 71,4% das amostras. Apesar da maioria das amostras ter apresentado capacidade de produzir slime e/ou biofilme não foi observada total correlação com a presença do gene icaAD enfatizando a natureza multifatorial da produção de biofilme. As amostras aderiram melhor ao esfigmomanômetro, e também, neste fômites, foi encontrado a maior porcentagem de amostras positivas para a produção de slime. Para aderência ao vidro e aderência ao poliestireno não foi encontrada correlação com os fômites. Foram isoladas amostras S. epidermidis de todos os sítios hospitalares estudados e S. haemolyticus só não foi encontrado em Enfermaria de Clínica Médica. Em relação aos fômites, S. epidermidis foi encontrado em todos os fômites estudados, e S. haemolyticus, apenas foi encontrado em esfigmomanômetro e em outros fômites. Os fômites estão servindo como fontes de transmissão e disseminação de micro-organismos, sendo necessário maiores estudos a respeito. / Coagulase-negative staphylococci ( SCN ) are found in the skin and mucous membranes of humans and other animals , since some species are a constituent part of the normal flora of these same sites, which may constitute a reservoir for SCN. Staphylococcus epidermidis species, is recognized as a major opportunistic infections and serious nosocomial and community staff, as well as associated with infections in patients undergoing implants with medical devices, and Staphylooccus haemolyticus is the second species most frequent species of human blood cultures, one of species that has a high antimicrobial resistance. The present study aimed to investigate the presence of SCN on fomites (stethoscopes, thermometers and sphygmomanometers) in the hospital environment, identify the species S. haemolyticus and S. epidermidis and correlate their antimicrobial resistance profiles with the ability to produce biofilm. The technique of multiplex mPCR was used in the determination of the species and phenotyping was performed by conventional phenotypic tests. The antimicrobial resistance profiles were checked by the disk diffusion test, MIC determination (oxacillin and vancomycin), determination of MBC and the presence of the mecA gene. The capacity of the biofilm was investigated by testing the Congo Red agar and adhesion assays abiotic surfaces (glass and polystyrene) in the presence and absence of oxacillin and vancomycin in addition to the PCR icaAD gene. The results demonstrated that the conventional biochemical tests, it was found more species S. epidermidis (43,5%). After confirmation by PCR , 29 samples (82%) were identified as S. epidermidis, and 6 samples (18%) were identified as S. haemolyticus. All samples were multiresistant, oxacillin-resistant and vancomycin-sensitive, and only 5 samples S. epidermidis (17,2%) were tolerant to oxacillin. The presence of the mecA gene was detected in 71,4% of samples. Although most of the samples have shown the ability to produce slime and/or biofilm not fully correlate with the presence of the gene was observed icaAD emphasizing the multifactorial nature of biofilm production. Samples adhered better to the sphygmomanometer, and that too, in this fomites, found the highest percentage of samples positive for slime production. For adhesion to glass and adherence to polystyrene was found no correlation with fomites. S. epidermidis samples of all hospital sites studied, and S. haemolyticus were isolated not only found in Infirmary Medical Clinic. Regarding fomites, S. epidermidis was found in all studied fomites, and S. haemolyticus, have been found only on sphygmomanometer and other fomites. The fomites are serving as sources of transmission and spread of microorganisms, and further study concerning necessary.

Made available in DSpace on 2014-12-17T14:10:22Z (GMT). No. of bitstreams: 1 EutaliaENFS_DISSERT.pdf: 2712662 bytes, checksum: 8c38ff6fb5ec0c379f1f2e3b3fe8a0c7 (MD5) Previous issue date: 2009-12-07 / In a hospital environment, these bacteria can be spread by insects such as ants, which are characterized by high adaptability to the urban environment. Staphylococcus is a leading cause of hospital infection. In Europe, Latin America, USA and Canada, the group of coagulase negative staphylococci (CoNS) is the second leading cause of these infections, according to SENTRY (antimicrobial surveillance program- EUA). In this study, we investigated the potential of ants (Hymenoptera: Formicidae) as vehicle mechanics of Staphylococcus bacteria in a public hospital, in Natal-RN. The ants were collected, day and night, from June 2007 to may 2008, in the following sectors: hospitals, laundry, kitchen, blood bank. The ants were identified according to the identification key of Bolton, 1997. For the analysis of staphylococci, the ants were incubated in broth Tryptic Soy Broth (TSB) for 24 hours at 35 ? C and then incubated on Mannitol Salt Agar. The typical colonies of staphylococci incubated for 24 hours at 35 ? C in Tryptic Soy Agar for the characterization tests (Gram stain, catalase, susceptibility to bacitracin and free coagulase). The identification of CoNS was performed through biochemical tests: susceptibility to novobiocin, growth under anaerobic conditions, presence of urease, the ornithine decarboxylation and acid production from the sugars mannose, maltose, trehalose, mannitol and xylose. The antimicrobial susceptibility examined by disk-diffusion technique. The technique of Polymerase Chain Reaction was used to confirm the presence of mecA gene and the ability to produce biofilm was verified by testing in vitro using polystyrene inert surface, in samples of resistant staphylococci. Among 440 ants, 85 (19.1%) were carrying coagulase-negative staphylococci (CoNS) of the species Staphylococcus saprophyticus (17), Staphylococcus epidermidis (15), Staphylococcus xylosus (13), Staphylococcus hominis hominis (10), Staphylococcus lugdunensis (10), Staphylococcus warneri (6), Staphylococcus cohnii urealyticum (5), Staphylococcus haemolyticus (3), Staphylococcus simulans (3), Staphylococcus cohnii cohnii (2), and Staphylococcus capitis (1). No Staphylococcus aureus was found. Among the isolates, 30.58% showed resistance to erythromycin. Two samples of CoNS (2.35%), obtained from the ant Tapinoma melanocephalum collected in the post-surgical female ward, S. Hominis hominis and S. lugdunensis harbored the mecA gene and were resistant to multiple antibiotics, and the specie S. hominis hominis even showed to be a biofilm producer. This study proves that ants act as carriers of multidrug-resistant coagulase-negative Staphylococci and biofilm producers and points to the risk of the spreading of pathogenic microorganisms by this insect in the hospital environment / No ambiente hospitalar, bact?rias podem ser disseminadas por insetos, tais como as formigas, que se destacam pela alta adaptabilidade ao ambiente urbano. As bact?rias do g?nero Staphylococcus s?o uma das principais causas de infec??o hospitalar. Em pa?ses da Europa, Am?rica Latina, Estados Unidos e Canad?, o grupo dos estafilococos coagulase-negativos (ECN) representa a segunda maior causa dessas infec??es, segundo o SENTRY (Programa de vigil?ncia antimicrobiana- EUA). No presente estudo foi analisado o potencial de formigas (Hymenoptera: Formicidae) como ve?culos mec?nicos de bact?rias do g?nero Staphylococcus em um hospital da rede p?blica de sa?de, no munic?pio de Natal-RN. As formigas capturadas em coletas diurnas e noturnas, entre junho de 2007 e maio de 2008, nos seguintes setores: enfermarias, lavanderia, cozinha, banco de sangue. Esses insetos foram identificados segundo a chave de identifica??o de Bolton, 1997. Para a an?lise da presen?a de estafilococos, as formigas foram incubadas em caldo de case?na de soja (TSB) por 24h, a 35?C para posterior semeadura em Agar Manitol Salgado. As col?nias caracter?sticas de estafilococos incubadas por 24h a 35?C, em Tryptic Soy Agar, para testes de caracteriza??o do g?nero (colora??o de Gram, catalase, susceptibilidade ? bacitracina e coagulase livre). A identifica??o dos ECN foi realizada atrav?s das provas bioqu?micas: susceptibilidade ? novobiocina, crescimento em anaerobiose, presen?a de urease, descarboxila??o da ornitina e produ??o de ?cidos a partir dos a??cares manose, maltose, trealose, manitol e xilose. A susceptibilidade aos antimicrobianos analisada atrav?s da t?cnica disco-difus?o. Para confirmar a presen?a do gene mecA foi utilizada a t?cnica da Rea??o em Cadeia da Polimerase e a capacidade de produ??o de biofilme foi verificada atrav?s de ensaio in vitro usando superf?cie inerte de poliestireno, em amostras de estafilococos resistentes. Entre 440 formigas, 85 (19,1%) estavam transportando os ECN das esp?cies Staphylococcus saprophyticus (17), Staphylococcus epidermidis (15), Staphylococcus xylosus (13), Staphylococcus hominis hominis (10), Staphylococcus lugdunensis (10), Staphylococcus warneri (6), Staphylococcus cohnii urealyticum (5), Staphylococcus haemolyticus (3), Staphylococcus simulans (3), Staphylococcus cohnii cohnii (2), e Staphylococcus capitis (1 ). Nenhum Staphylococcus aureus foi encontrado. Entre os isolados, 30,58% apresentaram resist?ncia ? eritromicina. Duas amostras de ECN (2,35%), obtidas a partir da formiga Tapinoma melanocephalum coletadas na enfermaria feminina p?s-cir?rgica, S. hominis hominis e S. lugdunensis albergavam o gene mecA e foram resistentes a m?ltiplos antibi?ticos. Al?m disso, a esp?cie S. hominis hominis ainda mostrou ser um produtor de biofilme. Este estudo demonstra que as formigas podem agir como veiculadoras de ECN multiresistentes aos antimicrobianos e produtores de biofilme, e, ainda, aponta para o risco da dissemina??o de microrganismos patog?nicos por esse inseto no ambiente hospitalar

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Os Staphylococcus coagulase-negativos (SCN) são encontrados na pele e mucosas de seres humanos e outros animais, já que algumas espécies são parte constituinte da microbiota normal destes mesmos sítios, e podem constituir um reservatório para SCN. A espécie Staphylococcus epidermidis, é reconhecida como grande oportunista e agente de graves infecções nosocomiais e comunitárias, além de associado com infecções em pacientes submetidos a implantes com dispositivos médicos, e a espécie Staphyloccus haemolyticus é a segunda espécie mais isolada de hemoculturas humanas, sendo uma das espécies que apresenta elevada resistência aos antimicrobianos. O presente estudo teve como objetivo principal investigar a presença de SCN em fômites (estetoscópios, termômetros e esfigmomanômetros) no ambiente hospitalar, identificar as espécies S. haemolyticus e S. epidermidis e correlacionar seus perfis de resistência aos antimicrobianos com a capacidade de produção de biofilme. A técnica de multiplex-mPCR foi empregada na determinação das espécies e a fenotipagem foi realizada pelos testes fenotípicos convencionais. Os perfis de resistência aos antimicrobianos foram verificados através do teste de disco-difusão, determinação da CIM (oxacilina e vancomicina), determinação da CBM e presença do gene mecA. A capacidade de produção de biofilme foi investigada pelos testes do Ágar Vermelho do Congo e ensaios de aderência em superfícies abióticas (poliestireno e vidro) na presença e ausência de oxacilina e vancomicina, além da PCR para o gene icaAD. Os resultados demonstraram que pelos testes bioquímicos convencionais, a espécie mais encontrada foi S. epidermidis (43,5%). Após a confirmação pela técnica de PCR, 29 amostras (82%) foram identificadas como S. epidermidis, e 6 amostras (18%) foram identificadas como S. haemolyticus. Todas as amostras foram multirresistentes, oxacilina resistentes e vancomicina sensíveis, sendo que apenas 5 amostras S. epidermidis (17,2%) foram tolerantes a oxacilina. A presença do gene mecA foi detectada em 71,4% das amostras. Apesar da maioria das amostras ter apresentado capacidade de produzir slime e/ou biofilme não foi observada total correlação com a presença do gene icaAD enfatizando a natureza multifatorial da produção de biofilme. As amostras aderiram melhor ao esfigmomanômetro, e também, neste fômites, foi encontrado a maior porcentagem de amostras positivas para a produção de slime. Para aderência ao vidro e aderência ao poliestireno não foi encontrada correlação com os fômites. Foram isoladas amostras S. epidermidis de todos os sítios hospitalares estudados e S. haemolyticus só não foi encontrado em Enfermaria de Clínica Médica. Em relação aos fômites, S. epidermidis foi encontrado em todos os fômites estudados, e S. haemolyticus, apenas foi encontrado em esfigmomanômetro e em outros fômites. Os fômites estão servindo como fontes de transmissão e disseminação de micro-organismos, sendo necessário maiores estudos a respeito. / Coagulase-negative staphylococci ( SCN ) are found in the skin and mucous membranes of humans and other animals , since some species are a constituent part of the normal flora of these same sites, which may constitute a reservoir for SCN. Staphylococcus epidermidis species, is recognized as a major opportunistic infections and serious nosocomial and community staff, as well as associated with infections in patients undergoing implants with medical devices, and Staphylooccus haemolyticus is the second species most frequent species of human blood cultures, one of species that has a high antimicrobial resistance. The present study aimed to investigate the presence of SCN on fomites (stethoscopes, thermometers and sphygmomanometers) in the hospital environment, identify the species S. haemolyticus and S. epidermidis and correlate their antimicrobial resistance profiles with the ability to produce biofilm. The technique of multiplex mPCR was used in the determination of the species and phenotyping was performed by conventional phenotypic tests. The antimicrobial resistance profiles were checked by the disk diffusion test, MIC determination (oxacillin and vancomycin), determination of MBC and the presence of the mecA gene. The capacity of the biofilm was investigated by testing the Congo Red agar and adhesion assays abiotic surfaces (glass and polystyrene) in the presence and absence of oxacillin and vancomycin in addition to the PCR icaAD gene. The results demonstrated that the conventional biochemical tests, it was found more species S. epidermidis (43,5%). After confirmation by PCR , 29 samples (82%) were identified as S. epidermidis, and 6 samples (18%) were identified as S. haemolyticus. All samples were multiresistant, oxacillin-resistant and vancomycin-sensitive, and only 5 samples S. epidermidis (17,2%) were tolerant to oxacillin. The presence of the mecA gene was detected in 71,4% of samples. Although most of the samples have shown the ability to produce slime and/or biofilm not fully correlate with the presence of the gene was observed icaAD emphasizing the multifactorial nature of biofilm production. Samples adhered better to the sphygmomanometer, and that too, in this fomites, found the highest percentage of samples positive for slime production. For adhesion to glass and adherence to polystyrene was found no correlation with fomites. S. epidermidis samples of all hospital sites studied, and S. haemolyticus were isolated not only found in Infirmary Medical Clinic. Regarding fomites, S. epidermidis was found in all studied fomites, and S. haemolyticus, have been found only on sphygmomanometer and other fomites. The fomites are serving as sources of transmission and spread of microorganisms, and further study concerning necessary.

Staphylococcus spp. é uma das principais causas da mastite bovina, onde o uso de antimicrobianos tem sido comprometido por mecanismos de resistência bacteriana e geração de resíduos que alteram a qualidade e segurança alimentar do leite e derivados. Foi avaliada a atividade in vitro da nisina (NS), do brometo de dioctadecildimetilamônio (DDA) e do complexo NS/DDA contra Staphylococcus spp. resistentes isolados de mastite bovina. A CBM50 da nisina e DDA foi 50 e 4&#956;g/mL, respectivamente, enquanto que a CBM50 do complexo NS/DDA foi 3/2&#956;g/mL, com efeito parcialmente sinérgico. O estudo de time-kill revelou redução de 3 log10 UFC/mL após uma hora de interação entre NS/DDA e a bactéria. A microscopia de fluorescência confirmou uma perda da viabilidade após 6 horas de interação. A interação NS/DDA resultou na formação de nanopartículas (148,5 nm) catiônicas (+8,84 mV) cuja interação com a superfície bacteriana negativa (-27,32 mV) resultou em ação bactericida. NS/DDA pode ser uma alternativa promissora contra Staphylococcus spp. resistentes isolados de mastite bovina. / Staphylococcus spp. is a major cause of bovine mastitis, where the use of antimicrobials has been compromised by bacterial resistance mechanisms and waste generation that change the food quality and safety of milk and dairy products. The in vitro activity antibacterial was evaluated of the nisin (NS), of the dioctadecyldimethylammonium bromide (DDA) and of the NS/DDA complex against drug-resistant Staphylococcus spp. isolated from bovine mastitis. The CBM50 of nisin and DDA were 50 and 4&#956;g/ml, respectively, while the CBM50 NS/DDA complex was 3/2mg/mL, with partially synergistic effect. The time-kill study showed reduction of 3log10 CFU/mL after an hour of interaction between NS/DDA and bacteria. Fluorescence microscopy confirmed a loss of viability after 6h of interaction. NS/DDA interaction resulted in formation of nanoparticles (148.5 nm) cationic (+8.84 mV) which interact with negative bacterial surface (-27.32 mV) resulted in bactericidal activity. NS/DDA may be a promising alternative against drug-resistant Staphylococcus spp. isolated from bovine mastitis.

Coagulase negative staphylococci (CoNS) are the most prevalent bacterial contaminants of platelet concentrates (PCs), and have been implicated in severe and fatal transfusion reactions. Of this group, Staphylococcus epidermidis is most frequently identified. The preliminary objective of this thesis was to confirm that S. epidermidis could form biofilms under platelet storage conditions. This was achieved using a modified crystal violet staining assay to detect plastic-adherent bacterial cells and examination of attachment processes by scanning electron microscopy. A collection of CoNS isolated from PCs obtained from reportedly healthy donors was then assessed for biofilm-forming potential at the genetic and phenotypic level. Despite the presumable commensal origin of these isolates, a high proportion of S. epidermidis strains displayed a biofilm positive phenotype. The threat of S. epidermidis biofilm formation during platelet storage identified herein signifies that any alterations made to platelet storage protocols should be evaluated with consideration of this risk. The advent of platelet additive solutions (PASs) as an alternative to plasma for PC storage provides a relevant example, since little is known about the effect of PAS on contaminant bacteria, and vice versa. Growth and biofilm formation by S. epidermidis and the Gram-negative bacterium Serratia liquefaciens were measured in PAS- or plasma-PCs over 5 days, simulating standard platelet storage conditions, after initial inoculation with low, clinically relevant bacterial concentrations. Assays for platelet quality were performed simultaneously. Only S. liquefaciens exhibited a slower doubling time in plasma-PCs than in PAS-PCs. Biofilm formation by both species was reduced during storage in PAS-PCs, increasing bacteria availability for detection. Although S. liquefaciens adversely affected platelet quality in both media, S. epidermidis contamination did not. Ultimately, culture-based detection remains the earliest indicator of bacterial presence in PAS-PCs. Lastly, since formation of platelet-bacteria aggregates is largely based on receptor-ligand interactions, it was postulated that biofilm formation by contaminant bacteria could be abrogated by receptor shielding. Methoxypoly(ethylene glycol) was applied to covalently modify the platelet surface using a process termed ‘PEGylation’. It is herein demonstrated that PEGylation of PCs inoculated with S. epidermidis results in significantly reduced bacterial binding and biofilm formation during platelet storage.

Orientador: Jose Luiz Pereira / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Engenharia de Alimentos / Made available in DSpace on 2018-08-07T14:47:03Z (GMT). No. of bitstreams: 1 Pereira_KarenSignori_D.pdf: 795788 bytes, checksum: 3c56762962a9dfbb567a0cc78805f20c (MD5) Previous issue date: 2006 / Resumo: As bactérias pertencentes ao gênero Staphylococcus são bastante peculiares porque apesar de terem distribuição ubiqüitária e formarem a microbiota residente na pele e mucosa de humanos também podem ser causadoras de diversas enfermidades aos mesmos, tais como a intoxicação alimentar estafilocócica.Todavia, para a indústria de produtos cárneos a importância dos estafilococos está além do fato de serem microrganismos patogênicos. Algumas espécies do gênero são coadjuvantes de tecnologia para a fabricação de salames, estando presentes como componentes de culturas starter ou iniciadoras. Entre as características importantes das espécies utilizadas em culturas iniciadoras está a incapacidade enterotoxigênica, o que tem sido diretamente relacionado às espécies coagulase positiva. Diversos trabalhos, porém, têm demonstrado a capacidade de estafilococos coagulase negativa produzirem enterotoxina em meio de cultivo laboratorial e há, inclusive, registros de surtos de intoxicação estafilocócica associados a espécies não produtoras de coagulase. Assim, 90 amostras de salames industrializados, pertencentes a seis diferentes marcas, foram analisadas visando a enumeração, identificação e verificação do potencial enterotoxigênico das espécies de estafilococos coagulase negativa (ECN). Determinações de pH, Aw, análises de coliformes termotolerantes, Salmonella, Staphylococcus coagulase positiva e bactérias láticas também foram realizadas. Salmonella foi detectada em uma amostra. Entre os 266 isolados de ECN nenhum produziu enterotoxina, e dos 252 identificados cerca de 90% eram S. xylosus e S. carnosus / Abstract: Staphylococcus is ubiquitous distribution bacteria and present in skin of humans and other animals. However, staphylococci species can cause various diseases. Staphylococcal food poisoning is one of these diseases. But for meat industry staphylococci importance is not only because diseases. Some species are very important for the fermented sausage¿s manufacture like starter cultures. To be used, staphylococci have do not produce coagulase. However, many researches have demonstrated capacity of coagulase negative staphylococci (CNS) to produce enterotoxin and there are registers of staphylococcal food poisoning outbreaks linked to CNS. Ninety samples of industrialized salamis, for six different brands, had been studied. Enumeration, identification and potencial enterotoxigenic of CNS were analyzed. Additionally, termotolerants coliforms, staphylococci coagulase positive and lactic acid were counted; Salmonella isolated; pH and Aw measured. Salmonella was isolated of one sample. None of 266 CNS produced enterotoxins, 252 were identified and about 90% were S. xylosus and S. carnosus / Doutorado / Doutor em Ciência de Alimentos

Le biofilm bactérien est une communauté de bactéries qui s’agrègent en un amas structuré recouvert d’une matrice polymérique et adhèrent sur une surface biotique ou abiotique. Ce mode de vie permet à ces bactéries de survivre dans un environnement hostile et cela entre autres grâce à une plus grande résistance aux antibiotiques que les bactéries sous forme libre ou planctonique. Les bactéries ayant la capacité de former des biofilms constituent donc un grave problème de santé tout aussi bien pour l’homme que pour l’animal comme par exemple dans le cas de la mammite bovine (MB). La MB est une inflammation de la glande mammaire de la vache induisant des dommages des tissus du pis et de ce fait, une réduction de la production de lait ainsi qu’une altération du bien-être de l’animal. Il est donc important de développer de nouvelles stratégies prophylactiques et thérapeutiques contre la MB. Des résultats préliminaires obtenus dans notre laboratoire avaient mis en évidence la capacité de certaines souches de staphylocoques à coagulase négative (SCN) produisant peu ou pas de biofilm à inhiber la formation de biofilm par d’autres bactéries responsables de MB. Notre hypothèse était donc que certaines souches faibles productrices de biofilm produisaient une ou plusieurs molécule(s) capable(s) d’inhiber de façon significative la formation de biofilm par d’autres SCN mais également par Staphylococcus aureus et possiblement d’autres agents pathogènes de la MB. Le but de ce projet fut donc de caractériser des molécules antibiofilm produites par des souches de SCN. Pour cela, 30 souches de staphylocoques (cinq espèces de SCN et S. aureus) fortes productrices de biofilm et 10 souches de SCN (Staphylococcus chromogenes et Staphylococcus simulans) faibles productrices de biofilm ont été utilisées. Nos résultats ont montré que certaines souches de SCN présentant un phénotype de faible production de biofilm réduisaient significativement la formation de biofilm chez plusieurs espèces de staphylocoques dont S. aureus. De plus, quatre souches de SCN (S. chromogenes C et E et S. simulans F et H) ont été capables d'inhiber de façon significative (p < 0,05) la formation de biofilm de 80% des souches testées. Cette activité antibiofilm a été également visualisée par microscopie confocale ainsi que dans des conditions dynamiques en utilisant un système de microfluidique. En parallèle, il a été démontré que les souches de SCN présentant un phénotype de faible production de biofilm n'inhibaient pas significativement la croissance des souches ayant un phénotype de forte production de biofilm. Par conséquent, l’activité antibiofilm observée ne semblait pas être due à une activité bactéricide. De plus, nos résultats ont montré que les surnageants de ces quatre souches présentaient également une activité antibiofilm et qu’ils possédaient un spectre d’activité étendu suggérant ainsi que les souches excrétaient une molécule antibiofilm dans son environnement extérieur. La caractérisation de ces surnageants a permis de mettre en évidence que l’activité inhibitrice était notamment conservée dans la fraction des surnageants < 3kDa et qu’une des molécules responsables de cette activité était hydrophile, thermorésistante et sensible à l’action de la RNase A. Enfin, nous avons pu observer que ces surnageants avaient la capacité de réduire voir même de prévenir la colonisation de la glande mammaire par une souche de S. aureus résistante à la méthicilline dans un modèle murin de mammite. Ces surnageants semblent être une alternative prometteuse dans le contrôle de la MB pour prévenir et/ou traiter cette infection que ce soit seul ou en association avec un traitement antibiotique. / Bacterial biofilms are structured communities of bacteria cells enclosed in a selfproduced polymeric matrix which is adherent to a biotic or abiotic surface. This lifestyle allows these bacteria to survive in hostile environments. For example, bacteria having the ability to form biofilms are significantly less susceptible to antibiotics than bacteria in planktonic form. Bacteria within biofilms pose a serious risk to human and animal health such as during bovine mastitis (BM). BM is an inflammation of the mammary gland of dairy cows which causes udder damages and reduces milk production. Therefore, it is important to develop new prophylactic and therapeutic strategies to control and treat BM. Preliminary results have demonstrated the ability of some coagulase-negative staphylococci (CNS) producing a weak biofilm to inhibit biofilm formation by other bacteria associated with BM. Our hypothesis is that some of CNS isolates having the ability to form a weak biofilm produce one or more molecule(s) able to significantly inhibit biofilm formation by other CNS, Staphylococcus aureus or other BM pathogens. The purpose of this project was to characterize antibiofilm molecules produced by CNS isolates. A total of 30 staphylococcal isolates (five species of CNS and S. aureus) with a strong biofilm phenotype and 10 CNS (Staphylococcus chromogenes and Staphylococcus simulans) isolates with a weak biofilm phenotype were used. Our results indicated that some CNS isolates with a weak biofilm phenotype significantly reduced biofilm formation of several staphylococcal species including S. aureus. Importantly, four isolates of CNS (S. chromogenes C and E and S. simulans F and H) were able to significantly inhibit biofilm formation (p < 0.05) of 80% of staphylococcal isolates tested. This activity was confirmed using confocal microscopy but also in dynamic conditions using a microfluidic system. Additionally, CNS with a weak biofilm phenotype did not significantly inhibit the growth of isolates with a strong biofilm phenotype. Therefore, the biofilm inhibition does not seem to be due to a bactericidal activity. The results also showed that the culture supernatants from these four bacteria still have an antibiofilm activity and own a broad spectrum of activity suggesting that the strains release an antibiofilm molecule into the external environment. The characterization of these supernatants indicated that the inhibitory activity was conserved in the < 3kDa fraction of the supernatants. Furthermore, one of the molecules responsible for the antibiofilm activity appears hydrophilic, heat-resistant and sensitive to the action of the RNase A. Finally, we observed that culture supernatants of these bacteria had the ability to reduce or even prevent colonization of the mammary gland by a strain of methicillin-resistant S. aureus in a murine model of mastitis. These supernatants appear to be a promising alternative alone or in combination with antibiotics in the control of BM.

Les staphylocoques à coagulase négative (SCN) sont généralement considérés comme des pathogènes opportunistes à faible virulence. Cependant, des études antérieures ont rapporté une pathogénicité de certaines souches similaire à celle observée chez S. aureus ce qui laisse supposer l’expression de facteurs de virulence. Cette thèse vise à contribuer à l’importance des SCN dans les infections primitives sévères. Nous avons évalué le potentiel pathogène de souches cliniques de SCN au Bénin. Pour atteindre cet objectif, des SCN associés à diverses infections cliniques sévères ont été collectés sur une période de 10 mois au Centre National Hospitalier et Universitaire Hubert Koutoukou Maga à Cotonou. Ces souches sont identifiées d’abord par la galerie API® Staph, puis par la spectrométrie de masse MALDI-TOF et analysées pour leur susceptibilité aux antibiotiques et leur capacité à produire des facteurs de virulence. Cette partie de l’étude a montré que les espèces les plus impliquées dans les infections à SCN au Bénin sont : S. haemolyticus et S. epidermidis suivi d’autres espèces comme S. cohnii, S. sciuri, S. arlettae, S. capitis. Nous avons aussi apporté la preuve de la multi-résistance des souches aux antibiotiques, ainsi que de la présence d’au moins un, voire plusieurs facteurs de virulence tels que la protéase, l’estérase, l’hémolysine, la leucotoxine et l’entérotoxine staphylococcique C chez 44% des souches testées particulièrement dans les souches hospitalières isolées d’hémocultures. Ensuite, nous avons caractérisé un nouveau facteur de virulence identifié chez deux souches de S. epidermidis : l’entérotoxine staphylococcique C nommée SECepi qui a été dosée à environ 100 µg/mL dans les surnageants de culture bactérienne. Le gène secepi est constitué de 801 pb correspondant à 266 acides aminés. Sur la base des résultats de la comparaison d'homologie entre la chaîne peptidique de SECepi et les séquences déjà connues, nous avons constaté que SECepi est proche de SEC3 de la souche de S. aureus Mu3, avec trois substitutions d'acides aminés dans le peptide signal et neuf substitutions d'acides aminés dans la protéine mature. Cependant, plusieurs résidus qui sont impliqués dans la formation du complexe trimoléculaire CMH-SEC-TCR sont conservés dans SECepi. L’analyse de la protéine recombinante (rSECepi) révèle une parenté antigénique et une forte homologie structurale prédite avec SECaureus. De plus, cette toxine présente les activités biologiques caractéristiques d'un superantigène (SAg) incluant la stimulation de la mitogénicité et de la production concomitante de fortes doses de cytokines pro-inflammatoires et suppressives chez des lymphocytes T humains activés. Par ailleurs, SECepi résiste assez bien au chauffage à 100°C et à la digestion par les enzymes gastro-intestinales telles que la pepsine et la trypsine. Ces résultats fournissent la preuve que SECepi peut agir comme un superantigène chez l'hôte humain bien que le type sauvage comporte plusieurs mutations chez S. epidermidis. L’étude du dossier médical de l’un des patients a montré que l’entérotoxine produite par la souche de S. epidermidis a bien pu être à l’origine d’éléments de gravité du tableau clinique présenté par ce dernier à son admission en hospitalisation. Enfin, l’analyse génomique des deux souches toxinogènes de S. epidermidis, ainsi que leur aptitude à former du biofilm, confirment les possibilités variées d’échanges génétiques entre cette espèce et S. aureus. Cette thèse souligne l'importance de la surveillance des infections à SCN chez l’homme parce que certaines souches, à l’instar de S. aureus, produisent des facteurs de virulence pouvant aggraver l’état générale l’hôte. / Coagulase-negative staphylococci (CNS) are generally considered as opportunistic pathogens with low virulence. However, previous studies have reported pathogenicity of some strains similar to that observed in S. aureus. This thesis aims to contribute to the importance of SCN in severe primitive infections. First, we evaluated the pathogenic potential of clinical CNS strains in Benin. To achieve this objective, CNS associated with various severe clinical infections were collected over at the Hubert Koutoukou Maga National Hospital and University Center in Cotonou. These strains are identified as well as their susceptibility to antibiotics and their ability to produce virulence factors. This part of the study showed that the most involved species in Benin are: S. haemolyticus and S. epidermidis followed by other species such as S. cohnii, S. sciuri, S. arlettae, S. capitis. We also demonstrated the multi-resistance of strains to antibiotics, as well as the presence of potential virulence factors such as protease, esterase, hemolysin, leukotoxin and, enterotoxin Staphylococcal C in 44% of strains tested particularly in hospital strains isolated from blood cultures. We, then, characterized a new virulence factor identified in two strains of S. epidermidis: staphylococcal enterotoxin C called SECepi, which was secreted at ~100 μg/mL in bacterial culture supernatants. The secepi gene consists of 801 bp corresponding to 266 amino acids. On the basis of the comparison between the peptide chain of SECepi and the already known peptide sequences of the SEC, we found that SECepi is close to SEC3 of S. aureus Mu3 strain with three amino acids substitutions in the signal peptide and nine amino acid substitutions in the mature protein. However, most residues involved in formation of the tri-molecular complex CMH-SEC-TCR are conserved in SECepi. Analysis of the recombinant protein (rSECepi) revealed antigenic relationships and a strong structural homology is predicted with SECaureus. Moreover, this toxin exhibits the biological activities characteristic of a SAg including the stimulation of the mitogenicity and the concomitant production of high doses of pro-inflammatory and suppressive cytokines in activated human T lymphocytes. Moreover, SECepi is resistant to heating at 100 °C and digestion by gastrointestinal enzymes such as pepsin and trypsin. These results provide evidence that SECepi can act as a superantigen in humans although the wild type has several mutations in S. epidermidis. The study of the medical record of one of the patients showed that the enterotoxin produced by the strain of S. epidermidis might be at the origin of severity of the clinics presented at hospital admission. Finally, genomic analysis of the two toxigenic S. epidermidis strains confirms the varied possibilities of genetic exchange between this species and S. aureus. This thesis underscores the importance of monitoring CNS infections in humans because some strains, like S. aureus, produce virulence factors that can aggravate the overall host condition.