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The importance of risk factors in the management and control of MRSA outbreaks
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Staphylococcus aureus são uma espécie de bactérias comensais da pele e mucosas, dos humanos e animais. Porém, também são patogénicos oportunistas podendo causar infeção através de cortes, feridas ou procedimentos médicos, especialmente em indivíduos imunocomprometidos. O aumento da resistência aos antibióticos tornou-se um desafio significativo para os médicos veterinários devido às opções terapêuticas limitadas, especialmente no caso de S. aureus resistente à meticilina (MRSA). Com as infeções por MRSA a tornarem-se cada vez mais frequentes, os surtos ocorrem com maior regularidade e a resistência crescente dificulta o seu controlo. O objetivo deste estudo foi compreender um surto de MRSA, identificar a sua possível origem, através de antibiograma, tipagem molecular, rastreamento da colonização, entre outros, e determinar formas de controlar surtos futuros. Durante este estudo, foram analisados vários fatores, incluindo o impacto do departamento, os procedimentos realizados, a duração da hospitalização e a positividade de colonização por MRSA do operador. Foram recolhidas amostras da mucosa nasal de 36 cavalos no momento da admissão, na alta, e na transferência entre unidades. As amostras foram colhidas utilizando uma zaragatoa de 20 cm em contacto com a mucosa nasal durante 30 segundos, em seguida colocadas num tubo seco e estéril e inoculadas num meio seletivo para MRSA e num meio não seletivo. As zaragatoas positivas a MRSA foram colocadas num meio de Chapman, ao qual foi adicionado um disco de cefoxitina para avaliar a resistência potencial. Os resultados indicaram uma positividade de 9% na admissão e de 55% na alta. Foi observado um aumento de 56% na colonização por MRSA em cavalos que estiveram no departamento de cirurgia durante o estudo, em comparação com um aumento de 40% e 33% nos departamentos de medicina interna e oftalmologia, respetivamente. Estes resultados foram comparados com outras informações disponíveis na literatura para compreender a importância de conhecer os possíveis fatores de risco na gestão de futuros surtos, bem como na implementação de planos de controlo de infeções. Ao identificar os fatores de risco, obtemos uma visão mais clara das nossas "fragilidades" na prevenção de casos de MRSA que possam evoluir para surtos, permitindo nos abordar o problema de forma mais eficaz. Além disso, entendemos a importância de um uso consciente e responsável dos antibióticos
Staphylococcus aureus is a type of bacterium that is commonly found on the skin and nasal passages of healthy people and animals. While often harmless, in some cases it can cause a range of infections when it enters the body through cuts, wounds, or medical procedures, and when individuals are immunocompromised. The increase in antibiotic resistance has become a significant challenge for veterinary medicine professionals due to the limited therapeutic options available, especially Methicillin resistant S. aureus. S. aureus infections are becoming increasingly prevalent in both humans and animals. As a result, outbreaks are occurring more frequently, and the growing resistance makes controlling these outbreaks progressively more challenging. The goal of this study was to understand the MRSA outbreak and possibly finding its origin and how to control possible future outbreaks. During this study several factors were studied, including the impact of the department, the procedures performed, the duration of hospitalization, and the operator on MRSA carriage positivity. It included 36 horses that were sampled upon entry, upon exit, and when changing units, the samples were made with a 20cm swab in contact with the mucosa for 30 seconds before being placed in a dry-cut tube and cultured in a selective medium for MRSA and an ordinary culture. Positive swabs were placed on a Chapman medium, to which a cefoxitin disc was added to assess potential resistance. The results indicated a 9% positive at admission and 55% at discharge. An increase of 56% was observed in MRSA carriage in horses that had been in the surgery department during the study, while this increase was only 40% and 33% for the internal medicine and ophthalmology departments. I compared these results with other information available in literature, so that I could understand the importance of knowing the possible risk factors in order to manage future outbreaks and implement preventive measures and infection control plans. By identifying the risk factors, we gain insight into our "weaknesses" in preventing an MRSA case from escalating into an outbreak, enabling us to address the issue more effectively. This is crucial, as MRSA is highly infectious and has shown an accelerated development of antibiotic resistance over time. Not only this, but we understand the importance of a conscient and responsible use of antibiotics, also called “antibiotic stewardship”
Staphylococcus aureus is a type of bacterium that is commonly found on the skin and nasal passages of healthy people and animals. While often harmless, in some cases it can cause a range of infections when it enters the body through cuts, wounds, or medical procedures, and when individuals are immunocompromised. The increase in antibiotic resistance has become a significant challenge for veterinary medicine professionals due to the limited therapeutic options available, especially Methicillin resistant S. aureus. S. aureus infections are becoming increasingly prevalent in both humans and animals. As a result, outbreaks are occurring more frequently, and the growing resistance makes controlling these outbreaks progressively more challenging. The goal of this study was to understand the MRSA outbreak and possibly finding its origin and how to control possible future outbreaks. During this study several factors were studied, including the impact of the department, the procedures performed, the duration of hospitalization, and the operator on MRSA carriage positivity. It included 36 horses that were sampled upon entry, upon exit, and when changing units, the samples were made with a 20cm swab in contact with the mucosa for 30 seconds before being placed in a dry-cut tube and cultured in a selective medium for MRSA and an ordinary culture. Positive swabs were placed on a Chapman medium, to which a cefoxitin disc was added to assess potential resistance. The results indicated a 9% positive at admission and 55% at discharge. An increase of 56% was observed in MRSA carriage in horses that had been in the surgery department during the study, while this increase was only 40% and 33% for the internal medicine and ophthalmology departments. I compared these results with other information available in literature, so that I could understand the importance of knowing the possible risk factors in order to manage future outbreaks and implement preventive measures and infection control plans. By identifying the risk factors, we gain insight into our "weaknesses" in preventing an MRSA case from escalating into an outbreak, enabling us to address the issue more effectively. This is crucial, as MRSA is highly infectious and has shown an accelerated development of antibiotic resistance over time. Not only this, but we understand the importance of a conscient and responsible use of antibiotics, also called “antibiotic stewardship”
Descrição
Dissertação de Mestrado Integrado em Medicina Veterinária, área científica de Clínica
Palavras-chave
MRSA Surto Cavalo Fatores de risco MRSA Outbreak Horse Risk factors