The pathogenicity and intractable nature of the microorganism Staphylococcus aureus (SA) has been long documented and highlighted by many health care agencies, with emphasis on its ability to exploit the human coagulation system to deadly effect. Two drugs from a class of inhibitors known as Direct Thrombin Inhibitors (DTI) have been shown to have a substantial effect on the enzyme secreted by SA known as Staphylocoagulase (SC), but up until now the application of this potential treatment has been limited. This paper strives to supply an overview of these clinical studies and propose a novel protocol for testing DTI's on SA in an in vitro setting. Three DTIs have been identified, including two already tested in clinical trials, and computational molecular docking simulations have been applied to elucidate the mechanisms of action for the inhibition. An additional DTI has been developed using these mechanisms as principles and shows promise for future development. After conducting this preliminary protocol, it has been found that running a minimum inhibitory concentration test across several tubes with varying degrees of these DTIs demonstrated varying levels of coagulation consistent with the findings of clinical research papers. It is fair to conclude, then, that after development or discovery of new coagulase inhibitors, they can be quickly and accurately tested against existent DTIs to gauge their efficacy.

La mammite subclinique est un problème de santé fréquent et coûteux. Les infections intra-mammaires (IIM) sont souvent détectées à l’aide de mesures du comptage des cellules somatiques (CCS). La culture bactériologique du lait est cependant requise afin d’identifier le pathogène en cause. À cause de cette difficulté, pratiquement toutes les recherches sur la mammite subclinique ont été centrées sur la prévalence d’IIM et les facteurs de risque pour l’incidence ou l’élimination des IIM sont peu connus. L’objectif principal de cette thèse était d’identifier les facteurs de risque modifiables associés à l’incidence, l’élimination et la prévalence d’IIM d’importance dans les troupeaux laitiers Canadiens. En premier lieu, une revue systématique de la littérature sur les associations entre pratiques utilisées à la ferme et CCS a été réalisée. Les pratiques de gestion constamment associées au CCS ont été identifiées et différentiées de celles faisant l’objet de rapports anecdotiques. Par la suite, un questionnaire bilingue a été développé, validé, et utilisé afin de mesurer les pratiques de gestion d’un échantillon de 90 troupeaux laitiers canadiens. Afin de valider l’outil, des mesures de répétabilité et de validité des items composant le questionnaire ont été analysées et une évaluation de l’équivalence des versions anglaise et française a été réalisée. Ces analyses ont permis d’identifier des items problématiques qui ont du être recatégorisés, lorsque possible, ou exclus des analyses subséquentes pour assurer une certaine qualité des données. La plupart des troupeaux étudiés utilisaient déjà la désinfection post-traite des trayons et le traitement universel des vaches au tarissement, mais beaucoup des pratiques recommandées n’étaient que peu utilisées. Ensuite, les facteurs de risque modifiables associés à l’incidence, à l’élimination et à la prévalence d’IIM à Staphylococcus aureus ont été investigués de manière longitudinale sur les 90 troupeaux sélectionnés. L’incidence d’IIM semblait être un déterminant plus important de la prévalence d’IIM du troupeau comparativement à l’élimination des IIM. Le port de gants durant la traite, la désinfection pré-traite des trayons, de même qu’une condition adéquate des bouts de trayons démontraient des associations désirables avec les différentes mesures d’IIM. Ces résultats viennent souligner l’importance des procédures de traite pour l’obtention d’une réduction à long-terme de la prévalence d’IIM. Finalement, les facteurs de risque modifiables associés à l’incidence, à l’élimination et à la prévalence d’IIM à staphylocoques coagulase-négatif (SCN) ont été étudiés de manière similaire. Cependant, afin de prendre en considération les limitations de la culture bactériologique du lait pour l’identification des IIM causées par ce groupe de pathogènes, une approche semi-Bayesienne à l’aide de modèles de variable à classe latente a été utilisée. Les estimés non-ajusté de l’incidence, de l’élimination, de la prévalence et des associations avec les expositions apparaissaient tous considérablement biaisés par les imperfections de la procédure diagnostique. Ce biais était en général vers la valeur nulle. Encore une fois, l’incidence d’IIM était le principal déterminant de la prévalence d’IIM des troupeaux. Les litières de sable et de produits du bois, de même que l’accès au pâturage étaient associés à une incidence et une prévalence plus basse de SCN. / Subclinical mastitis is a very frequent and costly health issue that can be detected using somatic cell count (SCC) measurements, but requires the use of milk bacteriological culture for identification of the causal pathogen. Because of this latter difficulty, nearly all subclinical mastitis research has focused on prevalent intramammary infections (IMI) and less is known on risk factors for IMI incidence or elimination. The main objective of this thesis was to identify the manageable risk factors associated with the incidence, elimination, and prevalence of IMI of importance in Canadian dairy herds. First, a systematic review of the literature on the associations between management practices used on farms and SCC was carried out. Management practices consistently associated with SCC were identified and differentiated from other practices for which anecdotic reports were available. Then, a bilingual questionnaire was developed, validated, and employed to measure the practices used on a sample of 90 Canadian dairy herds. To validate this tool, measures of repeatability and of validity of the questionnaire’s items were analyzed and an evaluation of the equivalence of the English and French versions was conducted. These analyses indicated that the questionnaire was, in general, acceptable, but also pinpointed some problematic items. These items were recategorized when possible or otherwise excluded from subsequent analyses to ensure good data quality. Most of the herds studied were already using post-milking teat disinfection and blanket dry cow therapy. Many other frequently recommended practices were not widely adopted. Next, manageable risk factors associated with Staphylococcus aureus IMI incidence, elimination, and prevalence were investigated on the 90 selected herds in a longitudinal fashion. The S. aureus IMI incidence appeared to be a stronger determinant of the herd prevalence than the elimination rate. Among other practices, wearing gloves during milking, using pre-milking teat disinfection, and having an adequate teat end condition showed desirable associations with the outcomes. These results highlight the importance of good milking practices to achieve a long-term reduction of S. aureus IMI prevalence. Finally, manageable risk factors associated with coagulase-negative staphylococci (CNS) IMI incidence, elimination, and prevalence were investigated in a similar manner. Because of the greater limitations of milk bacteriological culture to identify IMI caused by this group of pathogens, a semi-Bayesian latent class model approach was used. Sensitivity and specificity estimates from an internal validation study were used to link the observed IMI milk culture result to the latent true quarter IMI status. Non-adjusted estimates of IMI incidence, elimination, prevalence, and of associations with expositions appeared to be considerably biased by the diagnostic procedure’s imperfections. Most often, estimates were biased toward the null value. Again, IMI incidence was the main determinant of the herd IMI prevalence. Sand and wood products bedding were associated with lower CNS incidence and prevalence. Sending cows to pasture was also associated with lower CNS IMI incidence and prevalence.

L’objectif de cette étude était de déterminer l’impact d’une infection intra-mammaire (IIM) subclinique causée par staphylocoque coagulase-négative (SCN) ou Staphylococcus aureus diagnostiquée durant le premier mois de lactation chez les taures sur le comptage de cellules somatiques (CCS), la production laitière et le risque de réforme durant la lactation en cours. Des données bactériologiques provenant d’échantillons de lait composites de 2 273 taures Holstein parmi 50 troupeaux ont été interprétées selon les recommandations du National Mastitis Council. Parmi 1 691 taures rencontrant les critères de sélection, 90 (5%) étaient positives à S. aureus, 168 (10%) étaient positives à SCN et 153 (9%) étaient négatives (aucun agent pathogène isolé). Le CCS transformé en logarithme népérien (lnCCS) a été modélisé via une régression linéaire avec le troupeau comme effet aléatoire. Le lnCCS chez les groupes S. aureus et SCN était significativement plus élevé que dans le groupe témoin de 40 à 300 jours en lait (JEL) (P < 0.0001 pour tous les contrastes). La valeur journalière du lnSCC chez les groupes S. aureus et SCN était en moyenne 1.2 et 0.6 plus élevé que le groupe témoin respectivement. Un modèle similaire a été réalisé pour la production laitière avec l’âge au vêlage, le trait génétique lié aux parents pour la production laitière et le logarithme népérien du JEL de la pesée inclus. La production laitière n’était pas statistiquement différente entre les 3 groupes de culture de 40 à 300 JEL (P ≥ 0.12). Les modèles de survie de Cox ont révélé que le risque de réforme n’était pas statistiquement différent entre le groupe S. aureus ou SCN et le groupe témoin (P ≥ 0.16). La prévention des IIM causées par SCN et S. aureus en début de lactation demeure importante étant donné leur association avec le CCS durant la lactation en cours. / The objective of this study was to determine the effect of a subclinical intramammary infection (IMI) caused by coagulase-negative staphylococci (CNS) or Staphylococcus aureus diagnosed during the first month of lactation in heifers on somatic cell count (SCC), milk production and culling risk during the entire first lactation. Bacteriological analysis data of composite milk samples taken from 2,273 Hostein heifers among 50 dairy herds were interpreted according to the National Mastitis Council guidelines. Among the 1,691 heifers meeting the selection criteria, 90 (5%) were diagnosed with S. aureus, 168 (10%) with CNS, and 153 (9%) were negative (no pathogen isolated). Test-day SCC transformed in natural logarithm (lnCCS) was fit in a linear regression model with herd as random effect. The lnSCC in S. aureus and CNS groups were significantly higher than in negative group from 40 to 300 days in milk (DIM) (P < 0.0001 for all contrasts). At test-day level, lnSCC in S. aureus and CNS groups was on average 1.2 and 0.6 higher than the negative group respectively. A similar model was used for milk yield with age at calving, parent average genetic value for milk yield and natural logarithm of tested DIM included. Milk yield was not statistically different between culture groups from 40 to 300 DIM (P ≥ 0.12). Compared with negative heifers, the culling hazard ratio estimated using Cox survival analysis in S. aureus and CNS infected heifers was not significant (P ≥ 0.16). Prevention of CNS or S. aureus IMI in early lactation remains important for its association with SCC during the ensuing lactation.

L’objectif de cette étude était de déterminer l’impact d’une infection intra-mammaire (IIM) subclinique causée par staphylocoque coagulase-négative (SCN) ou Staphylococcus aureus diagnostiquée durant le premier mois de lactation chez les taures sur le comptage de cellules somatiques (CCS), la production laitière et le risque de réforme durant la lactation en cours. Des données bactériologiques provenant d’échantillons de lait composites de 2 273 taures Holstein parmi 50 troupeaux ont été interprétées selon les recommandations du National Mastitis Council. Parmi 1 691 taures rencontrant les critères de sélection, 90 (5%) étaient positives à S. aureus, 168 (10%) étaient positives à SCN et 153 (9%) étaient négatives (aucun agent pathogène isolé). Le CCS transformé en logarithme népérien (lnCCS) a été modélisé via une régression linéaire avec le troupeau comme effet aléatoire. Le lnCCS chez les groupes S. aureus et SCN était significativement plus élevé que dans le groupe témoin de 40 à 300 jours en lait (JEL) (P < 0.0001 pour tous les contrastes). La valeur journalière du lnSCC chez les groupes S. aureus et SCN était en moyenne 1.2 et 0.6 plus élevé que le groupe témoin respectivement. Un modèle similaire a été réalisé pour la production laitière avec l’âge au vêlage, le trait génétique lié aux parents pour la production laitière et le logarithme népérien du JEL de la pesée inclus. La production laitière n’était pas statistiquement différente entre les 3 groupes de culture de 40 à 300 JEL (P ≥ 0.12). Les modèles de survie de Cox ont révélé que le risque de réforme n’était pas statistiquement différent entre le groupe S. aureus ou SCN et le groupe témoin (P ≥ 0.16). La prévention des IIM causées par SCN et S. aureus en début de lactation demeure importante étant donné leur association avec le CCS durant la lactation en cours. / The objective of this study was to determine the effect of a subclinical intramammary infection (IMI) caused by coagulase-negative staphylococci (CNS) or Staphylococcus aureus diagnosed during the first month of lactation in heifers on somatic cell count (SCC), milk production and culling risk during the entire first lactation. Bacteriological analysis data of composite milk samples taken from 2,273 Hostein heifers among 50 dairy herds were interpreted according to the National Mastitis Council guidelines. Among the 1,691 heifers meeting the selection criteria, 90 (5%) were diagnosed with S. aureus, 168 (10%) with CNS, and 153 (9%) were negative (no pathogen isolated). Test-day SCC transformed in natural logarithm (lnCCS) was fit in a linear regression model with herd as random effect. The lnSCC in S. aureus and CNS groups were significantly higher than in negative group from 40 to 300 days in milk (DIM) (P < 0.0001 for all contrasts). At test-day level, lnSCC in S. aureus and CNS groups was on average 1.2 and 0.6 higher than the negative group respectively. A similar model was used for milk yield with age at calving, parent average genetic value for milk yield and natural logarithm of tested DIM included. Milk yield was not statistically different between culture groups from 40 to 300 DIM (P ≥ 0.12). Compared with negative heifers, the culling hazard ratio estimated using Cox survival analysis in S. aureus and CNS infected heifers was not significant (P ≥ 0.16). Prevention of CNS or S. aureus IMI in early lactation remains important for its association with SCC during the ensuing lactation.

La mammite subclinique est un problème de santé fréquent et coûteux. Les infections intra-mammaires (IIM) sont souvent détectées à l’aide de mesures du comptage des cellules somatiques (CCS). La culture bactériologique du lait est cependant requise afin d’identifier le pathogène en cause. À cause de cette difficulté, pratiquement toutes les recherches sur la mammite subclinique ont été centrées sur la prévalence d’IIM et les facteurs de risque pour l’incidence ou l’élimination des IIM sont peu connus. L’objectif principal de cette thèse était d’identifier les facteurs de risque modifiables associés à l’incidence, l’élimination et la prévalence d’IIM d’importance dans les troupeaux laitiers Canadiens. En premier lieu, une revue systématique de la littérature sur les associations entre pratiques utilisées à la ferme et CCS a été réalisée. Les pratiques de gestion constamment associées au CCS ont été identifiées et différentiées de celles faisant l’objet de rapports anecdotiques. Par la suite, un questionnaire bilingue a été développé, validé, et utilisé afin de mesurer les pratiques de gestion d’un échantillon de 90 troupeaux laitiers canadiens. Afin de valider l’outil, des mesures de répétabilité et de validité des items composant le questionnaire ont été analysées et une évaluation de l’équivalence des versions anglaise et française a été réalisée. Ces analyses ont permis d’identifier des items problématiques qui ont du être recatégorisés, lorsque possible, ou exclus des analyses subséquentes pour assurer une certaine qualité des données. La plupart des troupeaux étudiés utilisaient déjà la désinfection post-traite des trayons et le traitement universel des vaches au tarissement, mais beaucoup des pratiques recommandées n’étaient que peu utilisées. Ensuite, les facteurs de risque modifiables associés à l’incidence, à l’élimination et à la prévalence d’IIM à Staphylococcus aureus ont été investigués de manière longitudinale sur les 90 troupeaux sélectionnés. L’incidence d’IIM semblait être un déterminant plus important de la prévalence d’IIM du troupeau comparativement à l’élimination des IIM. Le port de gants durant la traite, la désinfection pré-traite des trayons, de même qu’une condition adéquate des bouts de trayons démontraient des associations désirables avec les différentes mesures d’IIM. Ces résultats viennent souligner l’importance des procédures de traite pour l’obtention d’une réduction à long-terme de la prévalence d’IIM. Finalement, les facteurs de risque modifiables associés à l’incidence, à l’élimination et à la prévalence d’IIM à staphylocoques coagulase-négatif (SCN) ont été étudiés de manière similaire. Cependant, afin de prendre en considération les limitations de la culture bactériologique du lait pour l’identification des IIM causées par ce groupe de pathogènes, une approche semi-Bayesienne à l’aide de modèles de variable à classe latente a été utilisée. Les estimés non-ajusté de l’incidence, de l’élimination, de la prévalence et des associations avec les expositions apparaissaient tous considérablement biaisés par les imperfections de la procédure diagnostique. Ce biais était en général vers la valeur nulle. Encore une fois, l’incidence d’IIM était le principal déterminant de la prévalence d’IIM des troupeaux. Les litières de sable et de produits du bois, de même que l’accès au pâturage étaient associés à une incidence et une prévalence plus basse de SCN. / Subclinical mastitis is a very frequent and costly health issue that can be detected using somatic cell count (SCC) measurements, but requires the use of milk bacteriological culture for identification of the causal pathogen. Because of this latter difficulty, nearly all subclinical mastitis research has focused on prevalent intramammary infections (IMI) and less is known on risk factors for IMI incidence or elimination. The main objective of this thesis was to identify the manageable risk factors associated with the incidence, elimination, and prevalence of IMI of importance in Canadian dairy herds. First, a systematic review of the literature on the associations between management practices used on farms and SCC was carried out. Management practices consistently associated with SCC were identified and differentiated from other practices for which anecdotic reports were available. Then, a bilingual questionnaire was developed, validated, and employed to measure the practices used on a sample of 90 Canadian dairy herds. To validate this tool, measures of repeatability and of validity of the questionnaire’s items were analyzed and an evaluation of the equivalence of the English and French versions was conducted. These analyses indicated that the questionnaire was, in general, acceptable, but also pinpointed some problematic items. These items were recategorized when possible or otherwise excluded from subsequent analyses to ensure good data quality. Most of the herds studied were already using post-milking teat disinfection and blanket dry cow therapy. Many other frequently recommended practices were not widely adopted. Next, manageable risk factors associated with Staphylococcus aureus IMI incidence, elimination, and prevalence were investigated on the 90 selected herds in a longitudinal fashion. The S. aureus IMI incidence appeared to be a stronger determinant of the herd prevalence than the elimination rate. Among other practices, wearing gloves during milking, using pre-milking teat disinfection, and having an adequate teat end condition showed desirable associations with the outcomes. These results highlight the importance of good milking practices to achieve a long-term reduction of S. aureus IMI prevalence. Finally, manageable risk factors associated with coagulase-negative staphylococci (CNS) IMI incidence, elimination, and prevalence were investigated in a similar manner. Because of the greater limitations of milk bacteriological culture to identify IMI caused by this group of pathogens, a semi-Bayesian latent class model approach was used. Sensitivity and specificity estimates from an internal validation study were used to link the observed IMI milk culture result to the latent true quarter IMI status. Non-adjusted estimates of IMI incidence, elimination, prevalence, and of associations with expositions appeared to be considerably biased by the diagnostic procedure’s imperfections. Most often, estimates were biased toward the null value. Again, IMI incidence was the main determinant of the herd IMI prevalence. Sand and wood products bedding were associated with lower CNS incidence and prevalence. Sending cows to pasture was also associated with lower CNS IMI incidence and prevalence.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2017-06-19T12:28:29Z No. of bitstreams: 1 claudiaoliveirafontes.pdf: 4732336 bytes, checksum: b5385191fb0ea13de3e2e756b49d0981 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2017-06-29T12:22:06Z (GMT) No. of bitstreams: 1 claudiaoliveirafontes.pdf: 4732336 bytes, checksum: b5385191fb0ea13de3e2e756b49d0981 (MD5) / Made available in DSpace on 2017-06-29T12:22:06Z (GMT). No. of bitstreams: 1 claudiaoliveirafontes.pdf: 4732336 bytes, checksum: b5385191fb0ea13de3e2e756b49d0981 (MD5) Previous issue date: 2013-04-12 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Neste estudo, os padrões de susceptibilidade a antimicrobianos, ocorrência de marcadores moleculares de resistência aos antimicrobianos e biocidas, bem como as características de virulência associadas aos Staphylococcus spp., foram avaliados tanto em SCN quanto em S. aureus isolados de queijo Minas Frescal no Brasil. Um total de 246 isolados bacterianos foram recuperados de 35 amostras de queijo, as quais foram obtidas em cinco lotes de cada uma das sete marcas comerciais diferentes avaliadas neste estudo. As contagens bacterianas variaram de 103 a 107 UFC/g de queijo. Os percentuais elevados de resistência a antimicrobianos foram observados nos dois grupos bacterianos com relação à oxacilina, penicilina e eritromicina. Um percentual baixo de resistência aos antimicrobianos foi encontrado com relação ao cloranfenicol, e todas as bactérias avaliadas se mostraram susceptíveis à vancomicina e linezolida. No total, o índice de resistência múltipla aos antimicrobianos (MAR) > 0,2 foi observado em 80,6 % e 84,2 % dos isolados de SCN e S. aureus, respectivamente. Entretanto, o índice MAR variou de 50 % a 100 % considerando apenas os isolados bacterianos estudados por marca comercial de queijo. Com relação à prevalência de SCN e S. aureus que carregam o gene mecA, respectivamente, 81,5 % e 47,4 % das linhagens isoladas foram consideradas mecA+, e 76,2 % e 42,1 % destas se mostraram fenotipicamente resistentes à oxacilina. Três isolados bacterianos carregavam o gene para produção de enterotoxina A (sea), 30,5 % produziram biofilme em um teste de laboratório, e a α ou ß-hemólise foi observada em 2,8 % e 7,2 %, respectivamente, em todos os Staphylococcus spp. avaliados. Os marcadores moleculares de resistência aos antimicrobianos e biocidas mais prevalentes encontrados nas linhagens de SCN e S. aureus foram blaZ, mecA, msrA, msrB, linA, aacA-aphD, e smr. Este estudo destaca a importância do fenômeno da resistência aos antimicrobianos com relação aos microrganismos negligenciados que são veiculados por alimentos, e os prováveis riscos para a saúde pública relacionados ao consumo de queijo contendo bactérias do gênero Staphylococcus. / In this study, antimicrobial susceptibility patterns, molecular markers of antimicrobial and biocide-resistance occurrence and virulence-associated characteristics were evaluated in CoNS and S. aureus isolated from soft cheese in Brazil. A total of 246 bacterial isolates were recovered from 35 cheese samples belonging to five batches with seven different trademarks. The bacterial counts ranged from 103 to 107 CFU g1. High antimicrobial resistance percentages were observed for oxacillin, penicillin and erythromycin for both S. aureus and SCN. A low antimicrobial resistance percentage was observed for chloramphenicol, and all of the tested bacteria were susceptible to vancomycin and linezolid. In total, a multiple antibiotic resistance (MAR) index of > 0.2 was observed for 80.6 % and 84.2 % of the isolated CoNS and S. aureus, respectively. However, the MAR index ranged from 50 % to 100 % when only bacterial cheese isolates belonging to the same trademark were considered. Regarding to the prevalence of SCN and S. aureus carrying mecA gene, respectively, 81.5 % e 47,4 % of the isolated strains were mecA+, and 76.2 % and 42.1 % of these were phenotypically resistant to oxacillin. Three isolates carried the enterotoxin A gene (sea), 30.5 % produced biofilm in a laboratory test, and α- or ßhemolysis was observed for 2,8 % and 7.2 %, respectively, for all the Staphylococcus spp.. blaZ, mecA, msrA, msrB, linA, aacA-aphD, and smr were most prevalent molecular markers found both in SCN and S. aureus strains. This study highlights the extent of the antimicrobial resistance phenomenon in neglected foodborne microorganisms and the potential public health risks that are related to the consumption of Staphylococci-contaminated soft cheese.

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.

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.

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.

Darbo tikslas: nustatyti koaguliazei teigiamų stafilokokų paplitimą tarp gyvūnų augintinių. Darbo uždaviniai: 1. išskirti koaguliazei teigiamus stafilokokus iš gyvūnų augintinių nosies ertmės; 2. išskirti koaguliazei teigiamus stafilokokus iš gyvūnų augintinių tiesiosios žarnos; 3. identifikuoti išskirtas stafilokokų padermes; 4. įvertinti įvairių veiksnių įtaką stafilokokų paplitimui; 5. nustatyti išskirtų stafilokokų atsparumą antimikrobinėms medžiagoms. Darbo apimtis – 50 puslapių. Šiame darbe yra 6 lentelės bei 14 paveikslų. Magistro darbą sudaro 4 dalys. Pirmojoje dalyje apžvelgiami literatūros šaltiniai susiję su analizuojama tema, išskiriant koaguliazei teigiamų stafilokokų virulentiškumo veiksnius, atsparumą antimikrobinėms medžiagoms, sukeliamas ligas ir šių ligų gydymą. Aptariamas Staphylococcus aureus bei Staphylococcus pseudintermedius paplitimas ir paplitimą įtakojantys veiksniai. Antrojoje dalyje nurodyti tyrimo metodai, kuriais remiantis gauti duomenys tyrimų analizei. Trečiojoje dalyje analizuojami gauti tyrimo rezultatai pagal iškeltus uždavinius. Rezultatai pateikiami atsižvelgiant į statistinių duomenų patikimumą. Ketvirtoji dalis skirta literatūros apžvalgos ir tyrimo rezultatų skirtumų ir panašumų palyginimui. Tyrimo metu iš gyvūnų augintinių nosies ertmės ir tiesiosios žarnos išskirti Staphylococcus aureus bei Staphylococcus pseudintermedius. Nustatyta, kad koaguliazei teigiamų stafilokokų paplitimas gyvūnų augintinių tarpe priklauso nuo gyvūnų... [toliau žr. visą tekstą] / The The goal of the study: to determine prevalence of coagulase positive staphylococci in companion animals. The aim of the study: 1. to isolate coagulase positive staphylococci in nasal cavity of companion animals; 2. to isolate coagulase positive staphylococci in rectum of companion animals; 3. to identificate the isolated strains of staphylococci; 4. to evaluate risk factors for prevalence of staphylococci; 5. to determine antibiotic resistance in isolated staphylococci. The master study consists of 50 pages. It includes 6 tables and 14 pictures. The master study consist of 4 major chapters. The first chapter is dedicated to review of literature that is related with analized topic. This part includes coagulase positive staphylococci virulence factors, antibiotic resistance, diseases caused by staphylococci and treatment use. Furthermore chapter contains review of the prevalence and risk factors influenced the prevalence of Staphylococcus aureus and Staphylococcus pseudintermedius. The second chapter introduce with materials and methods, that were used in the research at this master study. In the third chapter the results of the research are presented. The results are presented according to the statistical reliability. The fourth chapter is the resemblance and similarity comparision of the literature review and master study research. In this master study Staphylococcus aureus and Staphylococcus pseudintermedius were isolated from nasal cavity and rectum of companion... [to full text]