Bakgrund: Vårdrelaterade infektioner som Methicillin Resistent Staphylococcus Aureus, MRSA, ökar. Bakterien är komplicerad att avlägsna och idag är MRSA ett av de största vårdhygieniska problemen internationellt. Vid vård av personer som bär på MRSA krävs särskilda rutiner, såsom isoleringsvård och skyddskläder. Syfte: Att belysa personers upplevelser av att bära på MRSA i en vårdkontext. Metod: En litteraturstudie av åtta stycken kvalitativa, vetenskapliga artiklar. Materialet analyserades och sammanställdes med en beskrivande metasyntes, enligt Friberg (2012). Resultat: Tre teman tydliggjordes: ”Rutinernas inverkan på patientens upplevelse av vården”,” Patientens upplevelse av mötet med vårdpersonalen.” och ” Patientens känslomässiga upplevelse av att vara infekterad med MRSA”. Resultatet visade att MRSA infektionen ledde till starka känsloreaktioner samt att rutiner, föreskrifter och personalens förhållningssätt ofta upplevdes som negativt. Patienterna saknade förståelse för sin situation och fick inte adekvat information. Slutsats: Personer som bar på MRSA saknade information om sitt tillstånd. Det behövs ökad kunskap hos personalen för att kunna möta patienters psykiska och fysiska behov samt individanpassad patientinformation. Likaså behövs ytterligare forskning som studerar livssituationen hos MRSA bärare för att kunna lindra deras lidande

Staphylococci strains are among the most widespread multidrug-resistant nosocomial pathogens in Canada. Rapid and accurate identification and epidemiological typing of methicillin-resistant S. aureus (MRSA) and its discrimination from coagulase-negative staphylococci (CNS) and glycopeptide-intermediate S. aureus (GISA) are crucial for appropriate therapy and for monitoring and limiting intra- and inter-hospital spread of epidemic MRSA strains. Although pulsed-field gel electrophoresis and polymerase chain reaction methods for the identification of MRSA are reliable, they are technically demanding, time-consuming and inappropriate for routine clinical diagnosis. Moreover, no reliable method exists for discrimination of epidemic MRSA from sporadic MRSA and from GISA strains. The objective of the research described in this thesis was to investigate whether Fourier transform infrared (FTIR) spectroscopy could be used to distinguish MRSA from methicillin-susceptible S. aureus, borderline oxacillin-resistant S. aureus (BORSA), CNS, including methicillin-resistant CNS, and GISA. The application of FTIR spectroscopy for epidemiological typing of Canadian epidemic MRSA (CMRSA) strains as well as their discrimination from sporadic MRSA was also assessed. FTIR spectra were recorded from intact stationary-phase cells grown on Universal Medium (UM™) and deposited and dried on a ZnSe optical window, normalized, and converted to first-derivative spectra. Various chemometric approaches were employed to cluster the different phenotypes of staphylococci species and to subtype five CMRSA strains based on the similarity of their infrared spectral fingerprints in narrow spectral regions selected by visual inspection and by employing a singularvalue decomposition (SVD) algorithm. Pairwise separation of MRSA from MSSA, BORSA, CNS, MRCNS, and GISA was accomplished by using principal component analysis (PCA), self-organizing maps (SOM), and the K-nearest neighbors (KNN) algorithm. These chemometric techniques were also successfully employed for epidemiological typing of the five CMRSA strains and their discrimination from sporadic MRSA strains using a combination of different optimal spectral regions selected by SVD. These results demonstrate that FTIR spectroscopy has considerable potential as a rapid method for the identification of different phenotypes of staphylococci and epidemiological typing of MRSA.

Statement of the problem: Methicillin-resistant Staphyloccocus aureus (MRSA) is a pathogen of increasing concern and is associated with higher hospital readmission rates, poorer prognosis, and increased mortality resulting in increasing costs to the Canadian healthcare system.1-13 Institutions have been challenged with developing effective infection control programs to prevent the spread of MRSA. The purpose of this thesis was to examine the clinical and cost-effectiveness of a universal MRSA screening intervention within a large tertiary care facility. Methods of investigation: The retrospective population-based observational study consisted of two periods. In the first period (24 months), patients admitted to the Ottawa Hospital underwent risk factor-based screening. In the second period (20 months), universal MRSA screening was implemented in which all patients were screened for MRSA upon admission. Results: The regression analysis demonstrated that the universal MRSA screening intervention was not effective in reducing the number of nosocomial MRSA cases. The economic analysis estimated that the universal MRSA screening intervention incurred an additional cost of $1.16 million/year with an estimated additional cost per patient screened of $17.76. Conclusions: The universal MRSA screening intervention was not clinically or economically effective. Further research is required to verify/dispute these findings in other settings.

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

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

Thesis (DClinPsychol)--British Psychological Society. BLDSC no. DX233166.

Thesis (Ph. D.)--Virginia Commonwealth University, 2009. / Prepared for: School. of Pharmacy. Title from title-page of electronic thesis. Bibliography: leaves 129-140.

Class of 2006 Abstract / 1College of Pharmacy, University of Arizona 2El Rio Special Immunology Associates Objectives: To compare antibiotic resistance patterns of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) in HIV patients and the general population. We hypothesized that CA- MRSA strains in HIV patients may show a decreased susceptibility to trimethoprim/sulfamethoxazole (TMP/SMX) because of its widespread use for prophylaxis of Pneumocystis carinii pneumonia (PCP) in this population. Methods: Susceptibility reports for all Staphylococcus aureus isolates collected between November 1, 2004 and November 1, 2005 from Special Immunology Associates (SIA), an HIV clinic, and the neighboring Carondelet St. Mary’s Hospital Emergency Center (SMH) were analyzed. Results: Twenty-five cases in HIV patients at SIA (Mean age 40, Race: 21 Caucasian, 4 Hispanic) and 102 cases at SMH (Mean age 37, Race: 45 Caucasian, 34 Hispanic, 12 Native American, 8 African American) were identified as CA-MRSA. More than 95% of patients presented with skin infections and a seasonal peak was identified between June and October. No cases of TMP/SMX resistance were found at either institution despite the fact that 40% of the SIA patients with CA-MRSA had been exposed to TMP/SMX for PCP prophylaxis in the past. Susceptibility varied between SIA and SMH, with significant differences in susceptibility to tetracycline (57% vs. 86%, p<0.001) and levofloxacin (38% vs. 60%, p < 0.001). Erythromycin resistance in both institutions was greater than 90%. Conclusions: All CA-MRSA isolates from an HIV clinic and a neighboring health care facility were susceptible to TMP/SMX. HIV patients with CA-MRSA did not show a decrease in susceptibility to TMP/SMX, despite its routine use for prophylaxis in this population.

Statement of the problem: Methicillin-resistant Staphyloccocus aureus (MRSA) is a pathogen of increasing concern and is associated with higher hospital readmission rates, poorer prognosis, and increased mortality resulting in increasing costs to the Canadian healthcare system.1-13 Institutions have been challenged with developing effective infection control programs to prevent the spread of MRSA. The purpose of this thesis was to examine the clinical and cost-effectiveness of a universal MRSA screening intervention within a large tertiary care facility. Methods of investigation: The retrospective population-based observational study consisted of two periods. In the first period (24 months), patients admitted to the Ottawa Hospital underwent risk factor-based screening. In the second period (20 months), universal MRSA screening was implemented in which all patients were screened for MRSA upon admission. Results: The regression analysis demonstrated that the universal MRSA screening intervention was not effective in reducing the number of nosocomial MRSA cases. The economic analysis estimated that the universal MRSA screening intervention incurred an additional cost of $1.16 million/year with an estimated additional cost per patient screened of $17.76. Conclusions: The universal MRSA screening intervention was not clinically or economically effective. Further research is required to verify/dispute these findings in other settings.

Nonmenstrual toxic shock syndrome (TSS) due to Staphylococcus aureus can lead to significant morbidity and mortality. While drotrecogin alfa (DA) has been employed in patients with Methicillin-resistant Staphylococcus aureus (MRSA) severe sepsis and septic shock, its utility in TSS remains unclear. The authors report a case of severe sepsis in the setting of MRSA-associated TSS that responded to treatment with DA. This case illustrates a potential role for DA in the treatment of toxic shock syndromes and emphasizes the importance of aggressive diagnostic and therapeutic modalities in approaching these conditions.