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Prevalence and molecular epidemiology of Staphylococcus aureus in Swedish nursing homes – as revealed in the SHADES study
Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Health Sciences.
Ödeshög Health Care Centre, Ödeshög.
Clinical Microbiology, Department of Laboratory Medicine, Ryhov County Hospital, Jönköping.
Division of General Practice/Family Medicine, Department of Clinical Sciences in Malmö, Lund University, Malmö.
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2014 (English)In: Epidemiology and Infection, ISSN 0950-2688, E-ISSN 1469-4409, Vol. 142, no 6, 1310-1316 p.Article in journal (Refereed) Published
Abstract [en]

Knowledge of carriage and population dynamics of Staphylococcus aureus is crucial for infection risk assessment and to reveal transmission patterns of strains. We report the prevalence and molecular epidemiology of S. aureus in elderly people (n = 290) living in nursing homes in three cities in the south of Sweden. The overall carriage prevalence rate was 48% when results from nares (31%) and throat (34%) samples were combined. Common spa types were equally distributed but a frequent type, t160, was found only in one of the regions. Carriage of different spa types was detected in 23% of individuals and antimicrobial resistance rates were higher in S. aureus isolates from those carrying more than one spa type. Five of the 21 individuals who carried different spa types were colonized simultaneously with resistant and non-resistant strains. Seventeen per cent of the individuals carried S. aureus of the same spa type on all occasions. Methicillin resistance was not detected. In conclusion we found a high prevalence of S. aureus in this elderly population with a high rate of dual colonization with different spa types. We also found signs of institutional spread of one strain.

Place, publisher, year, edition, pages
Cambridge University Press, 2014. Vol. 142, no 6, 1310-1316 p.
Keyword [en]
Colonization, molecular typing, multiclonality, nursing home, spa type
National Category
Clinical Medicine
Identifiers
URN: urn:nbn:se:liu:diva-97342DOI: 10.1017/S0950268813002033ISI: 000334247600020PubMedID: 23962597OAI: oai:DiVA.org:liu-97342DiVA: diva2:646981
Available from: 2013-09-10 Created: 2013-09-10 Last updated: 2017-12-06Bibliographically approved
In thesis
1. Staphylococcus aureus: aspects of pathogenesis and molecular epidemiology
Open this publication in new window or tab >>Staphylococcus aureus: aspects of pathogenesis and molecular epidemiology
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Staphylococcus aureus is a human commensal colonizing about 30 per cent of the population. Besides, it is a frequent cause of infections such as skin, wound and deep tissue infections and also more life-threatening conditions such as pneumonia, endocarditis and septicaemia. S. aureus may also cause different toxicoses. Moreover, this bacterium is one of the most common causes of nosocomial infections worldwide and an increase in antibiotic resistance, especially against methicillin, is seen. This underlines the importance to prevent and control outbreaks of S. aureus. The aims of this thesis were to increase the knowledge of S. aureus virulence and pathogenesis as well as to understand pattern of colonization and transmission.

Various virulence factors operate together in the pathogenic process of S. aureus. The virulence of S. aureus was studied by the interaction with human umbilical vein endothelial cells (HUVEC) as a model. In paper I, we found that one bacterial isolate survived intracellularly and that 156 genes were differentially regulated in microarray analysis of HUVEC. The major part of these genes coded for proteins involved in innate immunity. In paper II, we wanted to explore possible differences in global gene expression patterns in HUVEC induced by invasive compared to colonizing isolates of S. aureus. We also used microarray to investigate possible differences in the presence of virulence genes between the two groups. The main finding was that virulent and commensal S. aureus did not differ in interaction with HUVEC and in the presence of virulence genes. All isolates survived intracellularly for days.

Since no obvious differences in virulence between the two groups of isolates were found, we focused on epidemiology and transmission patterns. Colonization with S. aureus is an important risk factor for subsequent S. aureus infection. In paper III, we investigated S. aureus colonization and transmission among nursing home residents in three regions in the south of Sweden and used staphylococcal protein A (spa) typing as an epidemiological tool. A diverse distribution of different spa types was found and a majority of types were unique to one individual. Interestingly, we found a local accumulation of one spa type in one nursing home. Also common spa types were equally distributed in the different regions. We also noted that some individuals were colonized with two different spa types of S. aureus and in five of these cases there was one resistant and one non-resistant strain.

The issue of multiclonal colonization and infection is highly important and clinical diagnostic laboratories do not routinely address this problem. Therefore, in paper IV a novel method to assess multiclonality of S. aureus was developed. It was based on denaturing gradient gel electrophoresis with the amplification of the spa gene. The method simultaneously separated eight different spa types. It also detected two spa types in an outbreak.

In conclusion, we found no differences in virulence genes and in the interaction with HUVEC between commensal and invasive isolates. This indicates that any isolate of S. aureus might have a pathogenic potential. We also confirmed that some spa types are more successful colonizers with a potential to nosocomial spread. The method for detection of multiclonality of S. aureus is of importance in future epidemiological and clinical studies.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2013. 78 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1371
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-97343 (URN)978-91-7519-568-1 (ISBN)
Public defence
2013-09-27, Originalet, Qulturum, Länssjukhuset Ryhov, Jönköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2013-09-10 Created: 2013-09-10 Last updated: 2013-09-12Bibliographically approved
2. Microbiological Surveillance in Primary Health Care: New Aspects of Antimicrobial Resistance and Molecular Epidemiology in an Ageing Population
Open this publication in new window or tab >>Microbiological Surveillance in Primary Health Care: New Aspects of Antimicrobial Resistance and Molecular Epidemiology in an Ageing Population
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background

The inexorable rise in antimicrobial resistance (AMR) interferes with the goals of health care services around the world, given how critical the antibacterials are in making infections treatable and surgical procedures doable. Nursing homes residents have been identified as a reservoir for AMR, possibly due to the combination of being physically and mentally frail, frequently treated with antibacterials, and frequently moved between nursing home and hospital. Microbiological surveillance is a key countermeasure against further AMR development. Yet, surveillance data is easily biased due to precision problems regarding how the data is collected and evaluated.

Methods

Beginning in 2008, we launched two programmes (“SHADES” and “MIDIO”) aimed to gathering AMR data in a systematic fashion from elderly nursing home residents and elderly people living in their own place of residence. In doing so, we focused on colonizing strains of the two most important nosocomial infectious agents, Staphylococcus aureus (S. aureus) and Escherichia coli (E. coli). The bacteria were collected from multiple body sites and analysed with respect to antimicrobial susceptibility and genetic diversity.

Results

Active surveillance of AMR showed that (i) a S. aureus isolate could be retrieved from 1 in every 2 individuals given a single round of sampling, but aggregating several rounds of sampling, this figure might reach 7 in every 10 individuals, (ii) an E. coli isolate could be retrieved from 4 in every 5 individuals, (iii) the overall prevalence of AMR was favourable when compared to the situation in many other countries, (iv) the genetic diversity of S. aureus was generally high and provided only limited evidence of clonal expansion or contraction, and (v) diabetes mellitus was one of very few patient-level factors to show an association with the degree of genetic diversity in S. aureus.

Conclusions

The prevalence of colonization with S. aureus and E. coli was somewhat higher than expected, but the degree of AMR was very low. The genetic diversity of S. aureus was generally high. Diabetes mellitus emerged as the only patient-level factor associated with a higher degree of genetic diversity in S. aureus.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2016. 76 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1556
Keyword
Colonization, Nosocomial, Bacteria
National Category
Family Medicine
Identifiers
urn:nbn:se:liu:diva-133246 (URN)10.3384/diss.diva-133246 (DOI)9789176856154 (ISBN)
Public defence
2017-02-07, Belladonna, Universitetssjukhuset i Linköping, ingång 78, Linköping, 13:00 (Swedish)
Opponent
Supervisors
Funder
Medical Research Council of Southeast Sweden (FORSS)
Available from: 2016-12-19 Created: 2016-12-15 Last updated: 2016-12-22Bibliographically approved

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Stark, LisaLindgren, P-E

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