staph. aureus mini research
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RESEARCH, METHODOLOGY, AND
PROJECT
(SPP 3621)
Prevalence ofStaphylococcus aureusnasal carriage in medical students
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Content
2
Chapter 1:Introduction
Chapter 2: Literaturereview
Chapter 3:Methodology
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INTRODUCTION
Staph.aureus
o Normal flora of skin and mucous membranes of human.
}However, S.aureus can also cause infections (eg.pyogenic
infections ,necrotizing fasciitis, toxic shock syndrome (TSS),
gastroenteritis and others).2
} But, for infections to be occured, there must be lesions/cut at
the sites mentioned as well as other factors. These factors will
be discussed later in chapter 2.
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} Nose: main site for S. aureus to reside(40%) 7
} So, human nose may become a potential source ofcolonization and infection.9
} Therefore, it increases the risk of human gettinginfected with this pathogen7
} Nasal carriage ofs. aureus occurs in 20-50% of
human2
Cont.
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Problem Statement
} S. aureus is one of the most common pathogens causing
nosocomial infection.1 The infection ofS. aureus can be easilytransmitted to the patient in the hospital setting by contact with
a healthcare worker (HCW). Medical students will become
HCW in future and HCW can be carrier fors. aureus.5 This is
of concern becauses. aureus infection may the ones which
resist to antibiotics. And spread of MRSA may cause patients
difficult to be treated.
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OBJECTIVESGeneral objective
To study the prevalence ofS.aureus nasal carriage in medicalstudents of University Putra Malaysia.
Specific objective
To determine the prevalence ofS. aureus from nasal swab ofmedical student.
To identify risk factor(social demographic, health status, skin
infection) for nasal carriage ofS. aureus in medical student.
To describe the antibiotic susceptibility pattern ofS. aureusisolated from nasal swab of pre-clinical and clinical medicalstudent.
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RESEARCH HYPOTHESIS
} There is no relationship between risk factors and
the colonization ofS. aureus in nares of medical
students.
} There is no significant different between antibiotic
susceptibility patterns ofS. aureus isolated from
nasal swab of pre-clinical and clinical medical
students.
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Literature review
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Epidemiology} The carrier rate of S. aureus in the nose among the healthy
people are 20-50%.2
o And there is cross-sectional study regarding MRSA. From 4612
patients (in which their sample culture of S. aureus had been
taken),approximately 25% of patients was MRSA and among
them 85% cases were classified as health care-associated
(HA-MRSA).12% cases were classifie
das commun
ity-
associated (CA-MRSA), and 3% could not be classifieddue
to lack of information.6
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Colonizationo S. aureus is a commensal bacter ia or a
pathogen. 32
o About 23.4% individuals are nasally colonized
with S. aureus.32
o Provides a reservoir from which bacteria can
be introduced when host defenses are
breached (by shaving, insertion of an indwelling
catheter, or surgery)
o Increases the risk of infection.32
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Cont.
}Generally those with S. aureus infections are
infected with their colonizing strain.32
} Bloodisolates of 82% patients of bacteremia
were identical to nasal isolates.32
} Involve the host's contact with S. aureus and
the ability of S. aureus to adhere to host cells
and to evade the immune response.32
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Virulence factors
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RISK FACTORS
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Exposure to hospital
environment
} Doctors and nurses are the healthcare workers with
highest frequency of contact with the patients and
the most likely to transmit this pathogen. MRSA
carriage was particularly high among the Doctors
(65.2%) andNurses (64.7%).33
} In the developing nations healthcare givers are
potential transmitters of S. aureus.33
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Host factors}Modifiable} Health status(e.g.:
diabetes, skin lesion).
} Personal hygiene
}Non-modifiable} Gender
} Age
} Ethnicity
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Non-modifiable:
GenderStudy Findings
Heiman et.al,2005 Host character istics co-determine the S.
aureus carrier state. It is further supportedby the fact that S. aureus
carriage rates vary between gender withhigherin men.
Hamdan et.al,2010 A prospective study among healthycarriers in Mexican community.
Among nasal carriers ,male nasal carriers
were (40.9%) and female nasal carriers
were(33.9%).
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Age
Study Finding
Heiman et.al,2005 Host character istic co-determinedS.
aureus carriage state andis supportedthat S. aureus carriage rates vary depends
on age.
Hamdan et.al,2010 Nasal carrier was greaterin the age groupof 1 to 10 years(45.9%) than in the otherage group
Graham III,2001 People age less than 65 years were more
likely to acquiredS. aureus.Where those who age older than 65 yearsare more likely to have MRSAcolonization.
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Health statusStudy Findings
Heiman et.al,2005 Host characteristic co-determine the S.
aureus carrier state. High carriage rate in patients with diabetes
mellitus (both insulin dependent and non-
insulin dependent), patients undergoinghaemodialysis, patients with end stage liverdisease andpatients with HIV.
Kluytmans et.al,1997 Carriage forS. aureus increase in patients
with insulin dependant diabetes mellitus,
patients undergoing heamodialysis,continuous ambulatory peritoneal dialysis(CAPD), patients with S. aureus skin infection
andpatients with human immunodeficiencyvirus infection.
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Personal hygiene} Nasal carriage of S. aureus (NCSA) is a risk factor for nosocomial
infections with S. aureus,
} Nosepicking may become one of the determinant that cause
NCSA.
} Study done by Wertheim et.al from 124 patients, there were 56.5%
patients were non-carriers and 43.5% were carriers.
} In the non-carr ier group 44.0% of patients were positive for
nosepicking and in the carr ier group 65.0% patients were positivefor nosepicking. 34
} Nosepickingplays a role in nasal carriage of S. aureus.
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Conceptional framework
Prevalence
of S. aureusnasal
carriage
Host
factors
Age10
Personal
hygiene30
gender10
Race7,8
Healthstatus7,20
Exposure to
hospitalenvironment5
Antibiotic
susceptibility
pattern of S.aureus
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