staph. aureus mini research

8/7/2019 staph. aureus mini research

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RESEARCH, METHODOLOGY, AND

PROJECT

(SPP 3621)

Prevalence ofStaphylococcus aureusnasal carriage in medical students

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Content

2

Chapter 1:Introduction

Chapter 2: Literaturereview

Chapter 3:Methodology


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INTRODUCTION

Staph.aureus

o Normal flora of skin and mucous membranes of human.

}However, S.aureus can also cause infections (eg.pyogenic

infections ,necrotizing fasciitis, toxic shock syndrome (TSS),

gastroenteritis and others).2

} But, for infections to be occured, there must be lesions/cut at

the sites mentioned as well as other factors. These factors will

be discussed later in chapter 2.

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} Nose: main site for S. aureus to reside(40%) 7

} So, human nose may become a potential source ofcolonization and infection.9

} Therefore, it increases the risk of human gettinginfected with this pathogen7

} Nasal carriage ofs. aureus occurs in 20-50% of

human2

Cont.


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Problem Statement

} S. aureus is one of the most common pathogens causing

nosocomial infection.1 The infection ofS. aureus can be easilytransmitted to the patient in the hospital setting by contact with

a healthcare worker (HCW). Medical students will become

HCW in future and HCW can be carrier fors. aureus.5 This is

of concern becauses. aureus infection may the ones which

resist to antibiotics. And spread of MRSA may cause patients

difficult to be treated.

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OBJECTIVESGeneral objective

To study the prevalence ofS.aureus nasal carriage in medicalstudents of University Putra Malaysia.

Specific objective

To determine the prevalence ofS. aureus from nasal swab ofmedical student.

To identify risk factor(social demographic, health status, skin

infection) for nasal carriage ofS. aureus in medical student.

To describe the antibiotic susceptibility pattern ofS. aureusisolated from nasal swab of pre-clinical and clinical medicalstudent.

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RESEARCH HYPOTHESIS

} There is no relationship between risk factors and

the colonization ofS. aureus in nares of medical

students.

} There is no significant different between antibiotic

susceptibility patterns ofS. aureus isolated from

nasal swab of pre-clinical and clinical medical

students.

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Literature review

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Epidemiology} The carrier rate of S. aureus in the nose among the healthy

people are 20-50%.2

o And there is cross-sectional study regarding MRSA. From 4612

patients (in which their sample culture of S. aureus had been

taken),approximately 25% of patients was MRSA and among

them 85% cases were classified as health care-associated

(HA-MRSA).12% cases were classifie

das commun

ity-

associated (CA-MRSA), and 3% could not be classifieddue

to lack of information.6

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Colonizationo S. aureus is a commensal bacter ia or a

pathogen. 32

o About 23.4% individuals are nasally colonized

with S. aureus.32

o Provides a reservoir from which bacteria can

be introduced when host defenses are

breached (by shaving, insertion of an indwelling

catheter, or surgery)

o Increases the risk of infection.32

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Cont.

}Generally those with S. aureus infections are

infected with their colonizing strain.32

} Bloodisolates of 82% patients of bacteremia

were identical to nasal isolates.32

} Involve the host's contact with S. aureus and

the ability of S. aureus to adhere to host cells

and to evade the immune response.32

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Virulence factors


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RISK FACTORS

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Exposure to hospital

environment

} Doctors and nurses are the healthcare workers with

highest frequency of contact with the patients and

the most likely to transmit this pathogen. MRSA

carriage was particularly high among the Doctors

(65.2%) andNurses (64.7%).33

} In the developing nations healthcare givers are

potential transmitters of S. aureus.33

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Host factors}Modifiable} Health status(e.g.:

diabetes, skin lesion).

} Personal hygiene

}Non-modifiable} Gender

} Age

} Ethnicity

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Non-modifiable:

GenderStudy Findings

Heiman et.al,2005 Host character istics co-determine the S.

aureus carrier state. It is further supportedby the fact that S. aureus

carriage rates vary between gender withhigherin men.

Hamdan et.al,2010 A prospective study among healthycarriers in Mexican community.

Among nasal carriers ,male nasal carriers

were (40.9%) and female nasal carriers

were(33.9%).

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Age

Study Finding

Heiman et.al,2005 Host character istic co-determinedS.

aureus carriage state andis supportedthat S. aureus carriage rates vary depends

on age.

Hamdan et.al,2010 Nasal carrier was greaterin the age groupof 1 to 10 years(45.9%) than in the otherage group

Graham III,2001 People age less than 65 years were more

likely to acquiredS. aureus.Where those who age older than 65 yearsare more likely to have MRSAcolonization.

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Health statusStudy Findings

Heiman et.al,2005 Host characteristic co-determine the S.

aureus carrier state. High carriage rate in patients with diabetes

mellitus (both insulin dependent and non-

insulin dependent), patients undergoinghaemodialysis, patients with end stage liverdisease andpatients with HIV.

Kluytmans et.al,1997 Carriage forS. aureus increase in patients

with insulin dependant diabetes mellitus,

patients undergoing heamodialysis,continuous ambulatory peritoneal dialysis(CAPD), patients with S. aureus skin infection

andpatients with human immunodeficiencyvirus infection.

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Personal hygiene} Nasal carriage of S. aureus (NCSA) is a risk factor for nosocomial

infections with S. aureus,

} Nosepicking may become one of the determinant that cause

NCSA.

} Study done by Wertheim et.al from 124 patients, there were 56.5%

patients were non-carriers and 43.5% were carriers.

} In the non-carr ier group 44.0% of patients were positive for

nosepicking and in the carr ier group 65.0% patients were positivefor nosepicking. 34

} Nosepickingplays a role in nasal carriage of S. aureus.

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Conceptional framework

Prevalence

of S. aureusnasal

carriage

Host

factors

Age10

Personal

hygiene30

gender10

Race7,8

Healthstatus7,20

Exposure to

hospitalenvironment5

Antibiotic

susceptibility

pattern of S.aureus

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References

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1. Nikos M.Linardakis.Microbiology and Immunology(2ndedition).United State Of America:Mc Graw-Hill,1998

1. J. Shanmugam, R.Gopal. The Prevalence, Antibiogram AndCharacterisation OfStaphylococcus Aureus including MRSA amongthe Healthy Staff,Medical Students and Patients,India.2008

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Comparison ofCommunity and Health CareAssociated Methicillin-Resistant Staphylococcus aureus Infection, JAMA, Vol 290, No. 22.

Wertheim H.F. L., Melles D. C., Margreet C Vos, van LeeuwenW., vanBelkum A. , Henri A. V., Nouwen J. L,The role of nasal carriage inStaphylococcus aureus infections, Lancet Infectious Diseases2005, 5:751-62.

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Hamdan-Partida A., Sainz-Espunes T., Bustos-Martnez J.,Characterization and Persistence ofStaphylococcus aureus StrainsIsolated from the Anterior Nares and Throats ofHealthy Carriers in aMexican Community, Journal ofClinical Microbiology 2010;1701-1705.

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