Resumo: Neste estudo investigou-se a colonização por S. aureus e a associação entre cepas isoladas dos sítios nasal e lingual de voluntários adultos saudáveis. Adicionalmente verificou-se a presença de cepas MRSA, BORSA, com resistência constitutiva ou induzida à clindamicina e os portadores que persistiram após cinco meses. Foram obtidos swabs dos sítios nasal e lingual de 100 indivíduos adultos sem histórico de internação hospitalar, sem contato com serviços de saúde, doença de base, diabete e sem uso de antibióticos. Dos pacientes, 9,0% tiveram S. aureus isolados apenas do sítio nasal, 4,0% apenas no sítio lingual e 4,0% nos dois sítios. Uma cepa nasal foi considerada fenotipicamente MRSA com características de CA MRSA e uma foi considerada BORSA. Quatro cepas (19,0%) demonstraram resistência induzida à clindamicina. Uma delas de origem nasal e outra de origem lingual de diferentes indivíduos. As outras duas eram de origem nasal e lingual de um mesmo indivíduo. Entre os portadores 10,0% e 5,0% foram carreadores persistentes nasais e linguais respectivamente. O portador de MRSA nasal foi considerado persistente. A associação entre cepas nasal e lingual de um mesmo indivíduo foi excluída para um dos pacientes e confirmada por PFGE para os demais. Dentre os portadores persistentes, 2 foram persistentes apenas no sítio lingual. Os resultados de PFGE confirmaram que um deles era portador persistente do mesmo clone apenas no sítio lingual. Estes resultados sugerem que uma atenção específica ao sítio lingual nas profilaxias cirúrgicas com mupirocina poderia melhorar o resultado de seu emprego. Adicionalmente a associação clonal entre cepas nasal e lingual sugere que o sítio lingual seja um sítio provável para recolonizações pelos mesmos clones após profilaxia com mupirocina... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: In this study we attempted to investigate S. aureus colonization in healthy adult volunteer and tried to establish the correlation between strains isolated from the nasal and lingual sites. Additionally we verified the presence of MRSA, BORSA, clindamycin constitutive and inducible resistant and investigate the persistent carriers after 5 months. The swabs were obtained from nasal and lingual sites from 100 adult patients without a history of hospitalization, health care contact, antimicrobial use, basis disease and diabetes. Of the patients, 9.0% had only nasal colonization, 4,0% only lingual colonization and 4,0% had S. aureus colonization in both (nasal and lingual) sites. From the nasal isolations, one was considered a phenotypic methicillinresistant strain with CA MRSA’s characteristics and one a borderline oxacillin resistant. No one constitutive clindamycin constitutive resistant strain was isolated. Four isolations (19,0%) demonstrated inducible clindamycin resistance. One of them was from the nasal and another from the lingual site from different patients. The other two, were isolated from the same patient in both sites. From the nasal and lingual carriers 10,0% and 5,0% respectively were persistent carriers. The nasal methicillinresistant carrier was considered persistent. The clonally association between nasal and lingual strains in the same patient was excluded for one patient and confirmed by PFGE for the others. From the persistent 2 were only lingual persistent carriers. The PFGE confirmed that one of them was colonized with the same clone. It suggests that special attention should also be directed to this site for the control of nosocomial infection. It should be better the results of prophylaxis. In addition the association between the nasal and lingual strains suggested that lingual site can be a possible site for same clone recolonization after mupirocin prophylaxis ...(Complete abstract click electronic access below) / Orientador: Maria Stella Gonçalves Raddi / Coorientador: Antonio Carlos Pizzolitto / Banca: Sergio Aparecido Torres / Banca: Adalberto Farache Filho / Mestre

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Made available in DSpace on 2014-06-11T19:23:30Z (GMT). No. of bitstreams: 0 Previous issue date: 2007-03-22Bitstream added on 2014-06-13T19:09:20Z : No. of bitstreams: 1 colli_vc_me_arafcf.pdf: 925467 bytes, checksum: 92428d78f49961bbca367eaa22438a8d (MD5) / Universidade Estadual Paulista (UNESP) / Neste estudo investigou-se a colonização por S. aureus e a associação entre cepas isoladas dos sítios nasal e lingual de voluntários adultos saudáveis. Adicionalmente verificou-se a presença de cepas MRSA, BORSA, com resistência constitutiva ou induzida à clindamicina e os portadores que persistiram após cinco meses. Foram obtidos swabs dos sítios nasal e lingual de 100 indivíduos adultos sem histórico de internação hospitalar, sem contato com serviços de saúde, doença de base, diabete e sem uso de antibióticos. Dos pacientes, 9,0% tiveram S. aureus isolados apenas do sítio nasal, 4,0% apenas no sítio lingual e 4,0% nos dois sítios. Uma cepa nasal foi considerada fenotipicamente MRSA com características de CA MRSA e uma foi considerada BORSA. Quatro cepas (19,0%) demonstraram resistência induzida à clindamicina. Uma delas de origem nasal e outra de origem lingual de diferentes indivíduos. As outras duas eram de origem nasal e lingual de um mesmo indivíduo. Entre os portadores 10,0% e 5,0% foram carreadores persistentes nasais e linguais respectivamente. O portador de MRSA nasal foi considerado persistente. A associação entre cepas nasal e lingual de um mesmo indivíduo foi excluída para um dos pacientes e confirmada por PFGE para os demais. Dentre os portadores persistentes, 2 foram persistentes apenas no sítio lingual. Os resultados de PFGE confirmaram que um deles era portador persistente do mesmo clone apenas no sítio lingual. Estes resultados sugerem que uma atenção específica ao sítio lingual nas profilaxias cirúrgicas com mupirocina poderia melhorar o resultado de seu emprego. Adicionalmente a associação clonal entre cepas nasal e lingual sugere que o sítio lingual seja um sítio provável para recolonizações pelos mesmos clones após profilaxia com mupirocina... / In this study we attempted to investigate S. aureus colonization in healthy adult volunteer and tried to establish the correlation between strains isolated from the nasal and lingual sites. Additionally we verified the presence of MRSA, BORSA, clindamycin constitutive and inducible resistant and investigate the persistent carriers after 5 months. The swabs were obtained from nasal and lingual sites from 100 adult patients without a history of hospitalization, health care contact, antimicrobial use, basis disease and diabetes. Of the patients, 9.0% had only nasal colonization, 4,0% only lingual colonization and 4,0% had S. aureus colonization in both (nasal and lingual) sites. From the nasal isolations, one was considered a phenotypic methicillinresistant strain with CA MRSA s characteristics and one a borderline oxacillin resistant. No one constitutive clindamycin constitutive resistant strain was isolated. Four isolations (19,0%) demonstrated inducible clindamycin resistance. One of them was from the nasal and another from the lingual site from different patients. The other two, were isolated from the same patient in both sites. From the nasal and lingual carriers 10,0% and 5,0% respectively were persistent carriers. The nasal methicillinresistant carrier was considered persistent. The clonally association between nasal and lingual strains in the same patient was excluded for one patient and confirmed by PFGE for the others. From the persistent 2 were only lingual persistent carriers. The PFGE confirmed that one of them was colonized with the same clone. It suggests that special attention should also be directed to this site for the control of nosocomial infection. It should be better the results of prophylaxis. In addition the association between the nasal and lingual strains suggested that lingual site can be a possible site for same clone recolonization after mupirocin prophylaxis ...(Complete abstract click electronic access below)

Introduction: Staphylococcus aureus skin infection is an almost ubiquitous feature of patients with atopic dermatitis (AD). TLR1, 2 and 6 are important in immune sensing of these bacteria. The aim of this study was to determine whether defects in TLR1, 2 and/or 6 expression/function may explain the propensity to infection in humans and the NC eczema mouse model. Methods: Fibroblast cell lines from severe AD, nonatopic controls, and mouse embryonic fibroblasts (MEFs) from the NC, MSM/Ms wild-type strain and a 3T3 control strain TLR1, 2 and 6 expression were measured by qPCR and FACS. IL-6, TNF-α, TSLP and IL-33 production was measured by qPCR and ELISA at baseline and after stimulation with LPS, HKSA and a live strain of Staphylococcus aureus that produced only SEB. Results: No differences were found in either TLR expression or function in human fibroblasts derived from patients and controls. The MSM/Ms MEFs expressed significantly more TLR1 and 2, as well as exhibited high inflammatory profile after stimulation comparing with 3T3 and the NC MEFs. Live Staphylococcus aureus, but not HKSA, LPS or SEB, was a potent stimulus for the Th2-inducing cytokines (TSLP and IL-33), and induce cell death. Cytokines levels were found to be similar in AD and NC MEFs when compared to healthy controls. Conclusion: Eczema in both the human and NC mouse is not associated with abnormalities in fibroblasts TLR1, 2, and 6. Live, but not killed Staphylococcus aureus or its enterotoxin, is a potent inducer of TSLP and IL-33 in both species.

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.

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.

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.

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.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal