How are staph infections transmitted: Staph infections – Symptoms and causes
Staphylococcal infections – health.vic
Notification requirement for staphylococcal infections
Notification is not required.
Primary school and children’s services centres exclusion for staphylococcal infections
For impetigo due to staphylococcal infection, exclude until appropriate treatment has commenced.
Infectious agent of staphylococcal infections
There are more than 40 species of Staphylococcus. They are often commensal organisms of the skin and upper respiratory tract. Infection may result from endogenous organisms or may be transmitted from close contacts. It is important to differentiate coagulase-positive staphylococci, predominantly Staphylococcus aureus, from coagulase-negative staphylococci (for example, S. epidermidis). This is because of the greater virulence of S. aureus and the more significant role it plays in both community- and hospital-acquired infections. Resistance is a significant concern for both S. aureus and coagulase-negative staphylococci.
Identification of staphylococcal infections
Staphylococcal infection presents with a variety of clinical and epidemiological patterns among the general community, newborns, hospitalised patients, menstruating women and intravenous drug users.
S. aureus may cause:
- purulent skin infections such as boils, abscesses, styes, impetigo and scalded skin syndrome
- systemic infections such as bloodstream infections, pneumonia, osteomyelitis, endocarditis and deep abscesses
- hospital-acquired (nosocomial) infection of surgical wounds or treatment lines
- infections of prosthetic devices such as pacemakers, heart valves, joint replacements and other foreign bodies, including central venous catheters and peritoneal dialysis catheters
- food poisoning by releasing toxins into food
- toxic shock syndrome by releasing toxins into the bloodstream.
Coagulase-negative staphylococcal infections are more likely to be healthcare associated. They may cause:
- urinary tract infections due to S. saprophyticus in young women or S. epidermidis with indwelling catheters
- infections of prosthetic devices such as pacemakers, heart valves, joint replacements and other foreign bodies, including central venous catheters and peritoneal dialysis catheters
- similar infections to S. aureus in some circumstances (for example, immunosuppression), particularly the species S. lugdunensis.
Diagnosis is confirmed by isolation of the organism from relevant specimens. The antibiotic resistance profile is important in management.
Incubation period of staphylococci
The incubation period is variable and indefinite. It is most commonly 4–10 days.
Public health significance and occurrence of staphylococcal infections
Staphylococcal infections are frequent but are usually contained by immune mechanisms at the site of entry. The highest incidence of disease usually occurs in people with poor personal hygiene, people subject to overcrowding and children. However, anyone can develop a serious staphylococcal infection, including fit young people.
Since the late 1970s, methicillin-resistant S. aureus (MRSA) strains have been identified in Victoria as a major cause of nosocomial infections and outbreaks. MRSA accounts for approximately 30–50 per cent of hospital-acquired S. aureus isolated from normally sterile sites. However, alcohol-based hand hygiene programs have been successfully associated with a reduction in the rates of nosocomial infections. Healthcare employees and other carers may develop intermittent colonisation with MRSA. These workers rarely develop infection.
Community-associated outbreaks have been reported among close contacts, including wrestlers, football players, prison inmates, people in day-care centres, people in military quarters, homeless people, intravenous drug users and men who have sex with men.
Reservoir for staphylococci
Human carriers are a major source of infection. Approximately 50 per cent of the population is colonised with S. aureus in the anterior nasal passages, some intermittently (~30 per cent) and some persistently (~20 per cent). This rate has declined over time; suggested reasons for this decline include improved personal hygiene, changes in socioeconomic class and smaller families.
Staphylococci have prolonged survival in the hospital environment due to resistance to antiseptics and disinfectants. Specific reservoirs, such as pigs, have been the source for outbreaks in humans who work directly with these animals.
Mode of transmission of staphylococci
Staphylococci are most often transmitted by direct or indirect contact with a person who has a discharging wound or clinical infection of the respiratory or urinary tract, or who is colonised with the organism. MRSA can be carried on the hands of healthcare personnel, and this is a likely mode of transmission between patients and staff. Contaminated surfaces and medical equipment are also possible sources of MRSA.
Period of communicability of staphylococcal infections
Communicability exists as long as purulent lesions continue to drain, or the carrier state persists.
Susceptibility and resistance to staphylococcal infections
Staphylococcal infection can affect people of any age, with or without comorbidities. Particular groups at higher risk include those who use intravenous drugs or have intravenous devices (for example, dialysis access lines, chemotherapy ports, long-term indwelling catheters), diabetics, burns patients, those who are immunosuppressed, the elderly and newborns.
Mechanisms of immunity are not well understood, although adequate neutrophil function plays a critical role.
Penicillin resistance was first described in 1944, and is currently present in more than 95 per cent of S. aureus isolates. Methicillin (as a marker of flucloxacillin) resistance was detected soon after the introduction of methicillin in 1959, and was first described in Australia in 1965. Approximately 25 per cent of S. aureus bacteraemia isolates were resistant to methicillin in a 2009 Australian study. MRSA are classified as hospital acquired (HA-MRSA; acquired >48 hours after admission to a hospital) or community acquired (CA-MRSA). Traditionally CA-MRSA isolates retained sensitivity to other anti-staphylococcal antibiotics (clindamycin, cotrimoxazole), whereas HA-MRSA were resistant to many classes of antibiotic, and most required intravenous vancomycin treatment. Vancomycin-resistant organisms are rare but concerning pathogens. They can be classified as VISA (vancomycin-intermediate S. aureus), h-VISA (heterogeneous vancomycin-intermediate S. aureus) or VRSA (vancomycin-resistant S. aureus). S. epidermidis is very frequently methicillin resistant (MRSE).
Flucloxacillin and first-generation cephalosporins (cephazolin, cephalothin) have been associated with the best outcomes for treatment of MRSA, and should be used in preference to other antibiotics. MRSA infections may or may not retain sensitivity to clindamycin or cotrimoxazole. Other antibiotics used for MRSA include vancomycin, rifampicin, fusidic acid, daptomycin and linezolid. Occasionally, for toxic shock syndrome or severe cellulitis, clindamycin is added to an anti-staphylococcal agent in an effort to minimise toxin production.
Control measures for staphylococcal infections
• Maintain good hygiene through public education in relation to handwashing, food preparation and avoiding sharing toilet articles.
• Cover purulent lesions with a waterproof dressing.
• In the healthcare setting
o educate hospital staff regarding the importance of handwashing
o use common, narrow-spectrum antibiotics, where possible
o consider decolonisation in patients planned for high-risk surgical procedures (see ‘Outbreak measures for staphylococcal infections’).
Control of case
Advise isolation until treatment of the infection has commenced. Search for, and cover, draining lesions. Infected people should avoid contact with infants and chronically ill patients. Added infection control precautions may be recommended for cases with infections due to multiresistant organisms.
Control of contacts
Routine contact tracing is not usually required.
Determining the carrier status of a pathogenic strain among family members may be occasionally useful. Carriers might be recommended antibiotics to eliminate the bacteria, such as mupirocin.
Control of environment
Encourage handwashing, especially in the hospital setting.
Outbreak measures for staphylococcal infections
The department may investigate unusual clusters of staphylococcal infections in the community, particularly those associated with antibiotic-resistant strains.
This may include:
- investigating the source of infection, including microbiological screening of contacts
- advising on added infection control precautions for cases and carriers
- making treatment recommendations for cases and carriers.
Within families or particular close-knit groups (sporting teams, prison inmates), treatment of carriers with a regimen to eliminate carriage of the bacteria may be recommended if a particularly virulent strain is causing issues with recurrent infection. Such ‘decolonisation’ involves the repetitive use of antiseptic body wash, in conjunction with intranasal antibiotics such as mupirocin.
Hospital nursery workers with minor lesions, such as boils or abscesses, should not have direct contact with infants until the lesion has healed.
All known or suspected cases in a nursery should be isolated. Two or more concurrent cases would constitute an outbreak and warrant investigation. Identification and treatment of carriers may be necessary in this situation.
In school settings, the child should be excluded from school until specific treatment begins. Lesions must be covered with a watertight dressing. Contacts do not need to be excluded.
Study reveals how Staph, MRSA spread in households
As a pediatric infectious physician in St. Louis, Stephanie Fritz, MD, sees a fair amount of patients with MRSA skin infections, many of which come back over the course of a year. And she and her colleagues frequently see these infections occurring in multiple members of the same family.
As a researcher who’s been studying MRSA (methicillin-resistant Staphylococcus aureus) for some time, Fritz has been wanting to get to the bottom of this. Staph bacteria is known to reside on the skin of roughly one third of the population, and while it’s well established that Staph infections are transmitted from person to person, the household environment and pets have also been implicated as potential sources. But research on how big a role these factors play in MRSA transmission has been limited.
What Fritz wanted to know was what was driving these within-family infections, and what dynamics were in place. How is MRSA getting into these households in the first place? Were household members getting infected by another family member, from an outside source, or by an item inside the house? What role do pets play? And why was she seeing so many recurrent infections?
“We really wanted to dig deeper,” said Fritz, an associate professor of pediatrics at Washington University in St. Louis (WUSTL) School of Medicine and lead author of a study on Staph transmission published yesterday in The Lancet Infectious Diseases. “We wanted to track these dynamics so that we could identify targets to interrupt transmission and acquisition.”
Sleuthing with sampling, molecular analysis
That’s exactly what Fritz, along with fellow researchers from WUSTL School of Medicine and the University of Chicago, has done in the HOME (Household Observation of MRSA in the Environment) study.
From 2012 through 2015, Fritz and her co-authors recruited 150 pediatric patients who had community-onset MRSA infections and no other health issues, along with their household members and dogs and cats. Over the course of 12 months, they visited the homes of the index patients five times, each time collecting swab samples from the occupants, their pets, and 21 household items (including bed sheets, bath towels, refrigerator door handles, and computer keyboards) and asking more than 100 detailed questions about personal habits and hygiene.
The researchers also performed molecular testing on all S aureus samples (both MRSA and methicillin-susceptible S aureus) collected over the 12 months to identify the particular strain of the bacteria. The molecular testing enabled them to determine whether a Staph strain that was acquired at the 6-month visit to a home, for example, represented an introduction—a novel strain that hadn’t been found in previous visits and came from outside the house—or a transmission of a strain that had been previously identified in the home (on a different family member, pet, or household item).
Altogether, 692 people took part in the study, along with 154 cats and dogs. Over the 12-month study period, 513 individuals were colonized at least once with S aureus, and 319 were colonized with MRSA. Of the 154 pets sampled, 68 were colonized with S aureus, 44 with MRSA. And at least one household surface was colonized with S aureus in 136 homes, while MRSA was found in 104 homes. A total of 3,819 S aureus samples were collected.
Household surfaces play key role
Across all household members, pets, and environmental surfaces, 1,267 strain acquisition events were observed, with the molecular analysis identifying 510 introductions of novel Staph strains, and 602 transmissions of strains within households. What this finding told Fritz and her colleagues was that household acquisition of S aureus and MRSA is driven nearly equally by introduction of novel strains into the household and transmission within the household.
What they also found as they probed deeper into household transmission dynamics was that the household items were not just being passively contaminated with S aureus and MRSA by family members, but were playing an active role in helping spread the bacteria from one family member to another. In several cases, the household item was the only possible source of contamination.
“Because of our strain typing and the longitudinal nature of our study, we could identify that those environmental surfaces actually served as reservoirs for transmission,” Fritz said.
Multivariable analyses of the factors involved with Staph introduction and transmission helped flesh out this connection. For example, the researchers found that household members who shared a bedroom or a bath towel with another household member were more likely to be both a source of Staph transmission and a recipient. “It really came down to sharing of personal hygiene items, like towels,” Fritz said.
They also found that transmission was more likely in homes that on previous visits had high Staph contamination, in rental homes, and in homes with lower cleanliness scores. Analysis of factors associated with introducing the bacteria into homes found that children who attend daycare are more likely to bring new strains into the home, while people who frequently wash their hands were less likely.
Fritz thinks this finding should be reassuring to people concerned about bringing MRSA—which can cause more serious infections if it gets into the blood, bones, or organs—into their homes.
“You don’t have to overhaul your life, you don’t have to stop going to the gym,” she said. “There are some subtle things you can do to protect yourself.”
Pets not the culprit
Another reassuring finding, at least for pet owners, is that while pets were found to play a role in Staph transmission dynamics, they were mostly receiving the bacteria from humans. Only three transmission events occurred in which the pet was the only possible source of the bacteria. This is important, Fritz explained, because patients with recurrent MRSA infections frequently tell her that their primary care physician has suggested that the pet may be the source of the problem.
“For me, one of the take-home messages is do not get rid of your pet,” she said. “They are not the major culprit.”
Fritz and her colleagues say that better hand washing, use of separate towels and other personal hygiene items by family members, and targeted decolonization of household surfaces could help reduce introduction and transmission of Staph bacteria in homes.
Nov 26 Lancet Infect Dis study
Staphylococcus aureus – APIC
S. aureus and how does it spread?
Staphylococcus aureus or “staph” is a type of bacteria found on human skin, in the nose, armpit, groin, and other areas. While these germs don’t always cause harm, they can make you sick under the right circumstances. S. aureus is the leading cause of skin and soft tissue infections, such as abscesses, boils, furuncles, and cellulitis (red, swollen, painful, warm skin). S. aureus germs can also cause more serious infections, such as pneumonia, bloodstream infections, endocarditis (infection of the inner lining of the heart chambers and heart valves), and bone and joint infections.
S. aureus is spread by touching infected blood or body fluids, most often by contaminated hands.
S. aureus infections?
Anyone can develop a S. aureus infection, although certain groups of people are more likely than others. This includes people with conditions such as: diabetes, cancer, vascular disease, eczema, lung disease, and people who inject drugs. Patients who are hospitalized in intensive care units (ICUs), patients who have undergone certain types of surgeries, and patients with medical devices inserted in their bodies, such as central lines and catheters, are at greater risk of a more serious S. aureus infection. People who often visit healthcare facilities and nursing home residents are also at an increased risk.
What are the symptoms of
S. aureus infections?
S. aureus infections typically appear on the skin as a pocket of pus surrounded by red, painful skin, or cellulitis.
S. aureus treated?
Treatment depends on the type of infection caused by the bacteria. When antibiotics are prescribed, they are selected based on laboratory testing of the bacteria and may involve more than one type.
Staph bacteria are very adaptable, and many varieties have become resistant to one or more antibiotics. The rise of antibiotic-resistant strains of staph bacteria—often described as methicillin-resistant S. aureus (MRSA) strains—has led to the use of IV antibiotics, with the potential for more side effects.
How can you prevent
S. aureus Infections?
To prevent staph infections, practice proper hand hygiene, keep infected areas covered and clean, and avoid sharing personal items like razors, towels, and needles.
Methicillin-Resistant Staphylococcus Aureus : OSH Answers
In the community, contact your doctor if you think you have an infection. Early treatment is very important.
- Wash your hands often, and always after changing the bandage or touching the infection. Use soap and water, or use an alcohol-based hand sanitizer.
- Do not treat the infection yourself, and do not pick or pop the sore.
- Cover the infection with dry bandages.
- Do not share personal items such as towels or razors.
- Wipe down non-washable equipment with an antibacterial solution, especially before being used by another person.
- Clean surfaces (counter tops, door knobs) with a standard disinfectant on a regular basis.
- Wash sheets, towels, and clothes with water and laundry detergent. Use a dryer to dry the items completely.
- If prescribed antibiotics, take all of the medicine as prescribed by your medical health professional. Finish your antibiotics as instructed, even if you feel better. If your healthcare professional tells you to stop taking antibiotics, return the unused medicine to your pharmacy.
- Do not share antibiotics with anyone, do not use leftover antibiotics, and do not use antibiotics that were prescribed to another person.
The prevention of MRSA infections in health care is based upon standard infection control precautions, which include routine practices, and contact precautions as required for all antibiotic-resistant organisms. Steps include, but are not limited to:
Contact precautions should be used with patients with known or suspected infections. It is not necessary to wait for testing to confirm a diagnosis. Use contact precautions (e.g., procedures to prevent droplet or aerosols). Post signs at the entrance to patient area. Single patient rooms may be used with designated toilets and sinks. Separating patients by 2 metres may also be used when a respiratory infection is present.
Hand hygiene can be performed with an alcohol-based hand rub or with soap and water. Alcohol-based hand rub is used at the point of care in healthcare settings when hands are not visibly soiled. If hands are visibly soiled, wash with soap and water.
Wear gloves when touching blood, body fluids and contaminated items. Remove gloves between patient contacts and clean hands immediately.
Wear a mask and eye protection, or face shields, or masks with a visor attachment during procedures that are likely to generate splashes or droplets of respiratory secretions, blood, or body fluids.
Long-sleeved cuffed gowns are not routine, but may be needed in specific situations. Follow your organization’s policies.
Patient Care Equipment
Appropriate cleaning, disinfection and sterilization of patient care equipment and rooms are important in limiting the transmission of organisms. Equipment may be dedicated to a single patient when possible. Surfaces that are likely to be touched or used should be cleaned and disinfected more frequently (e.g., bedrails, tables, call bells, door knobs, bathroom facilities, etc.).
Education of Patient, Families and Visitors
All people involved should be educated about the importance of the precautions being used to help prevent the transmission of the disease. Hand hygiene is particularly important.
Handling of Laundry
In healthcare settings, while care should be taken when handling soiled linen, special handling of linen from patients with additional precautions is not required. When at home, linens, wash towels and bed linens in a washing machine set to the hottest water setting (with added bleach, if possible) and dry them in a hot dryer. Wash gym and athletic clothes after each wearing.
For further information refer to Routine Practices and Additional Precautions for Preventing the Transmission of Infection in Healthcare Settings (2107) from the Public Health Agency of Canada.
See the OSH Answers on Antibiotic/Antimicrobial Resistance in Bacteria and Organisms for more information.
Staphylococcus aureus – golden staph
Staphylococcus aureus, or S. aureus, is a common bacterium that lives on the skin or in the nose. It is also called golden staph. In most situations, S. aureus is harmless. However, if it enters the body through a cut in the skin, it can cause a range of mild to severe infections, which may cause death in some cases.
How golden staph is spread
Golden staph is commonly carried on the skin or in the nose of healthy people. Around two to three out of every tenpeople carry the bacterium in their noses. This is known as ‘colonisation’ – the bacteria are present, but do not cause infection. The armpits (axilla), groin and under skin folds are other places golden staph likes to inhabit.
Golden staph can be spread by skin-on-skin contact or by touching contaminated surfaces. Poor personal hygiene and not covering open wounds can lead to infection with golden staph. Thorough hand washing and good housekeeping, such as damp dusting, are important as golden staph is part of our environment.
Infections caused by golden staph
Common infections caused by golden staph include:
- boils and abscesses – infections of the skin
- impetigo (school sores) – a highly contagious, crusty skin infection that may affect newborn babies and schoolchildren.
More serious infections include:
- meningitis – infection of the membranes lining the brain
- osteomyelitis – infection of the bone and bone marrow
- pneumonia – infection of one or both lungs
- septic phlebitis – infection of a vein
- endocarditis – infection of the heart valves.
Drug-resistant strains of golden staph
A bacterial infection consists of countless individual bacteria. Most infections caused by golden staph are treatable with antibiotics. However, there is a strong possibility that a few bacteria will survive a course of antibiotics, perhaps due to a gene mutation. The antibiotic-resistant golden staph bacteria that remain then flourish, since they no longer have to compete for resources with the rest of the colony.
Resistant strains of golden staph are known as multi-resistant S. aureus (MRSA). Unnecessary or excessive use of antibiotics encourages drug-resistant strains. The overuse of disinfectants in general can also lead to drug resistance. In most cases, good cleaning or washing with soap and warm water is enough.
Antibiotic resistance is a serious public health problem
Before antibiotics, a severe infection was fatal for many people. Penicillin was effective in treating golden staph until the bacterium became resistant. Throughout the second half of the 20th century, new antibiotics such as methicillin and vancomycin were developed, which successfully treated golden staph infections.
Methicillin-resistant strains of golden staph evolved in the 1970s and have troubled hospitals worldwide with persistent infections in patients. A vancomycin-resistant strain of golden staph emerged in Japan, and strains with partial resistance to vancomycin have been found in the USA, Australia and other countries.
Infection in hospitals
Hospital patients are more likely to be infected by golden staph because of surgical or other wounds. These people can become seriously ill if their golden staph infections resist treatment from most types of antibiotics, and they may require isolation from other patients.
Standard hygiene practices undertaken by hospital staff include:
- always washing hands when they are soiled for any reason
- using an alcohol-based hand rub solution (with or without chlorhexidine) between patients when taking observations (such as pulse and temperature), bed making or performing other similar duties
- washing hands before, and after, performing procedures on patients
- wearing gloves, gowns and masks (if necessary)
- handling used equipment and laundry with care
- isolating infected patients when required
- thoroughly cleaning all surfaces.
Golden staph infections with resistant strains are becoming more common in the community, including among people who have not been in hospital recently (within the past year) or had a medical procedure (such as dialysis, surgery or catheters).
These infections are called ‘community-acquiredgolden staph or ‘community-acquired MRSA’. These are similar, but different to strains of golden staph found in hospitals, and can cause mild to severe infections.
Preventing the spread of golden staph
Since golden staph is easily spread by contaminated hands, strict hygiene practices are needed, such as hand washing with soap and warm water, as well as good housekeeping.
Cover all open wounds with a waterproof occlusive dressing until healed.
The use of alcohol-based hand rub solutions in ‘clean’ situations when hands are visibly clean, particularly when water is not immediately available, may be useful when travelling or at a picnic, for example. These solutions are not necessary in the home or work situation.
There are some situations when alcohol-based hand rub solutions should never be used – for example, instead of washing after going to the toilet. Hands should be washed with soap and warm water and dried.
Long-term prevention of golden staph
Worldwide measures need to be taken to prevent new resistant strains of S. aureus from emerging. Experts propose:
- a more conservative approach to using antibiotics
- the use of narrow-spectrum rather than broad-spectrum antibiotics
- limiting the use of antibiotics like vancomycin
- maintaining or upgrading hygiene practices in hospitals and the community
- good infection prevention and control measures, such as hand washing
- developing new lines of antibiotics that are effective against golden staph.
Where to get help
Things to remember
- Staphylococcus aureus (S. aureus) is a common bacterium that lives on the skin and in some people’s noses.
- Golden staph can cause a range of mild to severe infections.
- Excessive use of antibiotics has led to drug-resistant strains of S. aureus (MRSA).
Disease Outbreak Control Division | Methicillin-resistant Staphylococcus aureus (MRSA)
Methicillin-resistant Staphylococcus aureus (MRSA)
Staphylococcus aureus, often called “staph” are bacteria commonly found on the skin or in the nose of healthy people. If the bacteria enter the skin through a cut or scrape, the wound can become infected. Staph bacteria are one of the most common causes of skin infections in the US. Most staph skin infections are minor and can be treated without medicines. However, staph bacteria can also cause more serious infections when they invade deeper tissues, the bloodstream or the lungs, causing pneumonia.
Some staph bacteria do not respond to medicines. MRSA is a type of staph that is resistant to medicines such as penicillin and amoxicillin.
Staph bacteria, including MRSA, can cause skin infections that may look like a pimple or boil, and can be red, swollen, painful, or have pus or other drainage. More serious infections may cause pneumonia, bloodstream infections or surgical wound infections.
Staph is spread through skin to skin contact and from direct contact with contaminated surfaces. Athletes, especially wrestlers and football players, are at high risk of skin infections from staph. Staph lives in salt water, and swimming or surfing with broken skin can cause infection. In a healthcare facility MRSA is usually spread by direct contact with an infected wound or from contaminated hands.
Many people are also infected with the bacteria from their own skin or noses.
The only way to know if MRSA is the cause of an infection is to perform a laboratory culture of the bacteria. Obtaining bacteria to culture is a procedure done by a doctor or nurse.
Most staph infections are treatable with medications prescribed by a doctor. MRSA infections can be treated by draining the wound. If the infection is not getting better with treatment, contact your doctor again, as the bacteria could be resistant to the medicine.
Currently, there is no immunity for MRSA.
Anyone can get MRSA on their body from contact with an infected wound or by sharing personal items, such as towels or razors, that have touched infected skin. MRSA infection risk can be increased when a person is in activities or places that involve crowding, skin-to-skin contact, and shared equipment or supplies. People including athletes, daycare and school students, military personnel in barracks, and those who recently received inpatient medical care are at higher risk.
In healthcare facilities such as hospitals and nursing homes, patients most likely to get an MRSA infection are those with other health conditions making them sick. Also, hospital or nursing home patients who have been treated with antibiotics, have wounds or invasive medical devices such as catheters are more likely to get an infection.
The Department of Health prepares an annual report on specific healthcare-associated infections from select hospitals, which is available here. The Department of Health tracks cases of MRSA bloodstream infections that are acquired from a hospital. In 2017, 19 cases of inpatient MRSA bacteremia were reported.
- Most skin infections can be prevented with good hygiene.
- Wash your hands thoroughly and often with soap and water, or use a hand sanitizer, especially after changing bandages or touching a wound.
- Keep cuts and scrapes clean and covered with a bandage until healed.
- Avoid contact with other people’s wounds.
- Don’t share personal items such as towels washcloths, razors or clothing that may have had contact with an infected wound.
- Wash sheets, towels and clothing that have become soiled with water and laundry detergent. Drying clothing in a hot dryer, rather than air-drying, will help kill bacteria in clothing.
- If you are an athlete, or someone who has frequent skin to skin contact with others, be extra careful with your personal hygiene. To learn more, visit: Prevention Information and Advice for Athletes
Hawaii State Department of Health MRSA Fact Sheets (PDF) :
English | Chuukese | Ilokano | Japanese | Marshallese | Tagalog
Clinicians play a critical role in slowing the spread of MRSA. Rapidly identifying patients colonized or infected with these organisms and placing them in Contact Precautions when appropriate, using antibiotics wisely, and minimizing device use are all important parts of preventing MRSA transmission.
Last reviewed December 2018
Methicillin-Resistant Staphylococcus Aureus (MRSA) | Michigan Medicine
What is methicillin-resistant Staphylococcus aureus (MRSA)?
Methicillin-resistant Staphylococcus aureus (MRSA) is a type of staphylococcus or “staph” bacterium that is resistant to many antibiotics. Staph bacteria, like other kinds of bacteria, normally live on your skin and in your nose, usually without causing problems. But if these bacteria become resistant to antibiotics, they can cause serious infections, especially in people who are ill or weak. MRSA is different from other types of staph because it cannot be treated with certain antibiotics such as methicillin.
MRSA infections are more difficult to treat than ordinary staph infections. This is because the strains of staph known as MRSA do not respond well to many common antibiotics used to kill bacteria. When methicillin and other antibiotics do not kill the bacteria causing an infection, it becomes harder to get rid of the infection.
MRSA bacteria are more likely to develop when antibiotics are used too often or are not used correctly. Given enough time, bacteria can change so that these antibiotics no longer work well.
How is MRSA spread?
MRSA, like all staph bacteria, can be spread from one person to another through casual contact or through contaminated objects. It is commonly spread from the hands of someone who has MRSA. This could be anyone in a health care setting or in the community. MRSA is usually not spread through the air like the common cold or flu virus, unless a person has MRSA pneumonia and is coughing.
MRSA that is acquired in a hospital or health care setting is called healthcare-associated methicillin-resistant Staphylococcus aureus (HA-MRSA). In most cases, a person who is already sick or who has a weakened immune system becomes infected with HA-MRSA. These infections can occur in wounds or skin, burns, and IV or other sites where tubes enter the body, as well as in the eyes, bones, heart, or blood.
In the past, MRSA infected people who had chronic illnesses. But now MRSA has become more common in healthy people. These infections can occur among people who have scratches, cuts, or wounds and who have close contact with one another, such as members of sports teams. This type of MRSA is called community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA).
What are the symptoms of MRSA?
Symptoms of a MRSA infection depend on where the infection is. If MRSA is causing an infection in a wound, that area of your skin may be red or tender. If you have pneumonia, you may develop a cough.
Community-associated MRSA commonly causes skin infections, such as boils, abscesses, or cellulitis. Often, people think they have been bitten by a spider or insect. Because MRSA infections can become serious in a short amount of time, it is important to see your doctor right away if you notice a boil or other skin problem.
How is an infection diagnosed?
If your doctor thinks that you are infected with MRSA, he or she will send a sample of your infected wound, blood, or urine to a lab. The lab will grow the bacteria and then test to see which kinds of antibiotics kill the bacteria. This test may take several days.
You may also be tested if your doctor suspects that you are a MRSA carrier. A MRSA carrier is a person who has the bacteria living on the skin and in the nose but who is not sick. The test is done by taking a swab from the inside of the nose.
How is an infection treated?
Depending on how serious your infection is, the doctor may drain your wound, prescribe antibiotic medicine, give you an IV (intravenous) antibiotic, or hospitalize you.
If you have a MRSA infection and need to be in a hospital, you may be isolated in a private room to reduce the chances of spreading the bacteria to others. When your doctors and nurses are caring for you, they may use extra precautions such as wearing gloves and gowns. If you have a MRSA pneumonia, they may also wear masks.
Most cases of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) begin as mild skin infections such as pimples or boils. Your doctor may be able to treat these infections without antibiotics by using a minor surgical procedure that opens and drains the sores.
If your doctor prescribes antibiotic medicine, be sure to take all the medicine even if you begin to feel better right away. If you do not take all the medicine, you may not kill all the bacteria. No matter what your treatment, be sure to call your doctor if your infection does not get better as expected.
How can I prevent getting or spreading MRSA?
As more antibiotic-resistant bacteria develop, hospitals are taking extra care to practice infection control, which includes frequent hand-washing and isolation of patients who are infected with MRSA.
You can also take steps to protect yourself from MRSA.
- Practice good hygiene.
- Keep your hands clean by washing them frequently and thoroughly with soap and clean, running water or using an alcohol-based hand sanitizer. Hand-washing is the best way to avoid spreading germs.
- Keep cuts and scrapes clean and covered with a bandage, and avoid contact with other people’s wounds or bandages.
- Do not share personal items such as towels or razors.
- Be smart about using antibiotics. Know that antibiotics can help treat bacterial infections but they cannot cure viral infections. Always ask your doctor if antibiotics are the best treatment. And avoid pressuring your doctor into prescribing antibiotics when they won’t help you get better.
- Always take all your antibiotic medicine as prescribed by your doctor. Using only part of the medicine may cause antibiotic-resistant bacteria to develop.
- Do not save any antibiotics, and do not use antibiotics that were prescribed for someone else.
- If you are in the hospital, remind doctors and nurses to wash their hands before they touch you.
If you have an infection with MRSA, you can keep from spreading the bacteria.
- Cover your wound with clean, dry bandages. And follow your doctor’s instructions on caring for your wound.
- Keep your hands clean. You, your family, and other people with whom you are in close contact should wash their hands often with soap and clean, running water or use an alcohol-based hand sanitizer, especially after changing a bandage or touching a wound.
- Do not share towels, washcloths, razors, clothing, or other items that may have had contact with your wound or a bandage. Wash your sheets, towels, and clothes with warm water and detergent and dry them in a hot dryer, if possible.
- Keep your environment clean by wiping all frequently touched surfaces (such as countertops, doorknobs, and light switches) with a disinfectant.
If you need to go to the hospital for some reason, and you have staph bacteria living on your skin and in your nose, you may be treated to try to prevent getting or spreading a MRSA infection. You may be given an ointment to put on your skin or inside your nose. And you need to wash your skin daily with a special soap that can get rid of the bacteria.
Staphylococcus aureus: what is it, symptoms, causes, treatment
What is it?
Staphylococci are a genus of anaerobic globular bacteria that cause pneumonia, endocarditis, a number of skin infections, osteomyelitis, meningitis, septic arthritis, toxic shock syndrome and other diseases. Bacteria constantly inhabit the skin of a healthy person, his nasopharynx and oropharynx. Infection occurs with a decrease in immunity.
Especially susceptible to staphylococcal infection are newborn children and lactating women, patients with reduced immunity, including those with influenza, tumors, leukemia, chronic pulmonary ailments, who are on dialysis, injection drug users, people with transplants and prostheses, with open wounds, burns surgical incisions.
Most often, staphylococci are transmitted by airborne droplets or by contact.
The most pathogenic for humans is Staphylococcus aureus, which leads to inflammatory processes and suppuration of almost all human organs. It is called “golden” because of the formation of a golden pigment. However, this is not the only type of bacteria. In addition to him, patients have:
- Staphylococcus epidermidis;
- saprophytic, leading to cystitis and urethritis;
- Hemolytic, affecting the skin and often leading to sepsis.
Symptoms of infection
Symptoms vary widely depending on the affected organ, the patient’s immunity, and age. There are cases of asymptomatic bacteremia, when microorganisms are found in the blood, but do not cause concern and do not affect the functioning of organs.
However, the most common symptoms may include:
- formation of pustules and carbuncles on the skin;
- stomatitis, conjunctivitis and other local inflammations;
- the appearance of skin rashes accompanied by itching;
- increase in body temperature, fever;
- impairment of appetite, general weakness and apathy;
- problems with the gastrointestinal tract: nausea, vomiting, flatulence, diarrhea;
- redness of the throat and enlargement of the tonsils are symptoms of sore throat.
Because staphylococci can affect any organ, symptoms can vary too.
Reasons for the development of staphylococcal infection
The main reason for the development of the disease is a decrease in immunity due to stress, illness, malnutrition, vitamin deficiency or taking medications. A drop in immunity, including seasonal, can provoke the multiplication of bacteria and subsequent infection.
There are other reasons:
- non-compliance with the doctor’s recommendations when caring for wounds, abrasions and injuries;
- close interaction with the carrier of the infection, for example, with a family member with angina;
- Eating poorly processed food – Bacteria can be transmitted through food.
Babies become infected due to pathologies during pregnancy and childbirth, for example, a long anhydrous period, prematurity, poor hygiene.
Due to the nature of the modes of transmission, staphylococcal bacteremia is relatively easy to prevent by observing basic hygiene requirements, not interacting with other people’s personal belongings, following the doctor’s recommendations and avoiding, if possible, close contact with those infected.
Diagnostics and treatment
Diagnostics of the disease includes:
- standard clinical blood tests, biochemistry;
- bacterial culture to determine a specific type of staphylococcus;
- ELISA assay, which will help determine the presence of antibodies.
Investigations of the specific affected organ may be needed.
Treatment – antibiotic therapy with the selection of drugs for a specific pathogen. This is important, because among the bacteria of the staphylococcal genus, there are those resistant to standard drugs that require a special approach. It is very important not to “prescribe” antibiotics to yourself – these are extremely strong and dangerous drugs, which can only be prescribed by a dermatologist.
In addition, agents for symptomatic treatment may be prescribed, for example, ointments for the treatment of abscesses and ulcers, antipyretic agents.
Staphylococcal infection – treatment, symptoms, causes of the disease, first signs
Staphylococcal infection is a large and diverse group of diseases that are caused by bacteria of the staphylococcal genus, have codes according to ICD A05.0, A41.0, A41. 1, A41.2, A48.3. It is diagnosed mainly in children and debilitated patients. May affect skin, soft tissue, bones, joints and internal organs. Pathogens provoke boils, abscesses, wound suppuration, meningitis, endocarditis, pneumonia, food poisoning and other pathologies.They become the cause of the development of sepsis and severe nosocomial infections.
Staphylococci are spherical gram-positive microorganisms (cocci) from the Micrococcaceae family. They can reproduce in both oxygen and anoxic environments. They remain viable for a long time in adverse conditions, resistant to heat, freezing, sunlight, alcohol and chlorine-containing antiseptics. They die when treated with hydrogen peroxide, prolonged boiling.The greatest clinical significance is Staphylococcus aureus, less often the disease is caused by epidermal and saprophytic staphylococci.
Sources of infection are both patients suffering from any form of staphylococcal infection and healthy carriers. Asymptomatic carriage is detected in 20-30% of healthy people, usually the bacterium is found in the nasal passages. Health workers, who often have antibiotic-resistant strains, are especially dangerous as distributors.Sometimes germs enter the patient’s body from cows, dogs, pigs or horses.
Contact and airborne transmission routes of the pathogen prevail. Alimentary contamination is possible through dairy products or confectionery. In 70-80% of staphylococci are resistant to antibiotics from the penicillin group. These microbes are often not affected by tetracyclines, aminoglycosides and chloramphenicol (chloramphenicol and analogs).
Staphylococci enter the body through mucous membranes, wounds, abrasions and scratches.Foci in the internal organs are formed when bacteria spread with blood. With alimentary infection, the amount of toxins matters, foodborne toxic infections occur when eating foods abundantly seeded with staphylococcus.
The onset of the disease is facilitated by a weakening of the body and a decrease in immunity. Staphylococcal infection is more often diagnosed in children during the first 3 years of life. It is a significant cause of the development of nosocomial infection in people suffering from endocrine and severe somatic diseases, viral infections, and various immunodeficiencies.The likelihood of pathology increases with prolonged use of antibiotics, immunosuppressants and hormonal drugs, X-ray therapy and chemotherapy.
Manifestations of staphylococcal infection are determined by the localization of the pathological process.
Lesions of soft tissues
For boils, carbuncles, hydradenitis, the formation of a focus of bluish-purple color is characteristic. After 1-3 days, the pains become twitching, throbbing, depriving of night sleep.Hyperthermia, intoxication syndrome are possible. After opening the abscess, the condition improves.
An abscess is a purulent focus bounded by a capsule. With phlegmon, the process spreads over the body or limb. The condition with abscesses and phlegmon is moderate or severe, there is a fever, severe intoxication. Panaritium affects the fingers, both mild superficial forms (paronychia, subcutaneous panaritium) and severe lesions (tendon, articular, bone panaritium) are possible.
In newborns, pemphigus, pyoderma, generalized scarlet fever-like rash, local bullous impetigo develop. The source of infection is often the umbilical wound. There is a detachment of the epithelium, the formation of merging blisters filled with a transparent sterile liquid.
ENT organs and bronchopulmonary system
With the defeat of the tonsils, staphylococcal infection causes a banal acute angina, which subsequently sometimes turns into chronic tonsillitis.Sinusitis and tracheitis usually complicate respiratory viral infections.
Pneumonia of staphylococcal etiology is rarely detected. For this form of pneumonia, a severe course, a bright intoxication syndrome, breathing disorders, severe shortness of breath are typical. Pathology can be complicated by pleural empyema and lung abscess, which pose a serious threat to the patient’s life.
Nervous system and senses
Purulent meningitis develops as a result of the penetration of staphylococcal infection from the paranasal sinuses, boils and wounds on the face.It is accompanied by neurological disorders, meningeal symptoms, epileptic seizures, and disorders of consciousness.
Otitis externa and otitis media occur against the background of sinusitis, tonsillitis, and other ENT diseases caused by staphylococcus. The disease is manifested by pain, purulent discharge, hearing loss, and the appearance of extraneous noise. Patients with staphylococcal conjunctivitis complain of cramps, lacrimation. During the night, purulent discharge accumulates and sticks together the eyelashes.
Bones and joints
Staphylococcal osteomyelitis usually has a hematogenous character, develops in children, often affects the humerus, femur, tibia.Against the background of intoxication and hyperthermia, intolerable tearing, twisting, twitching pains appear, aggravated by the slightest movements. When the abscess breaks out of the bone, the phlegmon of the surrounding tissues develops, which opens outward with the formation of a fistula.
Purulent arthritis is a complication of osteomyelitis, staphylococcal soft tissue infection. Patients are worried about sharp shooting or throbbing pain sensations. The joint swells, turns red. Movement becomes impossible due to pain.Arthritis and osteomyelitis are characterized by chills, severe hyperthermia, and weakness. Consciousness disturbances are possible.
Purulent pericarditis, as a rule, occurs secondarily when the infection spreads in patients with pneumonia, lung abscess, pleural empyema. Due to the compression of the heart muscle by pus accumulated in the heart bag, cardiac disorders appear: pain, tachycardia, cyanosis of the skin, excruciating shortness of breath. Cardiac tamponade is possible.
Staphylococcal endocarditis is more often diagnosed after open heart surgery. It is manifested by an increase in body temperature, weakness, cough, shortness of breath, chest pains. Damage to the valves leads to the development of acquired heart defects and heart failure. Phlebitis complicates the course of abscesses and infected wounds. The vein is painful, tense, visible under the skin in the form of a red stripe.
Urinary and genital organs
The most formidable diseases of the genitourinary system caused by staphylococci are acute purulent pyelonephritis, kidney abscess, pyonephrosis, endometritis, pyometra.Staphylococcal infection enters the kidneys or uterus by hematogenous or ascending route – through the urethra, bladder, vagina. Pains, intoxication, chills, specific discharge, changes in urine are noted.
The most common type of staphylococcal gastrointestinal infection is food toxicosis. It occurs when eating foods containing a large amount of staphylococcal toxins. It develops in just 1-2 hours after eating. It proceeds with nausea, vomiting, weakness, a feeling of bubbling in the abdomen, diarrhea, symptoms of intoxication.Dehydration is possible.
Infection of the blood can complicate the course of any staphylococcal infection. It is more often detected with purulent lesions of the lungs, heart and kidneys, large foci in soft tissues, bones and joints. Severe chills, wave-like fever are observed. Facial features are sharpened, the skin becomes gray or yellowish. Consciousness is impaired.
The functions of internal organs suffer, cardiovascular, respiratory and renal failure develops.The appearance of secondary purulent foci is possible. The most serious complication of sepsis is infectious-toxic shock, which in 90% ends with the death of the patient.
The leading role in the diagnosis of staphylococcal infection of any localization is played by the results of laboratory tests of smears, washings, sputum, and wound discharge. The following methods apply:
- Bacterioscopy . The material is stained and examined under a microscope.Immobile spherical bacteria are found, which are grouped in 2-3 pieces, forming a typical picture of a grape bunch.
- Microbiological examination . The material is inoculated on nutrient media, incubated for 1 day. When typical colonies are found, a bacterioscopy is done, the rest of the colony is subcultured and kept for another 3 days to clarify the type of pathogen and determine antibiotic sensitivity.
- Serological Techniques .Shown in chronic forms of staphylococcal infection. RNGA or a neutralization reaction is performed more often. Less commonly, ELISA is performed.
The plan of other diagnostic measures is determined by the localization of the infectious focus. According to indications, an x-ray of the bones of the extremities or chest, bronchoscopy, ECG, echocardiography, lumbar puncture, and other studies are prescribed. To assess the general condition of the body and the safety of the functions of internal organs, general and biochemical analyzes of blood and urine are used.
Treatment can be conservative or operative. The plan of therapeutic measures depends on the location and severity of the process. With limited skin lesions, uncomplicated ENT pathologies, a mild form of food toxicoinfection, symptomatic therapy is indicated for adults and older children, patients are observed on an outpatient basis.
In severe forms of staphylococcal infection, all patients are hospitalized regardless of age.Newborns, especially premature babies, are sent to the hospital even with mild symptoms. A prerequisite for detecting staphylococcus is isolation for 1 week to prevent the spread of nosocomial infection.
As part of conservative treatment, antibiotic therapy and immunocorrection are carried out, and specific anti-staphylococcal drugs are administered. If necessary, perform surgical operations and manipulations: opening and drainage of purulent foci, excision of necrotic tissues, dressings, and rinsing of cavities with antiseptic solutions.In severe cases, massive infusion therapy is indicated, treatment in the intensive care unit.
In case of food toxicoinfections, the stomach is washed, an abundant drink is prescribed, and intravenous infusions are made to restore the water-salt balance.
For the treatment of staphylococcal infection, drugs of the following groups are used:
- Antibiotics . At the initial stage, semisynthetic penicillins or cephalosporins are prescribed intramuscularly.With sepsis, meningitis, lung abscess, and other severe pathologies, 2 antibiotics are administered in maximum doses intravenously. After receiving the results of the microbiological study, the antibiotic therapy regimen is adjusted taking into account the sensitivity of the pathogen.
- Hyperimmune antistaphylococcal immunoglobulin . Recommended for generalization of the process, severe forms of staphylococcal infection, especially in young children. The medication is injected intramuscularly every day or every other day.
- Hyperimmune antistaphylococcal plasma . The preparation contains antibodies to staphylococcus. Intravenous administration is carried out at intervals of 1-3 days.
- Staphylococcal toxoid . It is necessary for a prolonged course of sepsis, pneumonia and skin infections due to a decrease in the body’s immune forces. Promotes the production of its own staphylococcal antitoxin. It is applied subcutaneously with a gradual increase in dose.
Symptomatic therapy is carried out according to general recommendations for the treatment of a particular disease.Most often, pain relievers and anti-inflammatory drugs are prescribed.
The information is for reference only and is not a guide to action. Do not self-medicate. At the first symptoms of the disease, see your doctor.
Folk remedies play an insignificant role in the treatment of staphylococcal infection, are used only in mild cases and in agreement with the doctor. For angina, rinses with decoctions of chamomile, sage, string, elderberry, calendula are used.To strengthen the immune system in adults, ginger drink, aloe with nuts and honey, echinacea decoction, rosehip compote are useful. Children can use herbal teas, rosehip compote, nut mixture with cranberries and apples.
It should be remembered that staphylococcal infection is fraught with complications that are life-threatening. Self-medication cannot be limited even with mild forms of the disease. If symptoms of the disease appear, an urgent need to consult a doctor.
The information is for reference only and is not a guide to action.Do not self-medicate. At the first symptoms of the disease, see your doctor.
- Infectious Diseases: National Guidelines. Short edition / ed. Yushchuka N.D., Vengerova Yu.V. – 2019.
- Staphylococcal infections / Akhtamov M.A., Sidikova K.A. – 1981.
- Infectious diseases in children / Uchaikin V.F., Nisevich N.I., Shamsheva O.V. – 2013.
- Staphylococcus and staphylococcal infection / ed. Ivanova N.R. – 1980.
Your comments on symptoms and treatment
Staphylococcus in the throat: what is it
Patients often turn to the laboratory of the Novopolotsk City Center for Hygiene and Epidemiology with a request to check them for the presence of staphylococcus in the upper respiratory tract.Staphylococcus aureus in the throat is one of the most common causative agents of ENT diseases. However, it should be borne in mind that about 80% of upper respiratory tract diseases are associated not with staphylococcus, but with viruses.
There are about 20 species of staphylococcus, most of them belong to opportunistic flora. Every healthy person has them in small quantities and do not cause much concern. With a decrease in immunity for various reasons or if an additional infection enters the body, the bacteria are activated.An inflammatory process begins, painful symptoms appear: redness in the throat and pain, especially when swallowing When a failure occurs and a weakened person is faced with a staphylococcal infection, then rhinitis may rapidly develop if the pathogen is in the nose, or pharyngitis, tonsillitis when a pathogenic microorganism enters the area throat.
The most common route of infection is contact: when using general hygiene items, dishes, cosmetics.Sometimes staphylococcus aureus in children is transmitted, for example, when collectively biting off pieces from an apple, the presence of common toys. Unwashed hands are a separate risk factor. After direct interaction of the skin, which already contains bacteria, with the mucous membrane, the infection is transmitted.
The airborne route of infection is known to everyone. An unhealthy body releases into the environment during exhalation, sneezing, coughing, pathogenic microflora, which enters the mucous membrane of a weakened person and begins to vigorously develop in the throat and nose.
There are a number of other transmission possibilities (for example, alimentary during breastfeeding, from mother to child), but they are not so common, and the symptoms of the disease are similar to the standard ones.
Such a concept as the carriage of staphylococcus is widespread. Carriers are generally healthy people, whose nasopharynx nevertheless contains a certain amount of staphylococci that are released into the external environment. Healthy carriers cannot infect people around them by contact or airborne droplets.The number of staphylococci secreted by them is small and not enough for the occurrence of a disease in another person. However, if such a healthy host works in a food company, then he can seed with staphylococcus some food products, which are a favorable breeding ground for him. These products are primarily various confectionery products (especially cakes, pastries, etc.). They contain a lot of sugar and moisture. In this environment, staphylococci multiply rapidly and secrete a dangerous poisonous toxin.Staphylococcal poisoning is a very dangerous disease. To avoid it, it is necessary to observe three provisions: do not allow carriers of staphylococcus to work at food enterprises, strictly observe the technology for preparing food products and prevent the sale and use of products with an expired shelf life
It is important to remember that treatment of the manifestations of staphylococcal infection without antibiotics will not be effective. And the main medicine must be prescribed by a doctor. Self-taken measures can only complicate the situation, contribute to the blurred course of the manifestations of the disease.
The microbiological laboratory of the Novopolotsk Center for Hygiene and Epidemiology conducts research for the presence of staphylococcus in the respiratory tract and breast milk. Before applying, it is advisable to consult a doctor. Telephone for inquiries in the microbiological laboratory: 75-54-97
Head of the microbiological laboratory, NSCHE
Staphylococcal infection in animals | Beleka.by
Mastitis caused by staphylococcal bacteria is extremely difficult to control with treatment alone. Effective control is achieved only by preventing infection. Staphylococcus aureus spreads throughout the body and causes serious diseases. Milkmaid hands, dishcloths, milking cup liners and insects are ways of spreading infection from cow to cow. Organisms that enter the teat canal during milking. Infected cows should either be separated from the herd and milked last, or milked in separate milking units.Teat cup liners should be rinsed and disinfected after milking infected cows.
The main vectors of these organisms are infected udders, teat canals and nipple lesions, but these bacteria have also been found on the skin of the nipples, muzzles, and nostrils of animals. Bacteria spread indoors through milking machines, rags, milkmaids’ hands and insects. Staphylococci do not persist on healthy nipple skin, but easily colonize the nipple canals if there is damage near the end of the nipple.These organisms multiply in infected lesions or colonized teat canals and easily penetrate the udder. Infected cows at calving may represent the most dangerous route of infection for uninfected herd mates.
Detection of staphylococcus
In order to detect an infection, cows’ milk is analyzed. This procedure should be carried out in herds where the infection has been previously identified and there have been cases of mastitis.
In herds with acute mastitis problems, milk samples from infected cows should be collected aseptically and cultured. Early detection of infection is important before bacteria can penetrate deep into the udder and form abscesses.
Treatment of the disease
Each case of mastitis is costly for the dairy producer in terms of reduced milk production, treatment costs, lower prices for milk quality, and the possible death of the affected animal.It takes extra milking time to correctly identify the infected cow and throw her milk away, and there is always a risk of contaminated milk entering the normal one. Curing the infection is difficult, as even with repeated treatments, the cow can get the infection again within a short period. These “subclinical” infections occur when the farmer stops antibiotic treatment because the milk looks normal, but the hard-to-kill mastitis organisms are still alive in the gland and waiting to attack again.
Staphylococcus aureus is one of the most common bacterial pathogens worldwide and is often the cause of chronic subclinical infections and clinical (clearly abnormal mammary) cases of mastitis. It is very important to consult with your veterinarian to first determine which organism is causing the mastitis in order to select the most appropriate drug and the duration of antibiotic therapy. Unfortunately, in order for a mastitis organism to be found in an individual, a minimum amount of bacteria must be present in the sample.Healthy cows must be protected from the infectious pathogens of mastitis, otherwise they risk new infections, high somatic cell counts and further spread of the disease.
To prevent infections, drugs based on Amoxicin are used. The Belarusian enterprise Belek produces this drug in the form of a powder, which is diluted in water and taken orally by cows. This drug contains an antibiotic that effectively fights the problem of infection.
Prevention of staphylococcus infection
Infected cows should be isolated from other cows to prevent the spread of the infection. This may be the most important preventive practice. Infected cows must be marked with unique, visible markings such as special colored leg bands or neck chains. Possible means of isolating cows:
- Do not milk cows with the same machine that is used for milking cows with mastitis.
- Separate infected cows into one group and milk them last. Another alternative is to sort the infected cows before each milking and keep them in an isolated pen until all other cows have been milked.
- Once purchased, animals should be isolated until milk samples have been obtained and the status of the causative agent of mastitis has been determined.
- Disinfect milking attachments after each milking of infected cows.
Insect bites injure the end of the nipple. Flies also carry a number of mastitis-causing organisms that can infect udder lesions. Eliminating fly breeding sites is one way to control them.
Dairy farmers who better look after the health of their herd have the rare problem of mastitis and staphylococcal infections. They have a higher milk yield per cow with fewer infections.They wash the udders with a disinfectant and wash the milking clusters after each milking. Thanks to competent care and monitoring of the health of animals, it is possible to avoid infection of the herd with staphylococcus, as well as create favorable conditions for obtaining the maximum productivity of cows.
Clinical hygiene of medical personnel – “Nizhnevartovsk Regional Hospital No. 2”
One of the most pressing problems of inpatient treatment of patients is hospital (nosocomial) infection.The term nosocomial infection means any clinically expressed disease of microbial origin that affects a patient as a result of his admission to the hospital or seeking medical help, as well as the illness of an employee due to his work in this institution, regardless of the appearance of symptoms of the disease during his stay in the hospital or after discharge.
The importance of this problem in connection with the progress of medicine not only does not diminish, but vice versa – it is growing, which is associated with the wide and haphazard use of antibiotics, an increase in the number and range of surgical interventions, the use of corticosteroids and cytostatics, an increase in the number of operated children, the elderly and patients with diseases previously considered incurable.The number of patients with nosocomial infection reaches, according to various estimates, from 10 to 70% of the number of hospitalized in the hospital, in 2% of cases the disease ends in death.
Like any other infection, nosocomial infection develops as a result of an infectious process, which is a complex process of interaction between a pathogen and a macroorganism under certain conditions of the external and internal environment. The infectious process implies the presence of a source of infection in which the pathogenic microorganism multiplies and accumulates, the pathways and factors of transmission of the microorganism and the sensitive macroorganism.Interruption of the infectious process at one of these links can significantly reduce the likelihood of infection. For this purpose, a number of preventive measures are carried out in the hospital.
The most frequent causative agents of nosocomial infection in the surgical department are such representatives of nonspecific pyogenic flora as Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, streptococci, Proteus. Hospital strains of these microbes are distinguished by high antibiotic resistance, virulence and pathogenicity.The nosology of hospital infection is extremely diverse, it includes wound suppuration, sepsis, pneumonia, postoperative peritonitis, various forms of infection of the urinary tract and gastrointestinal tract. Nosocomial infections also include cases of infection with syphilis, hepatitis B and HIV infection.
Due to the variety of etiological factors of hospital infection, its specific prevention is not possible, however, a vaccine against hepatitis B has been developed and is currently being used.Vaccinations are subject to persons classified as at risk, including medical workers whose activities are associated with possible contact with biological fluids.
The source of a surgical hospital infection can be a person suffering from an erased or manifest form of this disease, as well as asymptomatic carriers of a pathogenic microorganism. These are, in the overwhelming majority of cases, patients and medical staff of the surgical department.
Transmission of infectious agents in the hospital occurs mainly in two ways – contact and aerogenic.The contact pathway is realized through the hands of the medical staff, instruments, dressing and suture material, items of care and furnishings. In the case of an aerogenic pathway, the transmission factor is a droplet or dust aerosol. To interrupt the infectious process at this level, aseptic and antiseptic methods are used, as well as the rules of clinical hygiene.
It is possible to influence the source of nosocomial infection by timely and complete treatment of those who fall ill with it and active detection and sanitation of carriers of pathogenic microorganisms.If in relation to patients, these measures can be effectively carried out only with planned hospitalization, then in relation to medical personnel they are of a regular and systemic nature.
Each employee entering the surgical department undergoes a full medical examination, including examination by an otorhinolaryngologist and a dentist, bacteriological examination of smears from the mucous membrane of the pharynx and nose for the presence of pathogenic staphylococcus, a blood test for HBs antigen, antibodies to the causative agents of syphilis (reaction Wasserman) and HIV infection.All working personnel should be taken under dispensary registration for the timely detection and treatment of carious teeth, chronic inflammatory diseases of the nasopharynx, as well as for the timely detection of carriers of pathogenic staphylococcus. An individual health card is drawn up for each employee. The lack of effect from the treatment of chronic inflammatory processes is an obstacle to admitting a health worker to the surgical department or further work in it. In the latter case, a transfer to another job is made.
The bodies of sanitary and epidemiological supervision, together with the administration of the medical and prophylactic institution and the head of the department, take regular measures to identify the carriage of pathogens of nosocomial infection. Once a year, a blood test is performed for HBs antigen, antibodies to the causative agents of syphilis and HIV infection. A quarterly examination of smears from the mucous membrane of the pharynx and nose for the presence of pathogenic staphylococcus is carried out. In the presence of an unfavorable epidemiological situation in the department for hospital infection (3 or more cases of the same type of infection with one pathogen), an extraordinary check should be assigned to identify the source of infection, ways and factors of transmission, including examination of personnel for the carriage of pathogens of nosocomial infection.
If there is a positive result for antibodies to the causative agent of syphilis, the employee of the department is suspended from work for the period of examination, treatment and subsequent examination. The criterion for the possibility of returning to work in the surgical department is a threefold negative result of the Wasserman reaction. Detection of antibodies to HIV infection dictates the need to remove the employee from work and conduct additional testing methods. Upon confirmation of the disease, the health worker must be transferred to a job where there is no possibility of spreading the infection through his fault.Carriage of the Australian antigen is an indication for the temporary suspension of surgeons, urologists, gynecologists, operating and procedural nurses and other workers in whose work there is a real risk of infection of patients through contact with their wounds. A second blood test is carried out and in case of a negative result, return to work is possible.
In case of a positive test result for staphylococcus carriage, suspension from work does not occur, but the health worker is obliged to reorganize.In the event of an unfavorable epidemiological situation (an outbreak of acute respiratory infections, an increase in the number of hospital infections, a massive growth of staphylococcus when examining washings from furniture and care items), a single-stage general sanitation is carried out.
The following preparations are proposed for the sanitation of the nasal passages:
- 1% hexachlorophene ointment. The nasal passages are lubricated for 1 minute, 1 time per day with a six-hour working day, 2 times with a twelve-hour working day, and 3 times during daily duty.The rehabilitation course lasts 5-6 days;
- 3% tribromsalicylanilide ointment (tribrask). Lubrication of the nasal passages is carried out 2 times a day for 5-6 days;
- 2% oily solution of chlorophyllipt. It is applied 3 times a day for 6-7 days;
- 1% ointment or 0.1% lysozyme solution. Lubrication or instillation is performed 3 times a day for 6-7 days.
Reorganization of the throat is also carried out with the help of a number of antiseptic preparations:
- 1% alcohol solution of chlorophyllipt.Rinsing is carried out 3 times a day for 6-7 days;
- 0.02% furacillin solution. The throat should be rinsed once a day for 6 days;
- Lugol’s solution. Sanitation is carried out by rinsing once for 6 days;
- 0.01% potassium permanganate solution. Rinsing is carried out once a day for 6 days;
- infusion of eucalyptus leaves in the proportion of 1 tablespoon of infusion to 1 glass of water. This solution should be rinsed once a day.The rehabilitation course lasts 6 days.
After completing the full course of sanitation, its effectiveness is monitored by repeated examinations of swabs from the nose and throat. If at the same time staphylococcus is sown again, sanitation is repeated, and it is advisable to change the antiseptic drug. In case of ineffectiveness of three consecutive courses of sanitation, the health worker is transferred to a job where his carrier will not pose an epidemiological danger to patients and medical staff.
Clinical hygiene of medical personnel
Clinical hygiene of medical personnel is understood as a set of mandatory rules and measures carried out by medical workers, the purpose of which is to limit the spread of nosocomial infection during contacts with medical personnel, patients and people outside the surgical department. The main direction of action of these rules and measures is the interruption of the infectious process at the level of the pathways of the spread of the infectious agent.This is achieved by influencing the factors of transmission of microbes that are available to the daily and direct control of the health worker, that is, their own clothes, shoes, skin of the body and hands, hair, nails, etc.
The hands of a doctor or a nurse certainly have the greatest epidemiological significance among the above objects. The staff member of the surgical department must take care of the condition of the hands on a daily basis. There should be no wounds, cuts or cracks on the hands. If there are any defects, they should be sealed with adhesive plaster until the end of the working day.The skin of the hands should be soft and elastic, while it is more resistant to microtrauma. Unfortunately, this is prevented by frequent hand washing with antiseptic solutions and alkaline soaps. Therefore, regular skin care using emollient and moisturizing creams and solutions based on glycerin is advisable. Injury to the skin around the house should be done with gloves. Keep your nails short and cut neatly.
All manipulations in which hands can become contaminated with blood, serum, pus, saliva, urine, etc.the item should be carried out with rubber gloves.
Pathogenic and opportunistic microflora that causes the development of nosocomial infection in a weakened body is usually not a natural microflora of the skin of the hands, is of a transient nature and can be easily removed from the skin of the hands by hygienic disinfection and washing.
Hygienic disinfection of hands is carried out after contamination of the skin of the hands with biological fluids, after contact of the hands with the body of a patient with purulent-septic disease, after bandaging.If there is massive contamination of the gloves with blood, pus, etc., you should also treat your hands with antiseptic solutions after removing the gloves.
A number of methods are used for hygienic hand disinfection:
- treatment for 2 minutes with a swab dipped in 70% ethyl alcohol;
- treatment in a basin with a solution of pervomur (C4) for 1 minute;
- treatment in a basin with 0.5% chloramine solution for 2 minutes;
- treatment in a basin with 0.1% Deoxon solution for 2 minutes;
- treatment for 2 minutes with a swab soaked in a 0.5% solution of chlorhexidine bigluconate in 70% ethyl alcohol.
In case of contact with body fluids of a patient with hepatitis B or HIV infection, hands should be treated with 70% alcohol or 1% chloramine for 2-3 minutes. 6 months after the patient is discharged from the hospital, it is necessary to check the blood for the presence of HBs antigen or antibodies to the human immunodeficiency virus. Hand treatment after contact with the biological fluids of a patient with syphilis is carried out according to the general rules, however, if there are injuries on the hands and their contamination has occurred, it is necessary to immediately begin a course of preventive treatment.Suspension from work in this case does not occur, since against the background of timely antibiotic therapy, the infected person does not pose an epidemiological danger. However, it is necessary, one month after the alleged infection, to check the blood for antibodies to the causative agent of syphilis.
After carrying out the treatment according to one of the indicated schemes, in any case, you must wash your hands with water. Hands should also be washed before performing any procedures, before helping weakened patients and newborns, before and after contact with wounds, after caring for patients, and after examining patients; after any manipulations (even if the hands were in gloves) when contact with mucous membranes, blood, other body fluids, enema tips, vessels, linen was possible.
Hands should be washed in warm running water for 2 minutes with laundry soap or toilet soap in a disposable package, avoiding splashing water. To treat the subungual spaces, brushes are used, which should then be washed and boiled in a 2% soda solution for 15 minutes. Clean brushes are stored in sterile bixes, removed as needed with a sterile forceps. After washing, hands are dried with a dry towel or disposable paper towels. An individual towel is allocated for each working employee; it is changed at least once a day.
The clothing and footwear of the department staff is of great epidemiological importance, since the main reservoir of pathogenic staphylococcus in the department is the skin of the staff, and clothes in these conditions are the most important barrier, constantly becoming contaminated as they are worn. The most massively contaminated with microbes are hats, dressing gowns, trousers and shoes. On the gowns, hospital germs can be found after a few hours of wearing, especially on the sleeves, in the abdomen, at the level of the thighs. Therefore, to work in the surgical department for personnel of any level, special clothing is provided, and it includes not only the wearing of a medical gown.It is unacceptable to wear street or home clothes within the department. This is equally dangerous for patients and for the employee and his family members. In the surgical department, there should be a locker room for changing clothes, each employee should be provided with an individual wardrobe, consisting of two separate parts – for street clothes and for hospital clothes.
Before starting work, all outerwear, especially knitted and woolen, are removed and changed into a uniform intended only for work in the surgical department.It is preferable for both men and women to wear cotton trousers as a component of personal clothing, however, the latter are allowed to wear a clean, light dress. A medical gown is worn over personal clothing, which must be fastened or tied, covering the clothing underneath. The sleeves of the robe should be short or easily rolled up so that, if necessary, the forearm can be exposed to the elbow. Underwear is changed daily, the gown must be changed at least 2 times a week, and in the department of surgical infection – also daily.
Replaceable footwear should be as closed as possible, without holes and always made of non-woven material, so that it can be hygienically processed and disinfected.
The scalp is a huge area capable of collecting, accumulating, and then spreading dust with microorganisms. According to some reports, hair is more often a reservoir of staphylococci than the nasopharynx and skin. Wearing a cap (headscarf) is mandatory in the surgical department. Hair should be completely tucked away.
Personnel should wear protective masks (respirators) to work in aseptic and infected areas. They must be changed at least every 2 hours of operation, as well as after each operation. With longer wearing, masks themselves turn into a source of infection.
All dirty work should be carried out in oilcloth aprons worn over the gown and in working rubber gloves, which are disinfected after work.
Body hygiene of medical personnel provides for daily hygienic showers.Practicing a shower before the operation not only does not reduce, but on the contrary increases the number of purulent complications, since desquamation of the epithelium increases from the washed skin during the first hours, as a result of which an infected aerosol is formed.
Each employee of the surgical department is personally responsible for observing the rules of personal hygiene, as this is important for preventing the spread of infection in the hospital.
Rules for working with biological materials
In general terms, the algorithm for the collection, labeling and transportation of biological materials can be represented as follows:
- wash hands;
- aseptically prepare the workplace;
- take a sample in compliance with the requirements of asepsis, wear gloves, if necessary; do not cough, sneeze, do not talk;
- get enough material;
- collect and transport material in a sterile container;
- attach a label indicating the patient’s full name, diagnosis, department, ward, date and time of receipt of the material, the purpose of the study;
- to properly store and quickly deliver the resulting material to the laboratory.
Taking certain types of biological material is performed as follows:
I. Urine collection
- Explain to the patient the purpose of the examination, obtain his consent;
- Women wash themselves thoroughly with boiled water and soap, passing their hand from the pubis to the sacrum;
- Drain the right and left labia and the external opening of the urethra;
- For a man, take the penis, move the foreskin and wash it with soap and water, dry the glans penis;
- Take a container for collecting urine;
- The first portion of urine is discharged into the toilet, the second portion is taken for analysis;
- The container with urine is closed and sent for analysis.
II. Sputum collection
- Explain the purpose of the study;
- Brush your teeth the night before;
- Into a sterile container, after coughing up, spit out sputum without touching the edges of the can, immediately close the lid;
- Deliver the sputum for analysis no later than two hours after collection.
III. Feces collection
- Explain the purpose of the study;
- Option 1. Taking stool from the rectum with a glass rod: Put on gloves, spread the buttocks with your left hand, take a glass rod from the test tube with your right hand, insert it with rotational movements into the rectum to a depth of 6-8 cm., remove the stick and place in a test tube with a preservative.
- Option 2. Taking stool after bowel movement. The intestines are emptied into a dry, clean vessel. With a sterile spatula, take feces, mucus, pus into a sterile jar. Send to the sanitary laboratory.
IV. Throat swab
- Explain the purpose of the survey;
- The material is taken on an empty stomach or not earlier than 2 hours after eating, drinking, gargling;
- Instruct patient to open mouth wide;
- Using the left hand, press the root of the tongue with a spatula;
- With your right hand, carefully insert a sterile swab and remove plaque at the border of the affected area.Place the material in a sterile test tube;
- Send material to the laboratory.
V. Nasal swab
- Explain the purpose of the survey;
- With your left hand, lift the tip of the nose;
- With your right hand, take a sterile stick with a cotton swab and rotate it into the nasal passage to a depth of 1-2 cm;
- The resulting material is placed in a sterile tube;
- Sent to the sanitary laboratory.
90,000 Staphylococcal infections in pediatrics Text of a scientific article in the specialty “Clinical Medicine”
I.V. NIKOLAEVA, V. A. ANOKHIN UDC 6169-053-2
Kazan State Medical University
Staphylococcal infections in pediatrics
I Nikolaeva Irina Venidiktovna
Candidate of Medical Sciences, Associate Professor of the Department of Children’s Infections
420012, m.Kazan, st. Butlerova, 49a, tel .: (843) 267-81-02, e-mail: [email protected]
The review presents the clinical and epidemiological aspects, modern methods of diagnosis and treatment of various forms of staphylococcal infection in children. The most important pathogenic species for humans is Staphylococcus aureus, which can cause more than 100 nosological forms of diseases. Less often, purulent-inflammatory processes are caused by coagulase-negative staphylococci.The main clinical and epidemiological problem at present is represented by methicillin-resistant strains of staphylococci that exhibit multiple antibiotic resistance.
Keywords: children, Staphylococcus aureus, coagulase-negative staphylococci, S. epidermidis, methicillin-resistant staphylococci.
I.V. NIKOLAEVA, V.A. ANOKHIN
Staphylococcal infections in pediatrics
In the review clinical-epidemiological aspects, modern methods of diagnostics and treatment of various forms of a staphylococcal infection at children are presented.The major pathogenic kind for the human is Staphylococcus aureus which can cause more than 100 nosological forms of diseases. Rarely pyoinflammatory processes are caused by coagulasonegative staphylococcus. The basic clinical and epidemiological problem now represent methicillinresistent strain of staphylococcus, showing multiple antibiotic resistance.
Keywords: children, Staphylococcus aureus, coagulasonegative staphylococcus, methycillinresistent staphylococcus.
Until now, staphylococcal infections (SI) remain a serious problem in practical pediatrics. The reports available today indicate a progressive increase in morbidity and mortality from this pathology .
The genus Staphylococcus includes more than 20 species that differ in importance in human pathology. The most important pathogenic species for humans is Staphylococcus aureus – a persistent, highly virulent, infectious agent that easily acquires resistance to antimicrobial drugs.Less virulent are coagulase-negative staphylococci (CBS), among which the most common pathological processes in humans are caused by Staphylococcus epidermidis and Staphylococcus saprophyticus. The main clinical and epidemiological problem is currently represented by methicillin-resistant (oxacillin-resistant) strains of staphylococci S. aureus (MRSA) and S. epidermidis (MRSE), which are resistant to all β-lactam antibiotics and often exhibit associated resistance to other classes of antibiotics.Methicillin-resistant strains of staphylococci are the main causative agents of nosocomial infections, however, there is currently an increase in the number of carriers
MRSA and diseases in the community setting . The frequency of occurrence of MRSA among staphylococcal strains isolated in outpatients reaches 33.3-59.2% according to various authors [3, 12, 16]. There are reports of isolation of S. aureus strains with reduced sensitivity to vancomycin, which makes the treatment of staphylococcal infections in certain situations very problematic .
Epidemiology of staphylococcal infection
The development of staphylococcal infections in most cases is associated with the previous carriage of staphylococci in various ecological niches. S. aureus lives mainly on the nasal mucosa, oral cavity, less often in the gastrointestinal tract, in the vagina, in the armpits and on the skin of the perineum. Risk factors for the development of manifest forms of staphylococcal infection in carriers are: immunodeficiency states, violation of the integrity of the skin and mucous membranes, invasive interventions and suppression of the normal microflora of the skin and mucous membranes .The most susceptible to staphylococcal infections are newborns and children in the first months of life. The main source of infection of children with S. aureus in maternity hospitals and nurseries
hospitals are medical workers – carriers of the pathogen on the mucous membrane of the upper respiratory tract and skin. Less commonly, the source of infection is mothers (5-14%) or patients with various forms of staphylococcal infection . Transmission of infection occurs mainly through airborne droplets and through contaminated hands.In the first days of life, S. aureus is isolated from the nasal mucosa in 10-18% of newborns; by week 6, the frequency of excretion of this microbe reaches 40%. Children discharged from maternity hospitals can remain carriers of the same staphylococcal phagotypes with which they were infected in the first days of life for several months. In children over one year old, the frequency of S. aureus carriage on the nasal mucosa reaches 52.3%. On the mucous membrane of the pharynx, S. aureus is found in 39.4% of healthy people . As part of the intestinal microflora of S.aureus is found in 40-46% of healthy children of the first year and in 9-14.3% of children 2-3 years of age .
Carriage of staphylococci is of clinical and epidemiological significance. It has been established that in newborn children – carriers of staphylococci, manifest forms of staphylococcal infection develop more often. The likelihood of developing sepsis in newborns is 3 times higher in carriers of S. aureus in the nasal passages and 10 times higher with the combined carriage of these microorganisms in the nasal passages and umbilical wound compared with non-carriers .Carriage of S. aureus on the nasal and pharynx mucosa in young and preschool children is associated with recurrent upper respiratory tract infections .
Clinical variants of S. aureus infection are diverse and include more than 100 nosological forms from staphyloderma to septic endocarditis and toxic shock syndrome. There are localized and generalized forms of staphylococcal infection.In most cases, staphylococcal infection occurs in localized forms (omphalitis, vesiculopustulosis, pseudofurunculosis, laryngotracheobronchitis, enterocolitis, etc.)
Omphalitis – inflammation of the bottom of the umbilical wound, skin, subcutaneous fat layer around the navel and umbilical vessels. Characterized by prolonged weeping of the umbilical wound, purulent discharge, protrusion of the navel, hyperemia and swelling of the skin around it. With the progression of the inflammatory process, the development of umbilical sepsis is possible.
Vesiculopustulosis is a peculiar lesion of the skin of newborns, which manifests itself in a child on the 5-6th day of life in the form of bubbles filled with cloudy contents, located on the scalp, trunk and skin folds. The patient’s condition depends on the abundance of rashes.
Pseudofurunculosis (multiple skin abscesses) develops in young children with altered immunological reactivity.Infiltrates with a diameter of 0.5-1 cm appear on the skin, which further fester. The disease lasts a long time, accompanied by fever, symptoms of intoxication, a drop in body weight.
Pemphigus (pemphigus of newborns) is the most common and contagious form of staphyloderma. The disease proceeds with moderately pronounced symptoms of intoxication and is characterized by the appearance on the skin of the abdomen, neck, large folds of blisters of various sizes, filled with serous-purulent contents.After opening the elements, an erosive surface is formed.
In older children, staphylococcal skin lesions are usually manifested by folliculitis, furunculosis, less often – carbuncle, hydradenitis.
Diseases of the respiratory tract. Any topic of the lesion is possible (nasopharyngitis, sinusitis, tonsillitis, laryngotracheitis, pneumonia). Staphylococcal pneumonia is characterized by severe toxicosis, respiratory failure, a tendency to abscess formation and a high frequency of pleural complications (pneumothorax, pyopneumothorax, pleural empyema).
Diseases of the gastrointestinal tract. Most often, staphylococcal lesions of the gastrointestinal tract develop in children during the first months of life, which account for 64.9% of the total number of cases. Staphylococcal enterocolitis at this age is characterized by a protracted course and prolonged bacterial excretion of S. aureus. In newborns, against the background of septicemia caused by S. aureus, it is possible to develop necrotizing ulcerative enterocolitis with intestinal perforation.
Sepsis. S. aureus occupies a leading place in the etiological structure of sepsis in children of different age groups. It develops more often in newborns and premature babies. Mortality reaches 20-25% . In premature and newborn infants, the symptoms of sepsis are mild and may be nonspecific: hypothermia, low-grade fever, breast refusal, flat weight curve, pale gray color and marbling of the skin, cold extremities, anxiety or pathological drowsiness, hepatosplenomegaly.Respiratory distress, jaundice, hemorrhagic or pustular rash may develop. A long undulating course of the disease is characteristic. In older children, the clinical picture of sepsis is more typical: septic fever with chills, purulent foci of infection (pneumonia, carditis, enterocolitis, pyelonephritis, etc.), tachycardia, a tendency to hypotension and collapse, hepatosplenomegaly. With severe sepsis, multiple organ failure and septic shock develop. A pronounced inflammatory reaction of the blood is characteristic.
Diseases of the central nervous system. Among all cases of purulent meningitis, staphylococcal meningitis accounts for 2-3%. Staphylococcal meningitis often develops in children during the first months of life and usually has a secondary origin against the background of staphylococcal sepsis. A tendency to a protracted undulating current is characteristic. Perhaps the defeat of 3, 5, 7 and 11 pairs of cranial nerves and the development of brain abscesses.
Diseases of bones and joints.S. aureus most often serves as an etiological factor in osteomyelitis and purulent arthritis in children. Osteomyelitis should be suspected in every febrile child with pain in the arms or legs and leukocytosis. S. aureus also causes 70-80% of septic arthritis in adolescents.
Among the pathology caused by Staphylococcus aureus, a special place is occupied by lesions caused by the action of toxins – toxic shock syndromes, “scalded skin” and food poisoning.
Toxic shock syndrome (TSS). The starting point for the development of the disease is the formation of specific toxins by S. aureus (TSST-1, less often enterotoxins B and C). More often, the disease occurs against the background of menstruation in girls, young women who use tampons. TSS can develop against the background of purulent wounds, pharyngitis, abscesses and other foci of staphylococcal infection. Clinically manifests itself as high fever, vomiting, diarrhea, scarlet fever-like exanthema followed by desquamation on the palms and soles after 1-2 weeks, as well as a decrease in blood pressure with the development of shock and multiple organ failure (renal or hepatic failure, thrombocytopenia, impaired mental status)  …
The syndrome of “scalded babies” (Ritter’s exfoliative dermatitis) is observed in newborns who are infected.
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baths with exfoliatin-producing S. aureus strains. The disease begins violently. Characterized by the formation of foci of erythema on the skin, followed by the formation (after 2-3 days) of large blisters (as in thermal burns) and exposure of weeping eroded areas.
Staphylococcal scalded skin syndrome is a severe S. aureus infection characterized by large blisters and widespread scaling of the skin. The infection develops in older children and much less often in adults. In most cases, the disease begins with a rise in temperature and the appearance of a scarlet fever-like skin rash. Large blisters then form and widespread flaking of the skin appears.Also known as toxic epidermolysis of the skin, this syndrome (Lyell’s syndrome) can be caused by other pathogens or drug-related. Possible severe hemorrhagic lesions of the mucous membranes of the respiratory system and upper digestive tract.
Food poisoning develops as a result of consumption of S. aureus-infected food containing enterotoxin, and is characterized by a short incubation period (2-6 hours) and a short course.Clinically present with vomiting, abdominal pain, and watery diarrhea. Development of dehydration is possible.
Currently, the etiological role of coagulase-negative staphylococci in the development of purulent inflammatory processes in children has been determined. The overwhelming majority of diseases caused by CBS are nosocomial in nature and develop in newborns and patients with reduced resistance . CBS are currently recognized as the main causative agents of nosocomial infections in the intensive care units of newborn clinics in the United States and Europe .Risk factors for the development of CBS infections are: the use of intravascular catheters, prematurity, long-term hospitalization [9, 17]. The etiological role of S. epidermidis has been established both in the development of localized HVD (pyoderma, conjunctivitis, urinary tract infections) and severe generalized processes in newborns in 24.8-44.7% of cases . The frequency of S. epidermidis shedding during septicemia in infants of the first year of life reaches 27-38.1%, in premature infants – 62% . Massive intestinal contamination with epidermal staphylococcus can cause the development of necrotizing enterocolitis in premature infants [10 [.
Laboratory diagnostics of staphylococcal infections includes the isolation of the pathogen from pus, sputum, mucus from the throat and nose, cerebrospinal fluid, feces and other biological materials. Of greatest importance is the isolation of staphylococcal cultures from normally sterile biosubstrates (blood, CSF, urine, pleural exudate). Even a single isolation of S. aureus from blood is rarely the result of accidental contamination of the sample. For the rapid identification of Staphylococcus aureus (S.aureus) used a latex agglutination test using commercial AT-loaded latex particle kits. Serological tests (RPHA, ELISA) in the diagnosis of staphylococcal infections are of no fundamental importance. Isolated strains of staphylococci are tested for antibiotic resistance. The first step in determining the sensitivity of staphylococci to antibiotics should be a test for sensitivity to oxacillin, which is carried out by the disc diffusion method. Staphylococci showing resistance to oxacillin should be considered resistant to all β-lactam antibiotics, including cephalosporins.
Diagnostics of staphylococcal intoxication is mainly based on clinical data (in case of toxic shock – exclusively on them). Laboratory research plays a supporting role. Seroconversion against TSST-1 after an illness or the formation of a toxin in vitro by a strain isolated from a patient confirms the diagnosis of toxic shock, and the detection of staphylococcal enterotoxin in a food product confirms the diagnosis of food toxicosis.
The basis for the treatment of staphylococcal infections is an adequate antibiotic therapy. With superficial skin lesions, it is sufficient to treat the affected areas with antiseptics or topical antibiotics (fusidic acid, mupirocin). The antibacterial effect of mupirocin is to disrupt the synthesis of RNA and proteins in bacterial cells. Mupirocin has high in vitro activity against staphylococci, including methicillinresistant strains and streptococci.
For systemic therapy, the choice of antibiotic depends on the severity of the infection and the sensitivity of the isolated staphylococcus strain. In the treatment of staphylococcal infections caused by methicillin-sensitive strains, it is advisable to prescribe oxacillin, aminoglycosides, lincosamides (lincomycin, clindamycin), macrolides, CS II-III generation. These antibiotics are the drugs of choice in the empiric treatment of mild community-acquired cases of staphylococcal infection.In cases of infections caused by methicillin-resistant strains of staphylococci (MRSA / MRSE), vancomycin, teicoplakin, linezolid, rifampicin, co-trimoxazole, fusidin, fluoroquinolones (ciprofloxacin, levofloxacin) are used [1, 4]. These drugs are used both in cases of confirmed MRSA or MRSE infection, and in the empirical treatment of hospital and severe cases of community-acquired staphylococcal infections until the results of bacteriological research are obtained. Initial empiric therapy for severe CBS infections should include drugs effective against methicillin-resistant staphylococci .It is undesirable to use rifampicin and fusidin in monotherapy of staphylococcal infections due to the rapid development of pathogen resistance to these drugs. Clindamycin is used in the treatment of toxic shock syndrome because it can inhibit the synthesis of toxin (TSST-1) S. aureus.
To enhance antibacterial activity, as well as to prevent the development of antibiotic resistance in severe forms of staphylococcal infection, it is advisable to use combinations of antibiotics: p-lactams and aminoglycosides, p-lactams and clindamycin, co-trimoxazole and rifampicin, vancomycin and aminoglycosides, vancomycin, and rifcomycin, and rifcomycin fuzidin, etc.The duration of antibiotic therapy depends on the clinical form of SI. With localized forms, the duration of therapy is 5-7 days, with generalized forms (sepsis, osteomyelitis, purulent arthritis, endocarditis) – 3-6 weeks or more .
Due to the rapid development of resistance of staphylococci to antibacterial drugs, research is constantly being carried out to create new classes of antibiotics effective against methicillin-resistant and vancomycin-resistant strains of staphylococci.Currently, a new drug has been registered in Russia – the first representative of a new class of antibiotics, cyclic lipopeptides – daptomycin. The drug is characterized by a rapidly manifested bactericidal effect against a wide range of gram-positive pathogens, including methicil-
lin-, vancomycin-resistant staphylococci and vancomycin-resistant enterococci. The drug has a high activity against bacteria, both in the growth stage and in the stationary phase.Daptomycin is used to treat complicated skin and soft tissue infections caused by susceptible strains of gram-positive microorganisms and to treat Staphylococcus aureus bacteremia. The likelihood of the formation of resistance among bacteria is low due to the uniqueness of the mechanism of action of the drug. New glycopeptides, anti-MRSA cephems, peptide defermylase inhibitors, new oxazolidinones, and glycyclins are at various stages of testing .
Pyobacteriophage and staphylococcal bacteriophage are used for the treatment and prevention of purulent infections of the skin, mucous membranes, visceral organs caused by staphylococcal bacteria, for staphylococcal intestinal dysbiosis, as well as for the rehabilitation of carriers of staphylococci in various ecological niches.An important condition for effective phage therapy is a preliminary determination of the phage sensitivity of staphylococci isolated from the patient. Doses and method of administration of bacteriophages depend on the nature of the focus of infection (locally in the form of irrigation, lotions and tamponation; intradermally; in the cavity – abdominal, pleural, articular; into the bladder through a catheter; per os and per rectum). The duration of the course of treatment is 5-15 days. With a recurrent course of the disease, repeated courses of treatment are possible.
In the complex therapy of severe forms of staphylococcal infection, antistaphylococcal immunoglobulin and hyperimmune plasma are used.
In the treatment of protracted and chronic forms of staphylococcal infection, staphylococcal toxoid and therapeutic staphylococcal vaccine (antifagin) are used. Staphylococcal toxoid has antitoxic, antimicrobial, immunomodulatory and immunocorrective actions and is used for specific immunotherapy of acute and chronic staphylococcal infection in adults and adolescents. Staphylococcal vaccine (staphylococcal antifagin) – immunobiological preparation; causes the formation of specific antimicrobial anti-staphylococcal immunity in the vaccinated.It is used to treat acute and chronic skin diseases of staphylococcal etiology: boils, carbuncles, hydradenitis, pyoderma (staphyloderma) in children from 6 months of age and adults.
Muperacin ointment is used to sanitize S. aureus carriers on the skin and nasal mucosa. The use of systemic antibiotics for the sanitation of nasal carriage is unreasonable, except for cases of MRSA carriage in patients with recurrent staphylococcal infection.For the rehabilitation of carriers of staphylococci on the mucous membrane of the pharynx and nose, it is advisable to use immunotropic therapy: bronchomunal, imudon, IRS-19. For effective rehabilitation of children carrying S. aureus in the intestine, it is necessary to correct the composition of the intestinal microflora using bacteriophages and probiotics.
1. Beloborodov VB, Mitrokhin S.D. Staphylococcal infections. Infections and Antimicrobial Therapy 2003; five.(1): 12-18.
2. Nikolaeva I.V., Anokhin V.A., Aynutdinova I.A. Characteristics of intestinal microflora in healthy young children in Kazan. Russian Bulletin of Perinatology and Pediatrics 2009; 2: 30-34.
3. Nikolaeva IV, Anokhin VA, Bondarenko VM, Galeeva OP Drug resistance of Staphylococcus aureus strains isolated from children with intestinal dysbiosis. Journal. microbiol.2001; 1: 9-13.
4. Strachunsky L.S., Belkova Yu.A., Dekhnich A.V. Community-acquired MRSA is a new problem in antibiotic resistance. Wedge. microbiol. antimicrobial. chemother. 2005; 7. (1): 32-46.
5. Smirnov V.V., Vershigora A.E. Staphylococcus aureus. Kiev: Nauk. Dumka, 1988.247 p.
6. Chylak J. Bacterial flora of recurrent acute inflammation of upper respiratory tractinfections in children.Med-Dosw-Mikrobiol. 1994; 46: 1-2: 29-33.
7. Clementien L. V., Nico G. H., Fleer A. et al. Persistence of Clones of Coagulase-Negative Stapylococci among Prematur Neonates in Neonatal Intensiv Care Units Two-Center Study of Bacterial Genotyping and Patient Risk Factors. J. Clin. microbiol. 1998; 36: 9: 2485-2490.
8. Gaynes R. P., Edwards J. R., Jarvis W. R. et al. Nosocomial infections among neonates in high-risk nurseries in the United States.National Nosocomial Infections Surveillance System. Pediatrics 1996; 98: 3: 357-361.
9. Gray J.E., Richardson D.K., McCormic M.C. et al. Coagulase-negative staphylococcal bacteremia among very low birth weight infants relation to admission illness severity, resource use, and outcome. Pediatrics 1995; 95: 2: 223-230.
10. Gupta S., Morris J.G., Panigrahi P.Endemic necrotizing enterocolitis: lack of association with a specific infectious agent. Pediatr. Infect. Dis. J. 1994; 13: 8: 728-34.
11. Hans D., Kelly E., Wilhelmson K., Katz E. D. Rapidly Fatal Infections. Emerg. Med. Clin. North. Am. 2008; 26: 2: 259-279.
12. Iyer S., Jones D.H. Community-acquired methicillin-resistant Staphylococcus aureus skin infection: a retrospective analysis of clinical presentation and treatment of a local outbreak.J. Am. Acad. Dermatol. 2004; 50: 6: 854-858.
13. Jarvis W.R. The epidemiology of colonization. Infect. Control. Hosp. Epidemiol. 1996; 17: 1: 47-52.
14. Jernigan J. A., Farr Bm. et al. Short-course therapy of catheter-related Staphylococcus aureus bacteremia: A meta-analysis. Ann. Intern. Med. 1993; 119: 304-311.
15.Kallman J., Kihlstrom E., Sjoberg L., Schollin J. Increase of staphylococci in neonatal septicaemia: a fourteen-year study. Acta-Paediatr. 1997; 86: 5: 533-538.
16. Malonza I. M., Omari M. A., Bwayo J. J, Mwatha A. K. et al. Community acquired bacterial infections and their antimicrobial susceptibility in Nairobi, Kenya. East. Afr. Med. J. 1997; 74: 3: 166-170.
17. Martins A., Cunha M.L. Methicillin resistance in Staphylococcus aureus and coagulase-negative staphylococci: epidemiological and molecular aspects. Microbiol. Immunol. 2007; 51: 9: 787-795.
18. Mitsuda T., Arai K., Fujita S., Yokota S. Demonstration of mother-to-infant transmission of Staphylococcus aureus by pulsed-field gel electrophoresis. Eur.J. Pediatr. 1996; 155: 3: 194-199.
19. Mohandes A.E., Keiser J. F., Johnson L. A., Refat M., Jackson B. J. Aerobes isolated in fecal microflora of infants in the intensive care nursery: relationship to human milk use and systemic sepsis. Am. J. Infect. Control. 1993; 21: 5: 231-234.
20. Pillai S.K., Wennersten C., Venkataraman L., Eliopoulos G.M., Moellering R.C., Karchmer A.W. Development of reduced vancomycin susceptibility in methicillin-susceptible Staphylococcus aureus. Clin. Infect.Dis. 2009; 49: 8: 1169-1174.
21. Raybak M.I. The efficacy and safety of daptomycin: first in a new class of antibiotics for Gram-positive bacteria. Clin. Microbiol. Infect. 2006; 12: 1: 24-32.
22. Regine M., Fortunov et al. Evaluation and treatment of community-acquired Staphylococcus aureus infections in term and late-preterm previously healthy neonates. Pediatrics 2007; 120: 5: 937-945.
23. Sato T., Wada Y., Okazaki M., Kobayashi S. Study on septicaemia in infants and children in the past 20 years. Part 1. An analysis of causal organisms. Kansenshogaku-Zasshi. 1996; 70: 8: 775-783.
24. Sattler C.A., Mason E.O., Kaplan S.L. Prospective comparison of risk factors and demographic and clinical characteristics of community-acquired, methicillin-resistant versus methicillin-susceptible Staphylococcus aureus infection in children.Pediatr. Infect. Dis. J. 2002: 21: 910.
25. Vandenbroucke-Grauls C.M. Methicillin-resistant Staphylococcus epidermidis. Ned-Tijdschr-Geneeskd. 1996; 140: 3: 138-141.
90,000 Staphylococcus aureus – what is the danger?
Staphylococcus aureus is a very common and very dangerous opportunistic bacterium that can infect any person, regardless of gender and age.The source of infection is an infected adult or child. Pathogenic microorganisms are activated in those who have a sharp decrease in immunity or a deterioration in general condition.
Under normal living conditions and good immunity of the body, the bacterium can peacefully coexist with the human microflora, be present in the intestines, on the mucous membranes of the nasopharynx, genitals, etc., and thus not cause any diseases.
Staphylococcus aureus lives everywhere, on any food, for example, fatty cakes, sausage, multiplies in them.When eating such a stale or unsanitary product, a person can immediately receive a large dose of the toxin, which will cause severe vomiting, diarrhea, abdominal pain and require hospitalization with antibiotic therapy. Staphylococcus aureus is able to infect any organ, even the brain and bones, and cause a purulent-inflammatory process in it.
The danger of getting sick occurs with a decrease in immunity, for example, from an acute respiratory viral infection and influenza, with intestinal dysbiosis caused by a long course of antibiotic therapy, with injuries, operations and other medical procedures.
If Staphylococcus aureus enters the intestines, enterotoxin, which is produced by the bacterium, is dangerous. Enterotoxin in large quantities can cause severe intestinal poisoning in humans, while the severity of the treatment lies in the fact that the body is not able to develop strong immunity against this bacterium, so infection can occur again and again.
Due to the fact that in most cases staphylococcal infections proceed easily and without serious complications (however, there are also severe cases of such infections), and also because of the wide variety and constant variability of staphylococci, there is no vaccine against these microbes.
However, in the arsenal of doctors there are still means of specific protection against staphylococci – these are specific anti-staphylococcal sera, which are produced on the basis of the blood of people who have suffered a disease, or immunized animals. Fortunately, nowadays, thanks to antibiotics, the need for the use of such serums has decreased significantly.
Personal hygiene is the best means of prevention, its observance can really protect a person from many dangerous infections.Germs such as Staphylococcus aureus are spread primarily through food, dirty hands, or dirty objects. At the same time, it was noted that microbes perish on clean skin within 5-6 minutes, while microbes on dirty skin can find favorable conditions for development.
In the case of newborns or young children, the parents’ observance of the child’s hygiene is the most important factor in protecting the child from such types of infections as staphyloderma, that is, a bacterial skin lesion that proceeds with suppuration.
For older people, good personal hygiene can also be helpful in preventing microbial infections. As you know, most often staphylococci infect already damaged areas of the skin and mucous membranes (wounds, ulceration). Therefore, the primary role in preventing wound suppuration is played by its correct primary treatment and further care.
A certain role in the prevention of staphylococcal infection is played by proper nutrition and sufficient intake of vitamins and minerals in the body.As you know, the vitamin and mineral status directly determines the effectiveness of the immune defense and the metabolic process. Thus, the prophylactic intake of vitamin and mineral preparations can be called a non-specific means of preventing infections.
Take care of yourself and take care of your health!
Elena Prokopova, deputy. Head of the Department of Veterinary Medicine and Risk Analysis of Food Production, FGBU “Rostov Reference Center of Rosselkhoznadzor”