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Leite DPDSBM, Barbosa IC, da Silva RA, Fernandes PR, Abad ACA, da Silva JG, Mota RA, Porto TS. Occurrence of antimicrobial-resistant Staphylococcus aureus in a Brazilian veterinary hospital environment. Braz J Microbiol 2023; 54:2393-2401. [PMID: 37407882 PMCID: PMC10485224 DOI: 10.1007/s42770-023-01035-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 06/07/2023] [Indexed: 07/07/2023] Open
Abstract
Antimicrobial resistance is a threat to public health. The emergence of antibiotic-resistant Staphylococcus aureus represents a priority for the implementation of preventive measures. The objective was to isolate S. aureus in humans, animals, and animal health care environment, and to characterize the genotypic and phenotypic profile of antimicrobial resistance in these isolates. We isolated S. aureus from staff, animals, and environment of a veterinary hospital, and identified their antimicrobial resistance profiles. Samples were collected from 20 humans, 13 animals, 14 surfaces, 8 mobile phones, and 7 veterinarians' stethoscopes by using sterile swabs. S. aureus was isolated by culturing on mannitol salt agar and preliminary identification was done by Gram staining and catalase test. Subsequently, a polymerase chain reaction was performed for species confirmation and investigating their antimicrobial-resistant genotypic profiles. Phenotypic profiles of resistant isolates were determined using the disk-diffusion technique. Ten S. aureus isolates were recovered from 5/20 humans (25%), it was also recovered from 2/13 animals (15.38%), including 1 dog and 1 cat, and from 1/14 of surfaces (7.14%). The oxacillin-susceptible mecA-positive Staphylococcus aureus phenotype was identified in a feline. Most of the isolates carried at least two resistance genes of different antimicrobial classes, with 90% (9/10) presenting the gene blaZ, with 10% (1/10) presenting the gene mecA, 20% (2/10) presenting tet38, 10% (1/10) presenting tetM, 90% (9/10) presenting norA, 50% (5/10) presenting norC, 10% (1/10) presenting ermA, and 60% (6/10) presenting ermB. In antibiograms, resistance to penicillin was identified in all the isolates, resistance to erythromycin was identified in 80% (8/10), and all the isolate's resistance to erythromycin presented erythromycin-induced resistance to clindamycin. Antimicrobial resistance in the veterinary hospital requires attention due to the risk of interspecies transmission, gene transfer between bacteria that colonize companion animals and humans and, can make antimicrobial therapy difficult.
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Affiliation(s)
- Denny Parente de Sá Barreto Maia Leite
- Department of Veterinary Medicine, Federal Rural University of Pernambuco (UFRPE), Recife, Pernambuco, Brazil
- Department of Animal Morphology and Physiology, Federal Rural University of Pernambuco (UFRPE), Recife, Pernambuco, Brazil
| | - Iago Carvalho Barbosa
- Department of Veterinary Medicine, Federal Rural University of Pernambuco (UFRPE), Recife, Pernambuco, Brazil
- Department of Animal Morphology and Physiology, Federal Rural University of Pernambuco (UFRPE), Recife, Pernambuco, Brazil
| | - Renato Amorim da Silva
- Department of Veterinary Medicine, Federal Rural University of Pernambuco (UFRPE), Recife, Pernambuco, Brazil
- Department of Animal Morphology and Physiology, Federal Rural University of Pernambuco (UFRPE), Recife, Pernambuco, Brazil
| | - Pollyanne Raysa Fernandes
- Department of Veterinary Medicine, Federal Rural University of Pernambuco (UFRPE), Recife, Pernambuco, Brazil
- Department of Animal Morphology and Physiology, Federal Rural University of Pernambuco (UFRPE), Recife, Pernambuco, Brazil
| | - Atzel Candido Acosta Abad
- Department of Veterinary Medicine, Federal Rural University of Pernambuco (UFRPE), Recife, Pernambuco, Brazil
- Department of Animal Morphology and Physiology, Federal Rural University of Pernambuco (UFRPE), Recife, Pernambuco, Brazil
| | - José Givanildo da Silva
- Department of Preventive Veterinary Medicine and Animal Production, School of Veterinary Medicine and Zootechnics, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil
| | - Rinaldo Aparecido Mota
- Department of Veterinary Medicine, Federal Rural University of Pernambuco (UFRPE), Recife, Pernambuco, Brazil.
| | - Tatiana Souza Porto
- Department of Animal Morphology and Physiology, Federal Rural University of Pernambuco (UFRPE), Recife, Pernambuco, Brazil.
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Yang J, Brown C, Noland W, Johnson TJ, Ji Y. Identification and Validation of a Novel Antibacterial Compound MZ-01 against Methicillin-Resistant Staphylococcus aureus. Antibiotics (Basel) 2022; 11:1550. [PMID: 36358205 PMCID: PMC9686779 DOI: 10.3390/antibiotics11111550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 10/21/2022] [Accepted: 11/02/2022] [Indexed: 08/30/2023] Open
Abstract
The discovery of new classes of antibiotics is slow, and it is being greatly outpaced by the development of bacterial resistance. This disparity places us in an increasingly vulnerable position because we are running out of safe and effective therapeutic options to treat antibiotic-resistant infections. This is exemplified by the emergence and persistence of hospital-acquired and community-associated methicillin-resistant S. aureus (MRSA), which has markedly narrowed our options for treating life-threatening staph infections. Thus, there is an urgent need to develop novel, potent, preventive, and therapeutic agents. In our current study, we performed a whole-cell screening assay of synthetic libraries for antibacterial activity and identified a novel molecule, MZ-01. MZ-01 exhibited potent bactericidal activity against Gram-positive bacterial pathogens, including MRSA, Streptococcus pyogenes, and Streptococcus pneumoniae, at low concentrations. MZ-01 killed and lysed both the late exponential phase of an S. aureus population and bacteria inside mammalian cells. Furthermore, MZ-01 exhibited low cytotoxicity. These results indicate that MZ-01 is a promising scaffold to guide the development of novel, potent antibacterial agents against multidrug-resistant Gram-positive bacterial pathogens such as MRSA.
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Affiliation(s)
- Junshu Yang
- Department of Veterinary and Biomedical Sciences, University of Minnesota, St. Paul, MN 55108, USA
| | - Christopher Brown
- Department of Chemistry, University of Minnesota, Minneapolis, MN 55454, USA
| | - Wayland Noland
- Department of Chemistry, University of Minnesota, Minneapolis, MN 55454, USA
| | - Timothy J. Johnson
- Department of Veterinary and Biomedical Sciences, University of Minnesota, St. Paul, MN 55108, USA
| | - Yinduo Ji
- Department of Veterinary and Biomedical Sciences, University of Minnesota, St. Paul, MN 55108, USA
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Molecular epidemiology of methicillin-resistant Staphylococcus aureus isolated from pigs in Japan. Vet Microbiol 2022; 273:109523. [DOI: 10.1016/j.vetmic.2022.109523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 06/14/2022] [Accepted: 07/27/2022] [Indexed: 11/19/2022]
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Stone MJ, Swales C, Bond S, Muthayya P, Sarma JB. An outbreak of livestock-associated meticillin-resistant Staphylococcus aureus (LA-MRSA) clonal complex 398 in a Regional Burns Centre. J Hosp Infect 2021; 122:1-8. [PMID: 34902497 DOI: 10.1016/j.jhin.2021.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND MRSA outbreaks have previously been reported in burns centres with resulting mortality and morbidity. We describe the first human associated outbreak in the UK caused by a strain of mupirocin-resistant (MuR) livestock-associated meticillin-resistant Staphylococcus aureus clonal complex 398 (LA-MRSA CC398) in an Adult Burns Centre. The centre historically had a very low prevalence of MRSA infections. AIM This report describes the clinical and epidemiological context of how the outbreak was identified and contained using a range of infection prevention and control (IPC) measures guided by both traditional and genetic methods. METHODS A cluster of MuR-MRSA led to an outbreak investigation. Cases were detected via retrospective search and real-time laboratory surveillance. Isolates were sent continuously for whole genome sequencing (WGS). A live timeline of cases and interventions was produced throughout the period. FINDINGS The outbreak consisted of twelve cases, seven males and five females, aged between 22 to 70 years. Patients were identified between May and October 2020. All patients were colonized rather than infected. The strain acquired the plasmid bearing MupA while colonizing the index case before dissemination. The index case was found to be a chicken farmer. This outbreak was eventually controlled using IPC measures, audits and blind staff decolonization guided by the insight from WGS. CONCLUSION We could not determine how the strain entered the centre or if a staff carrier was involved. The outbreak demonstrated the potential for continued transmissions for months despite active surveillance and stringent control measures.
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Affiliation(s)
- Matthew James Stone
- Department of Burns and Plastic Surgery, The Mid Yorkshire Hospitals NHS Trust, UK
| | - Claire Swales
- Department of Burns and Plastic Surgery, The Mid Yorkshire Hospitals NHS Trust, UK
| | - Stuart Bond
- Pharmacy Department, The Mid Yorkshire Hospitals NHS Trust, UK
| | - Preetha Muthayya
- Department of Burns and Plastic Surgery, The Mid Yorkshire Hospitals NHS Trust, UK
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Livestock-Associated Meticillin-Resistant Staphylococcus aureus—Current Situation and Impact From a One Health Perspective. CURRENT CLINICAL MICROBIOLOGY REPORTS 2021. [DOI: 10.1007/s40588-021-00170-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Abstract
Purpose of Review
In this article, we aim to provide an overview of the occurrence and characteristics of livestock-associated (LA-) meticillin-resistant Staphylococcus aureus (MRSA). We further question the role of LA-MRSA as a potential foodborne pathogen. We investigate recent findings and developments from a One Health perspective also highlighting current strategies and initiatives aiming to improve reporting, control, and prevention of LA-MRSA.
Recent Findings
While the overall number of invasive MRSA infections in humans is decreasing (in most European countries and the USA) or steadily increasing (in the Asia-Pacific region), the role of LA-MRSA as causative agent of invasive disease and as potential foodborne pathogen is still poorly understood. LA-MRSA prevalence in livestock remains high in many geographical regions and the acquisition of new virulence and resistance determinants constitutes a growing threat for human health.
Summary
The true incidence of LA-MRSA infections due to occupational exposure is unknown. Improved MRSA monitoring and tracking procedures are urgently needed. Strain typing is crucial to enable improved understanding of the impact of LA-MRSA on human and animal health.
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Meijs AP, Hengeveld PD, Dierikx CM, Maassen CBM, de Greeff SC, de Haan A, Bosch T, van Duijkeren E. Prolonged carriage of (livestock-associated) MRSA in individuals without professional livestock contact. J Antimicrob Chemother 2020; 75:1405-1409. [DOI: 10.1093/jac/dkaa045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 01/13/2020] [Accepted: 01/28/2020] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
To investigate prolonged carriage of MRSA in adults from the general population living in a livestock-dense area, using WGS.
Methods
A cross-sectional study during 2014–15 among 2492 adults without professional livestock contact identified 14 (0.6%) nasal MRSA carriers, 10 of which carried livestock-associated (LA)-MRSA of multiple-locus variable-number tandem repeat analysis (MLVA) complex (MC) 398. Two years later, 12 MRSA-positive and 88 MRSA-negative participants provided a second nasal swab and filled in a short questionnaire. Isolates from persons who were MRSA positive at both timepoints were compared using MLVA and isolates with the same MLVA type were sequenced. The WGS data were used for core-genome MLST (cgMLST) and resistome analysis, including sequenced isolates from the national MRSA surveillance.
Results
All MRSA-negative persons tested negative again, while 6 of the 12 initially MRSA-positive persons tested positive again. MLVA revealed that isolate pairs from five individuals had the same MLVA type, of which three were LA-MRSA. cgMLST showed that the distance between these isolate pairs ranged between 3 and 13 genes, while the minimum distance to unrelated isolates from the national MRSA surveillance was 38 genes. Moreover, the resistome present in the five isolate pairs was identical within each pair. None of the prolonged carriers was hospitalized during the 3 months before the sampling moment and none of them with LA-MRSA had contact with livestock in this period.
Conclusions
Prolonged carriage of MRSA, including LA-MRSA, can be demonstrated after more than 30 months in persons without professional livestock contact.
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Affiliation(s)
- Anouk P Meijs
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Paul D Hengeveld
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Cindy M Dierikx
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Catharina B M Maassen
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Sabine C de Greeff
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Angela de Haan
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Thijs Bosch
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Engeline van Duijkeren
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
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Kittl S, Brodard I, Heim D, Andina-Pfister P, Overesch G. Methicillin-Resistant Staphylococcus aureus Strains in Swiss Pigs and Their Relation to Isolates from Farmers and Veterinarians. Appl Environ Microbiol 2020; 86:e01865-19. [PMID: 31836575 PMCID: PMC7028968 DOI: 10.1128/aem.01865-19] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 12/04/2019] [Indexed: 02/06/2023] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) has emerged over the last few decades as a One Health problem with an increasing prevalence in various animal species. The most notable animals are pigs, as asymptomatic carriers, and horses, where there is often an association with infections. The current study looked at the course of MRSA prevalence in Swiss livestock since 2009, with a special focus on pigs, followed by screening of veterinarians and farmers. Livestock isolates were obtained from the Swiss monitoring program and then characterized by spa typing. Concentrating on the year 2017, we analyzed the prevalence of MRSA in Swiss veterinarians and farmers, followed by whole-genome sequencing of selected human and animal strains. The phylogeny was assessed by applying core-genome multilocus sequence typing (MLST) and single-nucleotide polymorphism (SNP) analyses, followed by screening for resistance genes and virulence factors. The prevalence of MRSA in Swiss pigs showed a dramatic increase from 2% in 2009 to 44% in 2017. Isolates typically belonged to clonal complex 398 (CC398), split between spa t011 and t034. The higher prevalence was mainly due to an increase in t011. spa t034 strains from farmers were found to be closely associated with porcine t034 strains. The same could be shown for spa t011 strains from horses and veterinarians. spa t034 strains had a high number of additional resistance genes, and two strains had acquired the immune evasion cluster. However, all but one of the pig spa t011 strains clustered in a separate group. Thus, the increase in pig spa t011 strains does not directly translate to humans.IMPORTANCE MRSA is an important human pathogen; thus, its increasing prevalence in livestock over the last decade has a potentially large impact on public health. Farmers and veterinarians are especially at risk due to their close contact with animals. Our work demonstrates a dramatic increase in MRSA prevalence in Swiss pigs, from 2% in 2009 to 44% in 2017. Whole-genome sequencing allowed us to show a close association between farmer and pig strains as well as veterinarian and horse strains, indicating that the respective animals are a likely source of human colonization. Furthermore, we could demonstrate that pig spa t011 strains cluster separately and are probably less likely to colonize humans than are pig spa t034 strains. This research may provide a basis for a more substantiated risk assessment and preventive measures.
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Affiliation(s)
- Sonja Kittl
- Institute of Veterinary Bacteriology, University of Bern, Bern, Switzerland
| | - Isabelle Brodard
- Institute of Veterinary Bacteriology, University of Bern, Bern, Switzerland
| | - Dagmar Heim
- Federal Food Safety and Veterinary Office, Bern, Switzerland
| | | | - Gudrun Overesch
- Institute of Veterinary Bacteriology, University of Bern, Bern, Switzerland
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8
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Taus K, Schmoll F, El-Khatib Z, Auer H, Holzmann H, Aberle S, Pekard-Amenitsch S, Monschein S, Sattler T, Steinparzer R, Allerberger F, Schmid D. Occupational swine exposure and Hepatitis E virus, Leptospira, Ascaris suum seropositivity and MRSA colonization in Austrian veterinarians, 2017-2018-A cross-sectional study. Zoonoses Public Health 2019; 66:842-851. [PMID: 31419070 PMCID: PMC6851874 DOI: 10.1111/zph.12633] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 06/07/2019] [Accepted: 06/23/2019] [Indexed: 12/16/2022]
Abstract
We investigated the prevalence of Hepatitis E Virus (HEV), Leptospira and Ascaris suum (A. suum) seropositivity, and of nasal methicillin-resistant Staphylococcus aureus (MRSA) colonization among Austrian practising veterinarians, and assessed the association with occupational swine livestock exposure. The 261 participants completed a questionnaire on demographics, intensity of occupational swine livestock contact and glove use during handling animals and their secretions. Participants' blood samples were tested for HEV, Leptospira and A. suum seropositivity and nasal swabs cultured for MRSA. We compared swine veterinarians (defined as >3 swine livestock visits/week) to non-swine veterinarians (≤3 swine livestock visits/week) with regard to the outcomes through calculating prevalence ratio (PR) and 95% confidence interval (CI). Furthermore, the relationship between occupational swine livestock contact and the study outcomes was examined by age (</≥55 years) and glove usage. The prevalence of nasal MRSA colonization was 13.4% (95% CI: 9.3-17.6), of HEV seropositivity 20.8% (95% CI: 15.8-25.7) and A. suum seropositivity 44% (95% CI: 37.7-50.2). The highest anti-leptospiral antibodies titres were 1:200 (L. hebdomadis) and 1:100 (L. autumnalis, L. caicola) found in three non-swine veterinarians. Compared to non-swine veterinarians, swine veterinarians were 1.9 (95% CI: 1.0-3.4) and 1.5 (95%CI: 1.0-2.3) times more likely HEV seropositive and A. suum seropositive, respectively, and 4.8 (95%CI: 2.5; 9.3) times more likely nasally colonized with MRSA. Among glove-using veterinarians, occupational swine contact was no longer a determinant for HEV seropositivity (PR 1.6; 95% CI: 0.8-2.9). Similar was found for A. suum seropositivity, which was no longer associated with occupational swine livestock contact in the subgroup of glove using, ≥55-year-old veterinarians (PR: 1.07; 95% CI: 0.4-3.3). Our findings indicate that >3 occupational swine livestock visits per week is associated with HEV and A. suum seropositivity and nasal MRSA colonization and that glove use may play a putative preventive role in acquiring HEV and A. suum. Further analytical epidemiological studies have to prove the causality of these associations.
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Affiliation(s)
- Karin Taus
- Austrian Agency for Health and Food Safety (AGES), Vienna, Austria.,European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | | | - Ziad El-Khatib
- Austrian Agency for Health and Food Safety (AGES), Vienna, Austria.,Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Herbert Auer
- Institute for Specific Prophylaxis and Tropical medicine, Centre for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Heidemarie Holzmann
- Clinical Institute of Virology, Medical University of Vienna, Vienna, Austria
| | - Stephan Aberle
- Clinical Institute of Virology, Medical University of Vienna, Vienna, Austria
| | | | | | - Tatjana Sattler
- Austrian Agency for Health and Food Safety (AGES), Mödling, Austria.,Clinic for Ruminants and Swine, University Leipzig, Leipzig, Germany
| | | | | | - Daniela Schmid
- Austrian Agency for Health and Food Safety (AGES), Vienna, Austria
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9
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Verkola M, Pietola E, Järvinen A, Lindqvist K, Kinnunen PM, Heikinheimo A. Low prevalence of zoonotic multidrug-resistant bacteria in veterinarians in a country with prudent use of antimicrobials in animals. Zoonoses Public Health 2019; 66:667-678. [PMID: 31232511 DOI: 10.1111/zph.12619] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 05/28/2019] [Accepted: 06/05/2019] [Indexed: 12/20/2022]
Abstract
The occurrence of multidrug-resistant zoonotic bacteria in animals has been increasing worldwide. Working in close contact with livestock increases the risk of carriage of these bacteria. We investigated the occurrence of extended-spectrum beta-lactamase (ESBL) and plasmidic AmpC beta-lactamase producing Enterobacteriaceae (ESBL/pAmpC-PE) and livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) in Finnish veterinarians (n = 320). In addition to microbiological samples, background information was collected. Bacterial whole genome sequencing was performed to deduce sequence types (STs), spa types and resistance genes of the isolates. In total, 3.0% (9/297) of the veterinarians carried ESBL producing Escherichia coli, with one ESBL producing E. coli isolate producing also AmpC. Seven different STs, sequences of several different plasmid groups as well as several different blaESBL/pAmpC genes existed in different combinations. No carbapenemase or colistin resistance genes were detected. MRSA was detected in 0.3% (1/320) of the samples. The strain belonged to LA-MRSA clonal complex (CC) 398 (ST398, spa type 011, lacking Panton-Valentine leukocidin genes). In conclusion, this study shows low carriage of multidrug-resistant zoonotic bacteria in Finnish veterinarians. However, finding LA-MRSA for the first time in a sample from a veterinarian in a country with prudent use of animal antimicrobials and regarding the recent rise of LA-MRSA on Finnish pig farms, a strong recommendation to protect people working in close contact with animals carrying LA-MRSA CC398 is given. Further studies are needed to explain why the prevalence of LA-MRSA in veterinarians is lower in Finland than in other European countries.
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Affiliation(s)
- Marie Verkola
- Elintarvikehygienian ja ympäristöterveyden osasto, Eläinlääketieteellinen tiedekunta, Helsingin yliopisto, Helsinki, Finland
| | - Eeva Pietola
- Elintarvikehygienian ja ympäristöterveyden osasto, Eläinlääketieteellinen tiedekunta, Helsingin yliopisto, Helsinki, Finland
| | - Asko Järvinen
- Infektiosairauksien linja, Tulehduskeskus, Helsingin yliopistollinen keskussairaala ja Helsingin yliopisto, Helsinki, Finland
| | - Kristian Lindqvist
- Yliopistopalvelut, Lähipalvelutiimi Viikki, Helsingin yliopisto, Helsinki, Finland
| | - Paula M Kinnunen
- Eläinlääketieteellisten biotieteiden osasto, Eläinlääketieteellinen tiedekunta, Helsingin yliopisto, Helsinki, Finland.,Ruokavirasto, Helsinki, Finland
| | - Annamari Heikinheimo
- Elintarvikehygienian ja ympäristöterveyden osasto, Eläinlääketieteellinen tiedekunta, Helsingin yliopisto, Helsinki, Finland.,Ruokavirasto, Helsinki, Finland
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10
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Nadimpalli ML, Stewart JR, Pierce E, Pisanic N, Love DC, Hall D, Larsen J, Carroll KC, Tekle T, Perl TM, Heaney CD. Face Mask Use and Persistence of Livestock-associated Staphylococcus aureus Nasal Carriage among Industrial Hog Operation Workers and Household Contacts, USA. ENVIRONMENTAL HEALTH PERSPECTIVES 2018; 126:127005. [PMID: 30675826 PMCID: PMC6371678 DOI: 10.1289/ehp3453] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 11/16/2018] [Accepted: 11/17/2018] [Indexed: 05/27/2023]
Abstract
BACKGROUND Industrial hog operation (IHO) workers may persistently carry antibiotic-resistant, livestock-associated Staphylococcus aureus in their nasal cavities. It is unclear whether IHO work activities can alter IHO workers' and their household members' exposure to these bacteria. OBJECTIVE Our objective was to investigate the relationship of IHO work activities with persistence of antibiotic-resistant, livestock-associated S. aureus nasal carriage among IHO workers and their household members. METHODS At biweekly intervals over 4 months, IHO workers and their household members completed questionnaires and provided nasal swabs that were assessed for S. aureus, multidrug-resistant S. aureus (MDRSA), and livestock-associated markers (tetracycline resistance, scn absence, spa type). We examined the association between transient and habitual IHO work activities and S. aureus nasal carriage outcomes. RESULTS One hundred one IHO workers and 79 household members completed 1,456 study visits. Face mask use (each 25% increase) was associated with reduced odds of nasal carriage of MDRSA (odds ratio [OR]: 0.65 [95% confidence interval (CI): 0.46, 0.92], tetracycline-resistant S. aureus [OR = 0.74 (95% CI: 0.56, 0.97)], and S. aureus clonal complex (CC) 398/CC9 [OR = 0.77 (95% CI: 0.60, 0.99)]. IHO workers who ever (vs. never) gave pigs injections had higher odds of these outcomes. Among household members, living with an IHO worker who consistently ([Formula: see text] of the time) versus sometimes or never used a face mask was associated with reduced odds of carrying scn-negative S. aureus, tetracycline-resistant S. aureus, and S. aureus CC398/CC9 (OR range: 0.12-0.20, all [Formula: see text]), and consistent IHO worker coveralls use was associated with reduced odds of household member MDRSA carriage only. Living with an IHO worker who habitually had contact with [Formula: see text] hogs (vs. [Formula: see text]) was associated with higher odds of household member livestock-associated S. aureus carriage. CONCLUSIONS Consistent face mask use was associated with reduced exposure to antibiotic-resistant, livestock-associated S. aureus among IHO workers and their household members. https://doi.org/10.1289/EHP3453.
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Affiliation(s)
- Maya L Nadimpalli
- Department of Environmental Sciences and Engineering, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jill R Stewart
- Department of Environmental Sciences and Engineering, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Elizabeth Pierce
- Department of Environmental Sciences and Engineering, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Nora Pisanic
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - David C Love
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Johns Hopkins Center for a Livable Future, Johns Hopkins University, Baltimore, Maryland, USA
| | - Devon Hall
- Rural Empowerment Association for Community Help, Warsaw, North Carolina, USA
| | - Jesper Larsen
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Karen C Carroll
- Division of Medical Microbiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Microbiology Laboratory, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Tsigereda Tekle
- Microbiology Laboratory, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Trish M Perl
- Division of Infectious Diseases, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Christopher D Heaney
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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11
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Sun J, Yang M, Sreevatsan S, Bender JB, Singer RS, Knutson TP, Marthaler DG, Davies PR. Longitudinal study of Staphylococcus aureus colonization and infection in a cohort of swine veterinarians in the United States. BMC Infect Dis 2017; 17:690. [PMID: 29052523 PMCID: PMC5649086 DOI: 10.1186/s12879-017-2802-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 10/04/2017] [Indexed: 12/04/2022] Open
Abstract
Background People working with pigs are at elevated risk of harboring methicillin resistant S. aureus (MRSA) in their nose, which is attributable to occupational exposure to animals harboring livestock adapted S. aureus. To obtain insight into the biological nature of occupationally related nasal culture positivity, we conducted a longitudinal study of 66 swine veterinarians in the USA. Methods The study cohort resided in 15 US states and worked predominantly with swine. Monthly for 18 months, participants self-collected nasal swabs and completed a survey to report recent exposure to pigs and other animals; the occurrence of work related injuries; and any relevant health events such as skin and soft tissue infections or confirmed staphylococcal infections. Nasal swabs were cultured using selective methods to determine the presence of MRSA and methicillin susceptible S. aureus (MSSA), and isolates were characterized by spa typing and MLST. Results Prevalences of S. aureus (64%, monthly range from 58 to 82%) and MRSA (9.5%; monthly range from 6 to15%) were higher than reported for the US population (30% and 1.5% respectively). Predominant spa types were t034 (ST398, 37%), t002 (ST5, 17%) and t337 (ST9/ST398 13%), a distribution similar to that found in a concurrent study in pigs in the USA. Veterinarians were classified into three groups: Persistent carriers (PC, 52%), Intermittent carriers (IC, 47%) and Non-carriers (NC, 1%). Persistent carriage of a single spa type was observed in 14 (21%) of participants, and paired (first and last) isolates from PC subjects had minor genetic differences. Swabs from PC veterinarians carried higher numbers of S. aureus. Among IC veterinarians, culture positivity was significantly associated with recent contact with pigs. Conclusions Exposure to pigs did not lead to prolonged colonization in most subjects, and the higher numbers of S. aureus in PC subjects suggests that unknown host factors may determine the likelihood of prolonged colonization by S. aureus of livestock origin. Exposure to S. aureus and persistent colonization of swine veterinarians was common but rarely associated with S. aureus disease. Electronic supplementary material The online version of this article (10.1186/s12879-017-2802-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jisun Sun
- Department of Veterinary Population Medicine, University of Minnesota, 385 ASVM, 1988 Fitch Ave, St. Paul, MN, 55108, USA
| | - My Yang
- Department of Veterinary Population Medicine, University of Minnesota, 385 ASVM, 1988 Fitch Ave, St. Paul, MN, 55108, USA
| | - Srinand Sreevatsan
- Department of Veterinary Population Medicine, University of Minnesota, 385 ASVM, 1988 Fitch Ave, St. Paul, MN, 55108, USA
| | - Jeffrey B Bender
- Department of Veterinary Population Medicine, University of Minnesota, 385 ASVM, 1988 Fitch Ave, St. Paul, MN, 55108, USA
| | - Randall S Singer
- Department of Veterinary and Biomedical Sciences, University of Minnesota, St. Paul, MN, 55108, USA
| | - Todd P Knutson
- Department of Veterinary Population Medicine, University of Minnesota, 385 ASVM, 1988 Fitch Ave, St. Paul, MN, 55108, USA
| | - Douglas G Marthaler
- Department of Veterinary Population Medicine, University of Minnesota, 385 ASVM, 1988 Fitch Ave, St. Paul, MN, 55108, USA
| | - Peter R Davies
- Department of Veterinary Population Medicine, University of Minnesota, 385 ASVM, 1988 Fitch Ave, St. Paul, MN, 55108, USA.
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12
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Zomer TP, Wielders CCH, Veenman C, Hengeveld P, van der Hoek W, de Greeff SC, Smit LAM, Heederik DJ, Yzermans CJ, Bosch T, Maassen CBM, van Duijkeren E. MRSA in persons not living or working on a farm in a livestock-dense area: prevalence and risk factors. J Antimicrob Chemother 2017; 72:893-899. [PMID: 27999031 DOI: 10.1093/jac/dkw483] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 10/09/2016] [Indexed: 12/27/2022] Open
Abstract
Objectives MRSA emerged in livestock and persons in contact with livestock is referred to as livestock-associated MRSA (LA-MRSA). We assessed the prevalence and risk factors for MRSA carriage in persons not living or working on a farm. Methods A cross-sectional study was performed among 2492 adults living in close proximity of livestock farms. Persons working and/or living on farms were excluded. Nasal swabs were cultured using selective media. Participants completed questionnaires and the distance from the residential address to the nearest farm was calculated. The Mann-Whitney U -test was used to compare median distances. Risk factors were explored with logistic regression. Results Fourteen persons carried MRSA (0.56%; 95% CI 0.32%-0.92%), 10 of which carried LA-MRSA of multiple-locus variable-number tandem repeat analysis complex (MC) 398 (0.40%; 95% CI 0.20%-0.71%). MRSA MC 398 carriers lived significantly closer to the nearest farm than non-carriers (median: 184 versus 402 m; P < 0.01). In bivariate analyses correcting for contact with livestock, this difference remained significant. Conclusions Although the prevalence was low, living near farms increased the risk of MRSA MC 398 carriage for persons not living or working on a farm. Further research is necessary to identify the transmission routes.
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Affiliation(s)
- Tizza P Zomer
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, BA 3720, The Netherlands
| | - Cornelia C H Wielders
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, BA 3720, The Netherlands
| | - Christiaan Veenman
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, BA 3720, The Netherlands
| | - Paul Hengeveld
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, BA 3720, The Netherlands
| | - Wim van der Hoek
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, BA 3720, The Netherlands
| | - Sabine C de Greeff
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, BA 3720, The Netherlands
| | - Lidwien A M Smit
- Division of Environmental Epidemiology, Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, TD 3508, The Netherlands
| | - Dick J Heederik
- Division of Environmental Epidemiology, Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, TD 3508, The Netherlands
| | - C Joris Yzermans
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, BN 3500, The Netherlands
| | - Thijs Bosch
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, BA 3720, The Netherlands
| | - Catharina B M Maassen
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, BA 3720, The Netherlands
| | - Engeline van Duijkeren
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, BA 3720, The Netherlands
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13
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[Multidrug-resistant bacteria in Germany. The impact of sources outside healthcare facilities]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2017; 59:113-23. [PMID: 26446586 DOI: 10.1007/s00103-015-2261-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Currently, there is an ongoing discussion about the question whether the emergence of multidrug-resistant microorganisms (MDRO) among humans is due to transfer of these bacteria from animals. OBJECTIVES This review summarizes data on the occurrence of methicillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum beta-lactamase (ESBL) producing enterobacteria in animals and humans, and describes knowledge about transmission pathways. MATERIAL AND METHODS After a scientific literature analysis, relevant articles were identified by screening of titles and abstracts, amended by publications of infection control authorities and the respective reference lists. RESULTS MDRO are both transmitted in the nosocomial setting and are increasingly detected as sources of infection outside healthcare facilities. CONCLUSIONS Due to new transmission pathways of MDRO an inter-disciplinary approach towards prevention is necessary, involving medical, pharmaceutical and veterinary expertise.
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14
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Klous G, Huss A, Heederik DJ, Coutinho RA. Human-livestock contacts and their relationship to transmission of zoonotic pathogens, a systematic review of literature. One Health 2016; 2:65-76. [PMID: 28616478 PMCID: PMC5462650 DOI: 10.1016/j.onehlt.2016.03.001] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 02/11/2016] [Accepted: 03/14/2016] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Micro-organisms transmitted from vertebrate animals - including livestock - to humans account for an estimated 60% of human pathogens. Micro-organisms can be transmitted through inhalation, ingestion, via conjunctiva or physical contact. Close contact with animals is crucial for transmission. The role of intensity and type of contact patterns between livestock and humans for disease transmission is poorly understood. In this systematic review we aimed to summarise current knowledge regarding patterns of human-livestock contacts and their role in micro-organism transmission. METHODS We included peer-reviewed publications published between 1996 and 2014 in our systematic review if they reported on human-livestock contacts, human cases of livestock-related zoonotic diseases or serological epidemiology of zoonotic diseases in human samples. We extracted any information pertaining the type and intensity of human-livestock contacts and associated zoonoses. RESULTS 1522 papers were identified, 75 were included: 7 reported on incidental zoonoses after brief animal-human contacts (e.g. farm visits), 10 on environmental exposures and 15 on zoonoses in developing countries where backyard livestock keeping is still customary. 43 studies reported zoonotic risks in different occupations. Occupations at risk included veterinarians, culling personnel, slaughterhouse workers and farmers. For culling personnel, more hours exposed to livestock resulted in more frequent occurrence of transmission. Slaughterhouse workers in contact with live animals were more often positive for zoonotic micro-organisms compared to co-workers only exposed to carcasses. Overall, little information was available about the actual mode of micro-organism transmission. CONCLUSIONS Little is known about the intensity and type of contact patterns between livestock and humans that result in micro-organism transmission. Studies performed in occupational settings provide some, but limited evidence of exposure response-like relationships for livestock-human contact and micro-organism transmission. Better understanding of contact patterns driving micro-organism transmission from animals to humans is needed to provide options for prevention and thus deserves more attention.
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Affiliation(s)
- Gijs Klous
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, The Netherlands
- Institute for Risk Assessment Sciences, division Environmental Epidemiology, Utrecht University, The Netherlands
| | - Anke Huss
- Institute for Risk Assessment Sciences, division Environmental Epidemiology, Utrecht University, The Netherlands
| | - Dick J.J. Heederik
- Institute for Risk Assessment Sciences, division Environmental Epidemiology, Utrecht University, The Netherlands
| | - Roel A. Coutinho
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, The Netherlands
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15
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Reynaga E, Navarro M, Vilamala A, Roure P, Quintana M, Garcia-Nuñez M, Figueras R, Torres C, Lucchetti G, Sabrià M. Prevalence of colonization by methicillin-resistant Staphylococcus aureus ST398 in pigs and pig farm workers in an area of Catalonia, Spain. BMC Infect Dis 2016; 16:716. [PMID: 27894267 PMCID: PMC5127002 DOI: 10.1186/s12879-016-2050-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 11/21/2016] [Indexed: 11/30/2022] Open
Abstract
Background A livestock-associated clonal lineage (ST398) of methicillin-resistant Staphylococcus aureus (MRSA) has been identified causing colonization or infection in farm workers. The aim of the study was to analyze the prevalence of MRSA-ST398 colonization in pigs and in pig farmers in an area with a high pig population (Osona, Barcelona province, Catalonia, Spain). Methods We performed a cross-sectional prevalence study in Osona (Catalonia, Spain), from June 2014 to June 2015. All pig farm workers from 83 farms were studied. Twenty of these farms were randomly selected for the study of both pigs and farmers: 9 fattening and 11 farrow-to-finish farms. All workers over the age of 18 who agreed to participate were included. Samples were analyzed to identify MRSA-ST398 and their spa type. Results Eighty-one of the 140 pig farm workers analyzed (57.9% (95% IC: 50.0–66.4%)) were MRSA-positive, all of them ST398. The mean number of years worked on farms was 17.5 ± 12.6 (range:1–50), without significant differences between positive and negative MRSA results (p = 0.763). Over 75% of MRSA-ST398 carriers worked on farms with more than 1250 pigs (p < 0.001). At least one worker tested positive for MRSA-ST398 on all 20 selected pig farms. Ninety-two (46.0% (95% IC: 39.0–53.0%)) of the nasal swabs from 200 pigs from these 20 farms were MRSA-positive, with 50.5% of sows and 41.4% of fattening pigs (p = 0.198) giving MRSA-positive results. All the isolates were tetracycline-resistant, and were identified as MRSA-ST398. The spa type identified most frequently was t011 (62%). Similar spa types and phenotypes of antibiotic resistance were identified in pigs and farmers of 19/20 tested farms. Conclusions The prevalence of MRSA-ST398 among pig farm workers and pigs on farms in the studied region is very high, and the size of the farm seems to correlate with the frequency of colonization of farmers. The similar spa-types and phenotypes of resistance detected in pigs and workers in most of the farms studied suggest animal-to-human transmission.
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Affiliation(s)
- Esteban Reynaga
- Department of Internal Medicine, Hospital Universitari de Vic, Barcelona, Spain. .,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Marian Navarro
- Microbiology Department, Hospital Universitari de Vic, Barcelona, Spain
| | - Anna Vilamala
- Microbiology Department, Hospital Universitari de Vic, Barcelona, Spain
| | - Pere Roure
- Epidemiology Department, Hospital Universitari de Vic, Barcelona, Spain
| | - Manuel Quintana
- Epidemiology Department Hospital Vall d'Hebron, Barcelona, Spain
| | - Marian Garcia-Nuñez
- Infectious Diseases Unit, Health Sciences Research Institute of the Germans Trias i Pujol Foundation, Badalona, Barcelona, Spain.,CIBER de Enfermedades Respiratorias, Madrid, Spain
| | - Raül Figueras
- Veterinary, Associació Tecnicosanitària del Porcí (ASSAPORC), Vic, Barcelona, Spain
| | - Carmen Torres
- Area de Bioquímica y Biología Molecular, Universidad de La Rioja, Logroño, Spain
| | - Gianni Lucchetti
- Department of Internal Medicine, Hospital Universitari de Vic, Barcelona, Spain
| | - Miquel Sabrià
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Infectious Diseases Unit, Health Sciences Research Institute of the Germans Trias i Pujol Foundation, Badalona, Barcelona, Spain.,CIBER de Enfermedades Respiratorias, Madrid, Spain.,Infectious Diseases Department, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
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16
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Harrison EM, Gleadall NS, Ba X, Danesh J, Peacock SJ, Holmes M. Validation of self-administered nasal swabs and postage for the isolation of Staphylococcus aureus. J Med Microbiol 2016; 65:1434-1437. [PMID: 27902394 PMCID: PMC5203668 DOI: 10.1099/jmm.0.000381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Staphylococcus aureus carriers are at higher risk of S. aureus infection and are a reservoir for transmission to others. Detection of nasal S. aureus carriage is important for both targeted decolonization and epidemiological studies. Self-administered nasal swabbing has been reported previously, but the effects of posting swabs prior to culture on S. aureus yield have not been investigated. A longitudinal cohort study was performed in which healthy volunteers were recruited, trained in the swabbing procedure and asked to take weekly nasal swabs for 6 weeks (median: 3 weeks, range 1–6 weeks). Two swabs were taken at each sampling episode and randomly assigned for immediate processing on arrival to the laboratory (Swab A) or second class postage prior to processing (Swab B). S. aureus was isolated using standard methods. A total of 95 participants were recruited, who took 944 swabs (472 pairs) over a median of 5 weeks. Of these, 459 swabs were positive for S. aureus. We found no significant difference (P=0.25) between 472 pairs of nasal self-swabs processed immediately or following standard postage from 95 study participants (51.4 % vs. 48.6 %, respectively). We also provide further evidence that persistent carriers can be detected by two weekly swabs with high degrees of sensitivity [92.3 % (95 % CI 74.8–98.8 %)] and specificity [95.6 % (95 % CI 84.8–99.3 %)] compared with a gold standard of five weekly swabs. Self-swabbing and postage of nasal swabs prior to processing has no effect on yield of S. aureus, and could facilitate large community-based carriage studies.
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Affiliation(s)
- Ewan M Harrison
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | | | - Xiaoliang Ba
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - John Danesh
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Sharon J Peacock
- Wellcome Trust Sanger Institute, Hinxton, UK.,Department of Medicine, University of Cambridge, Cambridge, UK
| | - Mark Holmes
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
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17
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Wood ME, Sherrard LJ, Ramsay KA, Yerkovich ST, Reid DW, Kidd TJ, Bell SC. Methicillin-resistant Staphylococcus aureus acquisition in healthcare workers with cystic fibrosis: a retrospective cross-sectional study. BMC Pulm Med 2016; 16:78. [PMID: 27170040 PMCID: PMC4865022 DOI: 10.1186/s12890-016-0243-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 05/01/2016] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND People with cystic fibrosis (CF) may work in healthcare settings risking nosocomial pathogen acquisition. The aim of this study was to determine the incidence of methicillin-resistant Staphylococcus aureus (MRSA) infection in adult healthcare workers with CF (HCWcf). METHODS Data was collected in this observational study on MRSA acquisition from 405 CF patients attending an adult CF centre in Australia between 2001-2012. Demographic and clinical characteristics were compared between HCWcf and non-HCWcf. A sub-analysis was subsequently performed to compare demographic and clinical characteristics between those patients (HCWcf versus non-HCWcf) that acquired MRSA. We also investigated rates of chronic MRSA infection and the outcome of eradication treatment in HCWcf. RESULTS A higher proportion of HCWcf acquired MRSA [n = 10/21] compared to non-HCWcf [n = 40/255] (P <0.001). The odds of MRSA acquisition were 8.4 (95 % CI, 3.0 - 23.4) times greater in HCWcf than non-HCWcf. HCWcf with MRSA were older (P = 0.02) and had better lung function (P = 0.009), yet hospitalisation rates were similar compared to non-HCWcf with MRSA. Chronic MRSA infection developed in 36/50 CF patients (HCWcf, n = 6; non-HCWcf, n = 30), with eradication therapy achieved in 5/6 (83 %) HCWcf. CONCLUSIONS The rate of MRSA incidence was highest in HCWcf and the workplace is a possible source of acquisition. Vocational guidance should include the potential for MRSA acquisition for CF patients considering healthcare professions.
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Affiliation(s)
- Michelle E Wood
- Lung Bacteria Group, QIMR Berghofer Medical Research Institute, 300 Herston Road, Brisbane, QLD, 4006, Australia. .,Adult Cystic Fibrosis Centre, The Prince Charles Hospital, 627 Rode Road, Chermside, Brisbane, QLD, 4032, Australia. .,School of Medicine, The University of Queensland, 288 Herston Road, Brisbane, QLD, 4006, Australia.
| | - Laura J Sherrard
- Lung Bacteria Group, QIMR Berghofer Medical Research Institute, 300 Herston Road, Brisbane, QLD, 4006, Australia.,CF & Airways Microbiology Group, School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, UK
| | - Kay A Ramsay
- Lung Bacteria Group, QIMR Berghofer Medical Research Institute, 300 Herston Road, Brisbane, QLD, 4006, Australia.,School of Medicine, The University of Queensland, 288 Herston Road, Brisbane, QLD, 4006, Australia
| | - Stephanie T Yerkovich
- School of Medicine, The University of Queensland, 288 Herston Road, Brisbane, QLD, 4006, Australia.,Queensland Lung Transplant Service, The Prince Charles Hospital, Brisbane, QLD, 4032, Australia
| | - David W Reid
- Adult Cystic Fibrosis Centre, The Prince Charles Hospital, 627 Rode Road, Chermside, Brisbane, QLD, 4032, Australia.,Lung Inflammation and Infection Group, QIMR Berghofer Medical Research Institute, 300 Herston Road, Brisbane, QLD, 4006, Australia
| | - Timothy J Kidd
- Centre for Experimental Medicine, The Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, UK.,School of Chemistry and Molecular Biosciences, The University of Queensland, 288 Herston Road, Brisbane, QLD, 4072, Australia
| | - Scott C Bell
- Lung Bacteria Group, QIMR Berghofer Medical Research Institute, 300 Herston Road, Brisbane, QLD, 4006, Australia.,Adult Cystic Fibrosis Centre, The Prince Charles Hospital, 627 Rode Road, Chermside, Brisbane, QLD, 4032, Australia.,School of Medicine, The University of Queensland, 288 Herston Road, Brisbane, QLD, 4006, Australia
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18
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Bos MEH, Verstappen KM, van Cleef BAGL, Dohmen W, Dorado-García A, Graveland H, Duim B, Wagenaar JA, Kluytmans JAJW, Heederik DJJ. Transmission through air as a possible route of exposure for MRSA. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2016; 26:263-9. [PMID: 25515375 DOI: 10.1038/jes.2014.85] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Revised: 10/14/2014] [Accepted: 10/16/2014] [Indexed: 05/23/2023]
Abstract
Livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) is highly prevalent in pigs and veal calves. The environment and air in pig and veal calf barns is often contaminated with LA-MRSA, and can act as a transmission source for humans. This study explores exposure-response relationships between sequence type 398 (ST398) MRSA air exposure level and nasal ST398 MRSA carriage in people working and/or living on farms. Samples and data were used from three longitudinal field studies in pig and veal calf farm populations. Samples consisted of nasal swabs from the human participants and electrostatic dust fall collectors capturing airborne settled dust in barns. In both multivariate and mutually adjusted analyses, a strong association was found between nasal ST398 MRSA carriage in people working in the barns for >20 h per week and MRSA air levels. In people working in the barns < 20 h per week there was a strong association between nasal carriage and number of working hours. Exposure to ST398 MRSA in barn air seems to be an important determinant for nasal carriage, especially in the highly exposed group of farmers, next to duration of contact with animals. Intervention measures should therefore probably also target reduction of ST398 MRSA air levels.
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Affiliation(s)
- Marian E H Bos
- Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Koen M Verstappen
- Department of Infectious Diseases and Immunology, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Brigitte A G L van Cleef
- Laboratory for Medical Microbiology and Immunology, St. Elisabeth Hospital, Tilburg, The Netherlands
- Laboratory for Microbiology and Infection Control, Amphia Hospital, Breda, The Netherlands
| | - Wietske Dohmen
- Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Alejandro Dorado-García
- Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
- Department of Infectious Diseases and Immunology, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Haitske Graveland
- Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Birgitta Duim
- Department of Infectious Diseases and Immunology, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Jaap A Wagenaar
- Department of Infectious Diseases and Immunology, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
- Central Veterinary Institute of Wageningen UR, Lelystad, The Netherlands
| | - Jan A J W Kluytmans
- Laboratory for Medical Microbiology and Immunology, St. Elisabeth Hospital, Tilburg, The Netherlands
- Laboratory for Microbiology and Infection Control, Amphia Hospital, Breda, The Netherlands
- Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, The Netherlands
| | - Dick J J Heederik
- Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
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19
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Baptistão LG, Silva NCC, Bonsaglia ECR, Rossi BF, Castilho IG, Fernandes Junior A, Rall VLM. Presence of Immune Evasion Cluster and Molecular Typing of Methicillin-Susceptible Staphylococcus aureus Isolated from Food Handlers. J Food Prot 2016; 79:682-6. [PMID: 27052876 DOI: 10.4315/0362-028x.jfp-15-401] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The hands and noses of food handlers colonized by Staphylococcus aureus are an important source of food contamination in restaurants and food processing. Several virulence factors can be carried by mobile elements in strains of S. aureus, including the immune evasion cluster (IEC). This gene cluster improves the capacity of S. aureus to evade the human immune response. Many studies have reported the transmission of strains between animals and humans, such as farm workers that have close contact with livestock. However, there are few studies on the transmission between food and food handlers. The aim of this study was to detect the IEC and the mecA gene in strains isolated from food handlers and to type these strains using the spa typing method. Thirty-five strains of S. aureus isolated from the noses and hands of food handlers in three different kitchens were analyzed for the presence of the mecA gene and IEC and by spa typing. All strains were negative for the mecA gene, and the presence of IEC was observed in 10 (28.6%) strains. Fifteen different spa types were observed, with the most frequent being t127 (42.85%) and t002 (11.42%). Strains from the two most prevalent spa types and a novel spa type were typed by multilocus sequence typing. spa types t127, t002, and t13335 were determined to be multilocus sequence types (ST) ST-30, ST-5, and ST-45, respectively. The food handlers may have been contaminated by these strains of S. aureus through food, which is suggested by the low frequency of IEC and by ST that are observed more commonly in animals.
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Affiliation(s)
- Lívia G Baptistão
- Department of Microbiology and Immunology, Bioscience Institute, Universidade Estadual Paulista Julio de Mesquita Filho, 18618-689, Botucatu, São Paulo, Brasil
| | - Nathalia C C Silva
- Department of Food Science, Faculty of Food Engineering, University of Campinas, 13083-862, Campinas, São Paulo, Brazil;,
| | - Erika C R Bonsaglia
- Department of Microbiology and Immunology, Bioscience Institute, Universidade Estadual Paulista Julio de Mesquita Filho, 18618-689, Botucatu, São Paulo, Brasil
| | - Bruna F Rossi
- Department of Microbiology and Immunology, Bioscience Institute, Universidade Estadual Paulista Julio de Mesquita Filho, 18618-689, Botucatu, São Paulo, Brasil
| | - Ivana G Castilho
- Department of Microbiology and Immunology, Bioscience Institute, Universidade Estadual Paulista Julio de Mesquita Filho, 18618-689, Botucatu, São Paulo, Brasil
| | - Ary Fernandes Junior
- Department of Microbiology and Immunology, Bioscience Institute, Universidade Estadual Paulista Julio de Mesquita Filho, 18618-689, Botucatu, São Paulo, Brasil
| | - Vera L M Rall
- Department of Microbiology and Immunology, Bioscience Institute, Universidade Estadual Paulista Julio de Mesquita Filho, 18618-689, Botucatu, São Paulo, Brasil
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Walter J, Espelage W, Adlhoch C, Cuny C, Schink S, Jansen A, Witte W, Eckmanns T, Hermes J. Persistence of nasal colonisation with methicillin resistant Staphylococcus aureus CC398 among participants of veterinary conferences and occurrence among their household members: A prospective cohort study, Germany 2008-2014. Vet Microbiol 2016; 200:13-18. [PMID: 27039883 DOI: 10.1016/j.vetmic.2016.03.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 03/15/2016] [Accepted: 03/25/2016] [Indexed: 11/20/2022]
Abstract
There are only few data on the persistence and transmission of methicillin resistant Staphylococcus aureus (MRSA) of the clonal complex (CC) 398 among veterinarians and their household members. We therefore investigated the long-term colonisation with MRSA CC398 among participants of veterinary conferences in Germany in 2008/2009 and their household members. Forty-five initially MRSA CC398 positive and 180 initially MRSA CC398 negative conference participants were included in a longitudinal study. These persons and their household members were tested for nasal colonisation in 2011, 2012 and 2014. Of 31 continuously tested and initially MRSA CC398 positive participants only 8 (26%) were colonized with MRSA CC398at all 4 time points, 4 (13%) of them consistently with the same spa type. Among initially MRSA CC398 negative participants, 13 (7%) were tested MRSA CC398 positive at least once during the follow-up period. Data for household members at least at one time point were available for 185 households. Of these 21 (11%) households had one or more household member who tested positive for MRSA CC398at least once. The odds of household members to be MRSA CC398 positive was 12 times higher (95% confidence interval 4-37) when the conference participant tested MRSA CC398 positive in 2008/2009. This association remained strong when household members working in veterinary medicine or livestock farms were excluded. In summary, these data suggest that colonisation with MRSA CC398 is partially transient and that household members of MRSA CC398 colonized persons are at an increased risk of colonisation with MRSA CC398.
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Affiliation(s)
- Jan Walter
- Robert Koch Institute, Department for Infectious Disease Epidemiology Seestraße 10, D-13353 Berlin, Germany.
| | - Werner Espelage
- Robert Koch Institute, Department for Infectious Disease Epidemiology Seestraße 10, D-13353 Berlin, Germany
| | - Cornelia Adlhoch
- Robert Koch Institute, Department for Infectious Disease Epidemiology Seestraße 10, D-13353 Berlin, Germany
| | - Christiane Cuny
- Robert Koch Institute, Department of Infectious Diseases Burgstraße 37, D-38855 Wernigerode, Germany
| | - Susanne Schink
- Robert Koch Institute, Department for Infectious Disease Epidemiology Seestraße 10, D-13353 Berlin, Germany
| | - Andreas Jansen
- Robert Koch Institute, Department for Infectious Disease Epidemiology Seestraße 10, D-13353 Berlin, Germany
| | - Wolfgang Witte
- Robert Koch Institute, Department of Infectious Diseases Burgstraße 37, D-38855 Wernigerode, Germany
| | - Tim Eckmanns
- Robert Koch Institute, Department for Infectious Disease Epidemiology Seestraße 10, D-13353 Berlin, Germany
| | - Julia Hermes
- Robert Koch Institute, Department for Infectious Disease Epidemiology Seestraße 10, D-13353 Berlin, Germany
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Abstract
Staphylococcus aureus isolates belonging to clonal cluster 398 (CC398) have emerged over the previous decade as a risk to livestock workers. Though most of the research to date has focused on colonization with these strains, a number of infections have also been documented, ranging from mild skin infections to more serious invasive infections and even death. Here, we review existing reports of human infections with CC398 and discuss their geographic distribution, general characteristics, and implications for future research. We identified 74 publications describing CC398 infections in humans in 19 different countries, suggesting this is an emerging worldwide issue.
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Affiliation(s)
- Tara C Smith
- Kent State University College of Public Health, 750 Hilltop Drive, Lowry Hall, Kent, OH, USA,
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Groves MD, Crouch B, Coombs GW, Jordan D, Pang S, Barton MD, Giffard P, Abraham S, Trott DJ. Molecular Epidemiology of Methicillin-Resistant Staphylococcus aureus Isolated from Australian Veterinarians. PLoS One 2016; 11:e0146034. [PMID: 26735694 PMCID: PMC4703204 DOI: 10.1371/journal.pone.0146034] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 12/12/2015] [Indexed: 11/19/2022] Open
Abstract
This work investigated the molecular epidemiology and antimicrobial resistance of methicillin-resistant Staphylococcus aureus (MRSA) isolated from veterinarians in Australia in 2009. The collection (n = 44) was subjected to extensive molecular typing (MLST, spa, SCCmec, dru, PFGE, virulence and antimicrobial resistance genotyping) and antimicrobial resistance phenotyping by disk diffusion. MRSA was isolated from Australian veterinarians representing various occupational emphases. The isolate collection was dominated by MRSA strains belonging to clonal complex (CC) 8 and multilocus sequence type (ST) 22. CC8 MRSA (ST8-IV [2B], spa t064; and ST612-IV [2B], spa variable,) were strongly associated with equine practice veterinarians (OR = 17.5, 95% CI = 3.3–92.5, P < 0.001) and were often resistant to gentamicin and rifampicin. ST22-IV [2B], spa variable, were strongly associated with companion animal practice veterinarians (OR = 52.5, 95% CI = 5.2–532.7, P < 0.001) and were resistant to ciprofloxacin. A single pig practice veterinarian carried ST398-V [5C2], spa t1451. Equine practice and companion animal practice veterinarians frequently carried multiresistant-CC8 and ST22 MRSA, respectively, whereas only a single swine specialist carried MRSA ST398. The presence of these strains in veterinarians may be associated with specific antimicrobial administration practices in each animal species.
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Affiliation(s)
- Mitchell D. Groves
- School of Veterinary and Life Sciences, Murdoch University, Murdoch, Australia
| | - Bethany Crouch
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Geoffrey W. Coombs
- School of Veterinary and Life Sciences, Murdoch University, Murdoch, Australia
- Department of Microbiology, Path West Laboratory Medicine, WA, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - David Jordan
- School of Veterinary and Life Sciences, Murdoch University, Murdoch, Australia
- New South Wales Department of Primary Industries, Wollongbar, New South Wales, Australia
| | - Stanley Pang
- School of Veterinary and Life Sciences, Murdoch University, Murdoch, Australia
- Department of Microbiology, Path West Laboratory Medicine, WA, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Mary D. Barton
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Phil Giffard
- Menzies School of Health Research, Casuarina, Northern Territory, Australia
| | - Sam Abraham
- School of Veterinary and Life Sciences, Murdoch University, Murdoch, Australia
- * E-mail: (SA); (DT)
| | - Darren J. Trott
- School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy, South Australia, Australia
- * E-mail: (SA); (DT)
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Sun J, Yang M, Sreevatsan S, Davies PR. Prevalence and Characterization of Staphylococcus aureus in Growing Pigs in the USA. PLoS One 2015; 10:e0143670. [PMID: 26599635 PMCID: PMC4658009 DOI: 10.1371/journal.pone.0143670] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 11/06/2015] [Indexed: 01/02/2023] Open
Abstract
A decade of research of methicillin-resistant S. aureus (MRSA) in pigs shows that the prevalence and predominant genotypes (i.e., ST398, ST9, ST5) of MRSA vary widely geographically, yet knowledge of the epidemiology of S. aureus generally in swine remains rudimentary. To characterize S. aureus, including MRSA, in the US swine industry, we sampled 38 swine herds in 11 states in major swine producing regions. The herds sampled included pigs sourced from 9 different breeding stock companies, and the sample was likely biased towards larger herds that use regular veterinary services. Twenty nasal swabs were collected from 36 groups of growing pigs by 36 swine veterinarians, 2 more herds were sampled opportunistically, and a historically MRSA-positive herd was included as a positive control. S. aureus was detected on 37 of the 38 herds, and in 77% of pigs sampled. Other than the positive control herd, no MRSA were detected in the study sample, yielding a 95% upper confidence limit of 9.3% for MRSA herd prevalence. All but two (ST1-t127; ST2007-t8314) of 1200 isolates belonged to three MLST lineages (ST9, ST398, and ST5) that have been prominent in studies of MRSA in pigs globally. A total of 35 spa types were detected, with the most prevalent being t337 (ST9), t034 (ST398), and t002 (ST5). A purposively diverse subset of 128 isolates was uniformly negative on PCR testing for major enterotoxin genes. The findings support previous studies suggesting a relatively low herd prevalence of MRSA in the US swine industry, but confirm that methicillin susceptible variants of the most common MRSA genotypes found in swine globally are endemic in the US. The absence of enterotoxin genes suggests that the source of toxigenic S. aureus capable of causing foodborne enterotoxicosis from pork products is most likely post-harvest contamination.
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Affiliation(s)
- Jisun Sun
- Department of Veterinary Population Medicine, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota, United States of America
| | - My Yang
- Department of Veterinary Population Medicine, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota, United States of America
| | - Srinand Sreevatsan
- Department of Veterinary Population Medicine, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota, United States of America
| | - Peter R. Davies
- Department of Veterinary Population Medicine, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota, United States of America
- * E-mail:
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Goerge T, Lorenz MB, van Alen S, Hübner NO, Becker K, Köck R. MRSA colonization and infection among persons with occupational livestock exposure in Europe: Prevalence, preventive options and evidence. Vet Microbiol 2015; 200:6-12. [PMID: 26658156 DOI: 10.1016/j.vetmic.2015.10.027] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Revised: 10/19/2015] [Accepted: 10/27/2015] [Indexed: 12/31/2022]
Abstract
Colonization with livestock-associated Methicillin-resistant Staphylococcusaureus (LA-MRSA) among persons occupationally exposed to pigs, cattle or poultry is very frequent. In Europe, LA-MRSA mostly belong to the clonal lineage CC398. Since colonized persons have an increased risk of developing MRSA infections, defining the burden of work-related infection caused by LA-MRSA CC398 is of interest to exposed personnel, insurance companies and infection control staff. This review summarizes data on the types of occupation-related infections caused by LA-MRSA CC398, the incidence of such infections as well as potential preventive strategies. We identified twelve case reports on infections among livestock-exposed persons. Overall, there is a lack of data describing the incidence of occupation-related infections due to MRSA CC398. Currently, no specific guidance towards the prevention of LA-MRSA CC398 colonization of persons with routine exposure exists. In vitro, MRSA CC398 strains are susceptible (>95%) to mupirocin. Single reports have described effective decolonization of persons carrying LA-MRSA CC398, but long-term success rates are low in case of continuous livestock contact. Overall, the occupational health risk due to LA-MRSA CC398 is not well understood. Currently, prevention of human LA-MRSA CC398 infection is mostly based on the recommendation to perform screening and decolonization therapies prior to elective medical interventions in order to avoid nosocomial infections, but there is no conclusive evidence to perform specific measures aiming to forestall community-acquired infections.
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Affiliation(s)
- Tobias Goerge
- University Hospital Münster, Department of Dermatology, Von-Esmarch-Str. 58, 48149 Münster, Germany
| | - Marthe Barbara Lorenz
- University Hospital Münster, Department of Dermatology, Von-Esmarch-Str. 58, 48149 Münster, Germany
| | - Sarah van Alen
- University Hospital Münster, Institute of Medical Microbiology, Domagkstr. 10, 48149 Münster, Germany
| | - Nils-Olaf Hübner
- Institute of Medical Diagnostics (IMD), Vitus-Bering-Straße 27a, 17493 Greifswald, Germany
| | - Karsten Becker
- University Hospital Münster, Institute of Medical Microbiology, Domagkstr. 10, 48149 Münster, Germany
| | - Robin Köck
- University Hospital Münster, Institute of Medical Microbiology, Domagkstr. 10, 48149 Münster, Germany,.
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Michiels B, Appelen L, Franck B, den Heijer CDJ, Bartholomeeusen S, Coenen S. Staphylococcus aureus, Including Meticillin-Resistant Staphylococcus aureus, among General Practitioners and Their Patients: A Cross-Sectional Study. PLoS One 2015; 10:e0140045. [PMID: 26458264 PMCID: PMC4601797 DOI: 10.1371/journal.pone.0140045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 09/21/2015] [Indexed: 12/04/2022] Open
Abstract
Background The role of general practitioners (GPs) as reservoir and potential source for Staphylococcus aureus (SA) transmission is unknown. Our primary objective was to evaluate the prevalence of SA and community-acquired methicillin resistant SA (CA-MRSA) carrier status (including spa typing) among GPs and their patients in Belgium. The secondary objective was to determine the association between SA/CA-MRSA carriage in patients and their characteristics, SA carriage in GPs, GP and practice characteristics. Methods The Belgian GPs, who swabbed their patients in the APRES study (which assessed the prevalence of SA nasal carriage in nine European countries; November 2010 –June 2011), were asked to swab themselves as well (May-June 2011). GPs and their patients had to complete a questionnaire on factors related to SA carriage and transmission. SA isolation including CA-MRSA and spa typing was performed on the swabs. Results In eighteen practices 34 GPs swabbed patients of which 25 GPs provided personal swabs. The analysis was performed on 3008 patient records. Among GPs SA carriage (28%) was more prevalent than among their patients (19.2%), but CA-MRSA carriage was not present. SA was more prevalent among younger patients and those living with cattle. Spa typing SA and MRSA strains did not suggest correlation within practices or between patients and GPs, but chronic skin conditions of GPs and always handshaking patients by SA positive GPs were associated with more SA among patients, and hand washing after every patient contact with less SA among patients in practices with high antibiotic prescribing rates. Conclusion No MRSA was found among GPs, although their SA carriership was higher compared to their patients’. Spa types did not cluster within practices, possibly due to difference in timing of swabbing. To minimise SA transmission to their patients GPs should consider taking appropriate care of their chronic skin diseases, antibiotic prescribing behaviour, handshaking and hand washing habits.
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Affiliation(s)
- Barbara Michiels
- Department of Primary and Interdisciplinary Care Antwerp—Centre for General Practice, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- * E-mail:
| | - Lien Appelen
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Barbara Franck
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Casper D. J. den Heijer
- Department of Medical Microbiology, Maastricht University Medical Centre/CAPHRI, Maastricht, the Netherlands
| | - Stefaan Bartholomeeusen
- Department of Primary and Interdisciplinary Care Antwerp—Centre for General Practice, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Samuel Coenen
- Department of Primary and Interdisciplinary Care Antwerp—Centre for General Practice, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Vaccine & Infectious Disease Institute (VAXINFECTIO)—Laboratory of Medical Microbiology, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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The prevalence and influencing factors of methicillin-resistant Staphylococcus aureus carriage in people in contact with livestock: A systematic review. Am J Infect Control 2015; 43:469-75. [PMID: 25681305 DOI: 10.1016/j.ajic.2014.12.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 12/08/2014] [Accepted: 12/08/2014] [Indexed: 01/05/2023]
Abstract
BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA) is becoming a serious epidemic worldwide. Recently, studies have shown that people in contact with livestock may have a greater chance of MRSA carriage. We aimed to establish the prevalence of MRSA among people in contact with livestock and review the factors influencing MRSA carriage. METHODS We systematically examined published epidemiologic studies on MRSA prevalence in people in contact with livestock using Pubmed, Medline, Embase, Ovid, and the Cochrane Library. Prevalence estimates were pooled using a random-effects model. Study heterogeneity was assessed using Q statistics and quantified with I(2) statistics. RESULTS Thirty-three eligible studies were included in this systematic review. Prevalence of MRSA ranged from 0.0%-85.8%. The pooled prevalence estimate of MRSA was 14.2% (95% confidence interval, 9.1%-20.1%) for people in contact with livestock. Substantial heterogeneity in eligible studies was noted (χ(2) = 1,025; P < .001; I(2) = 96.9%). Subgroup analysis showed the prevalence of MRSA was high in people from Europe (15.9%), farmers (18.2%), and by longitudinal study design (38.9%). Animal contact and intensity of animal contact were associated with increased risk of MRSA carriage. CONCLUSION Our findings suggest that there may be transmission of MRSA between animals and humans.
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27
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Transmission and persistence of livestock-associated methicillin-resistant Staphylococcus aureus among veterinarians and their household members. Appl Environ Microbiol 2014; 81:124-9. [PMID: 25326300 DOI: 10.1128/aem.02803-14] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
After the first isolation of livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) in 2003, this MRSA variant quickly became the predominant MRSA obtained from humans as part of the Dutch national MRSA surveillance. Previous studies have suggested that human-to-human transmission of LA-MRSA, compared to that of other MRSA lineages, rarely occurs. However, these reports describe the transmission of LA-MRSA based on epidemiology and limited molecular characterization of isolates, making it difficult to assess whether transmission actually occurred. In this study, we used whole-genome maps (WGMs) to identify possible transmission of LA-MRSA between humans. For this, we used LA-MRSA isolates originating from a 2-year prospective longitudinal cohort study in which livestock veterinarians and their household members were repeatedly sampled for the presence of S. aureus. A considerable degree of genotypic variation among LA-MRSA strains was observed. However, there was very limited variability between the maps of the isolates originating from the same veterinarian, indicating that each of the veterinarians persistently carried or had reacquired the same LA-MRSA strain. Comparison of WGMs revealed that LA-MRSA transmission had likely occurred within virtually every veterinarian household. Yet only a single LA-MRSA strain per household appeared to be involved in transmission. The results corroborate our previous finding that LA-MRSA is genetically diverse. Furthermore, this study shows that transmission of LA-MRSA between humans occurs and that carriage of LA-MRSA can be persistent, thus posing a potential risk for spread of this highly resistant pathogen in the community.
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Nadimpalli M, Rinsky JL, Wing S, Hall D, Stewart J, Larsen J, Nachman KE, Love DC, Pierce E, Pisanic N, Strelitz J, Harduar-Morano L, Heaney CD. Persistence of livestock-associated antibiotic-resistant Staphylococcus aureus among industrial hog operation workers in North Carolina over 14 days. Occup Environ Med 2014; 72:90-9. [PMID: 25200855 PMCID: PMC4316926 DOI: 10.1136/oemed-2014-102095] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES This study aimed to evaluate the persistence of nasal carriage of Staphylococcus aureus, methicillin-resistant S. aureus and multidrug-resistant S. aureus over 14 days of follow-up among industrial hog operation workers in North Carolina. METHODS Workers anticipating at least 24 h away from work were enrolled June-August 2012. Participants self-collected a nasal swab and completed a study journal on the evening of day 1, and each morning and evening on days 2-7 and 14 of the study. S. aureus isolated from nasal swabs were assessed for antibiotic susceptibility, spa type and absence of the scn gene. Livestock association was defined by absence of scn. RESULTS Twenty-two workers provided 327 samples. S. aureus carriage end points did not change with time away from work (mean 49 h; range >0-96 h). Ten workers were persistent and six were intermittent carriers of livestock-associated S. aureus. Six workers were persistent and three intermittent carriers of livestock-associated multidrug-resistant S. aureus. One worker persistently carried livestock-associated methicillin-resistant S. aureus. Six workers were non-carriers of livestock-associated S. aureus. Eighty-two per cent of livestock-associated S. aureus demonstrated resistance to tetracycline. A majority of livestock-associated S. aureus isolates (n=169) were CC398 (68%) while 31% were CC9. No CC398 and one CC9 isolate was detected among scn-positive isolates. CONCLUSIONS Nasal carriage of livestock-associated S. aureus, multidrug-resistant S. aureus and methicillin-resistant S. aureus can persist among industrial hog operation workers over a 14-day period, which included up to 96 h away from work.
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Affiliation(s)
- Maya Nadimpalli
- Department of Environmental Sciences & Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jessica L Rinsky
- Department of Epidemiology, Gillings School of Global Public Health University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Steve Wing
- Department of Epidemiology, Gillings School of Global Public Health University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Devon Hall
- Rural Empowerment Association for Community Help (REACH), Warsaw, North Carolina, USA
| | - Jill Stewart
- Department of Environmental Sciences & Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jesper Larsen
- Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark
| | - Keeve E Nachman
- Johns Hopkins Center for a Livable Future, Johns Hopkins University, Baltimore Maryland, USA Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Dave C Love
- Johns Hopkins Center for a Livable Future, Johns Hopkins University, Baltimore Maryland, USA Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Elizabeth Pierce
- Department of Environmental Sciences & Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Nora Pisanic
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jean Strelitz
- Department of Epidemiology, Gillings School of Global Public Health University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Laurel Harduar-Morano
- Department of Epidemiology, Gillings School of Global Public Health University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Christopher D Heaney
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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van Rijen MML, Bosch T, Verkade EJM, Schouls L, Kluytmans JAJW. Livestock-associated MRSA carriage in patients without direct contact with livestock. PLoS One 2014; 9:e100294. [PMID: 25000521 PMCID: PMC4074048 DOI: 10.1371/journal.pone.0100294] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 05/22/2014] [Indexed: 01/28/2023] Open
Abstract
Background Livestock-associated MRSA (MC398) has emerged and is related to an extensive reservoir in pigs and veal calves. Individuals with direct contact with these animals and their family members are known to have high MC398 carriage rates. Until now it was assumed that MC398 does not spread to individuals in the community without pig or veal calf exposure. To test this, we identified the proportion of MC398 in MRSA positive individuals without contact with pigs/veal calves or other known risk factors (MRSA of unknown origin; MUO). Methods In 17 participating hospitals, we determined during two years the occurrence of MC398 in individuals without direct contact with livestock and no other known risk factor (n = 271) and tested in a post analysis the hypothesis whether hospitals in pig-dense areas have higher proportions of MC398 of all MUO. Results Fifty-six individuals (20.7%) without animal contact carried MC398. In hospitals with high pig-densities in the adherence area, the proportion of MC398 of all MUO was higher than this proportion in hospitals without pigs in the surroundings. Conclusions One fifth of the individuals carrying MUO carried MC398. So, MC398 is found in individuals without contact to pigs or veal calves. The way of transmission from the animal reservoir to these individuals is unclear, probably by human-to-human transmission or by exposure to the surroundings of the stables. Further research is needed to investigate the way of transmission.
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Affiliation(s)
- Miranda M. L. van Rijen
- Laboratory for Microbiology and Infection Control, Amphia Hospital, Breda, the Netherlands
- * E-mail: (MvR); (JK)
| | - Thijs Bosch
- Center for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Erwin J. M. Verkade
- Laboratory for Microbiology and Infection Control, Amphia Hospital, Breda, the Netherlands
- Laboratory for Medical Microbiology and Immunology, St. Elisabeth Hospital, Tilburg, the Netherlands
| | - Leo Schouls
- Center for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Jan A. J. W. Kluytmans
- Laboratory for Microbiology and Infection Control, Amphia Hospital, Breda, the Netherlands
- Department of Medical Microbiology and Infection ControlJK, VUmc Medical University, Amsterdam, the Netherlands
- * E-mail: (MvR); (JK)
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30
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The European Union Summary Report on antimicrobial resistance in zoonotic and indicator bacteria from humans, animals and food in 2012. EFSA J 2014. [DOI: 10.2903/j.efsa.2014.3590] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
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31
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Verkade E, Kluytmans J. Livestock-associated Staphylococcus aureus CC398: Animal reservoirs and human infections. INFECTION GENETICS AND EVOLUTION 2014; 21:523-30. [DOI: 10.1016/j.meegid.2013.02.013] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 02/14/2013] [Accepted: 02/20/2013] [Indexed: 11/29/2022]
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32
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Verhoeven PO, Gagnaire J, Botelho-Nevers E, Grattard F, Carricajo A, Lucht F, Pozzetto B, Berthelot P. Detection and clinical relevance of Staphylococcus aureus nasal carriage: an update. Expert Rev Anti Infect Ther 2013; 12:75-89. [PMID: 24308709 DOI: 10.1586/14787210.2014.859985] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Staphylococcus aureus nasal carriage is a well-defined risk factor of infection with this bacterium. The increased risk of S. aureus infection in nasal carriers is supported by the fact that the strains isolated from both colonization and infection sites are indistinguishable in most of the cases. Persistent nasal carriage seems to be associated with an increased risk of infection and this status could be defined now in clinical routine by using one or two quantitative nasal samples. There is evidence for supporting the detection of nasal carriage of S. aureus in patients undergoing cardiac surgery and in those undergoing hemodialysis in order to implement decolonization measures. More studies are needed to determine which carriers have the highest risk of infection and why decolonization strategies failed to reduce S. aureus infection in some other groups of patients.
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Affiliation(s)
- Paul O Verhoeven
- GIMAP EA 3064 (Groupe Immunité des Muqueuses et Agents Pathogènes), University of Lyon, 42023 Saint-Etienne, France
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