Prevalence and molecular epidemiology of <i>Staphylococcus aureus</i> in Swedish nursing homes – as revealed in the SHADES study

Stark, Lisa; Olofsson, Magnus; Löfgren, Sture; Mölstad, Sigvard; Lindgren, Per-Eric; Matussek, Andreas

doi:10.1017/s0950268813002033

Cited by 13 publications

(16 citation statements)

References 37 publications

(74 reference statements)

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“…This differs from the study by Haslund et al demonstrating that S. aureus of the same spa type always colonize the anterior nares and hand of a patient [6]. Simultaneous colonization with S. aureus of different spa types and simultaneous colonization with susceptible and resistant strains has been documented previously [36,37]. In case of an infection with multiple types, antibiotic susceptibility testing of solely one colony could lead to the detection of a susceptible rather than a resistant strain and thereby antibiotic treatment failure.…”

Section: Discussioncontrasting

confidence: 80%

Staphylococcus aureus colonization related to severity of hand eczema

Mernelius

Carlsson

Henricson

et al. 2016

Eur J Clin Microbiol Infect Dis

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Knowledge on Staphylococcus aureus colonization rates and epidemiology in hand eczema is limited. The aim of this study was to clarify some of these issues. Samples were collected by the "glove juice" method from the hands of 59 patients with chronic hand eczema and 24 healthy individuals. Swab samples were taken from anterior nares and throat from 43 of the 59 patients and all healthy individuals. S. aureus were spa typed and analysed by DNA-microarray-based genotyping. The extent of the eczema was evaluated by the hand eczema extent score (HEES). The colonization rate was higher on the hands of hand eczema patients (69 %) compared to healthy individuals (21 %, p < 0.001). This was also seen for bacterial density (p = 0.002). Patients with severe hand eczema (HEES ≥ 13) had a significantly higher S. aureus density on their hands compared to those with milder eczema (HEES = 1 to 12, p = 0.004). There was no difference between patients and healthy individuals regarding colonization rates in anterior nares or throat. spa typing and DNA-microarray-based genotyping indicated certain types more prone to colonize eczematous skin. Simultaneous colonization, in one individual, with S. aureus of different types, was identified in 60-85 % of the study subjects. The colonization rate and density indicate a need for effective treatment of eczema and may have an impact on infection control in healthcare.

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Section: Discussioncontrasting

confidence: 80%

Staphylococcus aureus colonization related to severity of hand eczema

Mernelius

Carlsson

Henricson

et al. 2016

Eur J Clin Microbiol Infect Dis

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“…A significant association between HCWs and a specific spa type (t160) was identified in paper IV, which is in line with a previous study, which, however, identified an association between two other spa types, namely t012 and t015, and HCWs (Olsen et al 2013). t160 was also the most common spa type in nursing homes in the same geographical area as the studies in papers III and IV (Stark et al 2014). This adds to the indication already suggested, based on the high prevalence of the previously undetected t084 in the region, that some strains are more prone to transmission and are more successful colonizers.…”

Section: Spa Type Distribution and Cluster Analysis (Papers III And Iv)supporting

confidence: 89%

“…Of the 29 most commonly identified spa types (figure 2, paper IV), 12 were found in the largest spa CC (spa CC 015). This spa CC has previously been identified as the largest spa CC among elderly people living in nursing homes in southern Sweden (Stark et al 2014). Only two of the 29 most common spa types (t084, the most commonly identified spa type, and t085) were found in the second largest spa CC.…”

Section: Spa Type Distribution and Cluster Analysis (Papers III And Iv)mentioning

confidence: 62%

“…These individuals were termed multiclonal individuals. The phenomenon of multiclonal individuals has also been described in elderly persons living in nursing homes (Stark et al 2014). Multiclonal colonization could mislead epidemiological conclusions.…”

Section: Spa Type Distribution and Cluster Analysis (Papers III And Iv)mentioning

confidence: 99%

“…Only two of the 29 most common spa types (t084, the most commonly identified spa type, and t085) were found in the second largest spa CC. (Stark et al 2014). The colonization with genetically different spa types in different sites indicates that there is a close match between the bacteria and not only the host, but also the specific site of colonization in that host.…”

Section: Spa Type Distribution and Cluster Analysis (Papers III And Iv)mentioning

confidence: 99%

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Infection control of Staphylococcus aureus : spa typing to elucidate transmission

Mernelius¹

2015

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Staphylococcus aureus is a commensal of the human flora, primarily colonizing the anterior nares and throat, but it may also cause infections ranging from mild skin and soft tissue infections to severe diseases such as endocarditis and septicemia. S. aureus is also a major nosocomial problem increasing with the worldwide dissemination of methicillin-resistant S. aureus (MRSA).The main vector for bacterial cross-transmission in healthcare settings is the hands of healthcare workers (HCWs). No S. aureus was detected in the air in this thesis demonstrating that transmission through air is not important. Despite the fact that good compliance with hand hygiene is essential to prevent cross-transmission the compliance is generally less than 50 %.Gold standard to track bacterial transmission in healthcare settings has for long been pulsedfield gel electrophoresis (PFGE), a method that is labor-intensive, lacks consensus protocol and relies on semi-subjective analysis. Molecular typing by sequencing of the hypervariable part of the S. aureus protein A gene (spa typing) has overcome these problems and has shown promising results in epidemiological investigations.The aims of this thesis were to study bacterial transmission with S. aureus colonization of newborn infants as a model and to evaluate spa typing as a molecular tool. Additionally, the influence of compliance with hygiene guidelines on S. aureus transmission was assessed.Analysis of 280 MRSA isolates by spa typing revealed excellent typeability and epidemiological concordance and satisfactory discriminatory power. Additionally, spa typing was considered superior to PFGE thanks to its accessibility, ease of use and rapidity. Also, spa typing results are registered in a global database, facilitating inter-laboratory comparison.The prevalence of S. aureus ranged from 41 % to 66 % in the populations studied and males had the highest colonization rate. Throat was the premier colonization site for adults and transmission from individuals colonized in the throat only was documented, suggesting that throat cultures should be included in S. aureus screening programs. The umbilicus was the premier colonization site for newborn infants. Incubating the swabs in enrichment broth prior to plating increased the prevalence of S. aureus positive samples by 46 %, resulting in prevalence viii ranging from 51 % to 70 % in the populations studied. Thus enrichment prior to plating is necessary to determine more truthful S. aureus colonization rates. There were no indications of an institutional flora, as the colonization rates, spa type distribution and antibiotic resistance prevalence were similar among parents and HCWs.Direct observations and self-reporting by HCWs were both validated as tools for monitoring compliance with hygiene guidelines. The compliance with hygiene guidelines was significantly higher following a 10-point hygiene intervention as compared to baseline. The compliance was also higher three years after the intervention in three of four participating departm...

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