Although the distinction between the Community-Associated-Methicillin-Resistant
(CA-MRSA) and Hospital-Associated-Methicillin-Resistant
(HA-MRSA) has blurred in recent years, the CA-MRSA is an ...important group because of its potential to cause fulminant and severe infections. Its importance has further increased with the emergence of Livestock-Associated-Methicillin-Resistant
(LA-MRSA).
In the present study we analysed clonal distributions and virulence factors in presumptive CA-MRSA isolated from January 2014 to December 2015 and compared the results with our previous study from 2010. Phenotypic definition for presumptive CA-MRSA was based on resistance to cefoxitin and oxacillin and susceptibility to at least two of the following four antibiotics: ciprofloxacin, erythromycin, clindamycin and gentamicin.
In 2014 and 2015 altogether 304 MRSA isolates fulfilled our screening phenotypic definition, 45 isolates were cultivated from clinical specimens and 259 from screening specimens. Sequence types ST398, LA-MRSA and
C MRSA increased significantly in 2015 compared to 2010 (p-value <0.05) and were spread over Slovenia.
The clonal distribution of presumptive CA-MRSA has changed within the study period in Slovenia. In 2015 the most frequent clone among clinical and screening specimens was a pig-associated clone, ST398, but the number of confirmed ST398 infections remains low. While previously ST398 and
C positive MRSA strains were geographically limited, they have spread throughout the country since 2010.
Livestock‐associated methicillin‐resistant Staphylococcus aureus (LA‐MRSA) represents a concern in both human and veterinary medicine. The aim of this study was to investigate potential LA‐MRSA ...transmission between animals and humans in rural settings. To this aim, a study was designed to include 14 farms in Slovenia, which were selected on the basis of a farmer (initial patient) with confirmed LA‐MRSA infection and regular animal contacts. On all farms, the initial patients, their household members, animals and barn environment were analysed for the presence of LA‐MRSA. In addition, the epidemiologically linked hospital‐related LA‐MRSA isolates were included to investigate possible nosocomial transmissions. On five farms, LA‐MRSA was discovered both in animals and in humans. In total, 49 LA‐MRSA isolates of different origins underwent whole‐genome sequencing, antimicrobial susceptibility testing and spa typing. All 49 isolates belonged to the sequence type 398 (ST398), spa types t011 and t034, and harboured staphylococcal chromosomal cassette mec Vc. High levels of concordance between resistance phenotypes and genotypes were observed. No transmission pairs between animals and initial patients were discovered. However, several isolates originating from farm animals and other household members formed clusters with pairwise distances of ≤14 single nucleotide polymorphisms (SNPs), indicating recent transmission events. In addition, three closely related isolates (0 SNP) form hospitalized patients were observed, indicating a possible nosocomial transmission. Two hospital‐related isolates harboured the immune evasion cluster genes, which are associated with adaptation to the human host; however, these two isolates differed in >30 SNPs from the remaining isolates. Characteristics of LA‐MRSA from Slovenia reflect those observed previously in other European studies. Immune evasion cluster‐positive LA‐MRSA ST398 suggests its re‐adaptation to the human host and calls for a closer monitoring of such emerging LA‐MRSA lineages, in addition to monitoring and preventing the introduction of LA‐MRSA from farms to hospitals where transmission is highly plausible.
Abstract
Introduction
According to the existing literature, a heterogeneous sequence type (ST) or clones of community-associated methicillin-resistant
Staphylococcus aureus
(CA-MRSA) circulate in ...Europe. In Europe, the European clone that belongs to sequence type ST80 is predominant.
Methods
The aim of the study was to investigate the phenotypic and genotypic characteristics and epidemiological data of CA-MRSA ST80 and its occurrence in Slovenia. We retrospectively analyzed those CA-MRSA isolates that were isolated during microbiological procedures in microbiological laboratories between 2006 and 2013. Only CA-MRSA isolates from the national collection of CA-MRSA strains that belonged to ST80 (European clone) were analyzed. We determined the Pantone-Valentine leukocidin (PVL),
mec
A genes, exfoliative toxin genes and type of staphylococcal cassette chromosome (SCC
mec
) by polymerase chain reaction (PCR). We determined also spa type and sequence type.
Results
ST80 was confirmed in only 2 (0.5%) out of 385 CA-MRSA isolates, collected in a national collection of CAMRSA. Both isolates were positive for the PVL genes,
mec
A gene, exfoliative toxin type D gene and SCC
mec
IV. One CA-MRSA isolate was confirmed in a wound swab taken from a 47-year-old male, and the second was isolated from blood cultures of a 69-year-old female. No epidemiological connections between them were found.
Conclusions
In Slovenia CA-MRSA infections caused by ST80 are rare. In the future, it is necessary that a surveillance study of CA-MRSA at the national level continues and CA-MRSA be considered as a public health threat.
Highlights ► Incidence of tick-borne encephalitis (TBE) in Gorenjska region (Slovenia) is 30/100,000. ► The number of subjects protected by vaccination is only 6.8% of the population of Gorenjska. ► ...Charity activities to reduce the price of vaccination increase the vaccination rate.
Bacterial vaginosis is of clinical interest because of its possible causal relationship with complications during pregnancy, postpartum, and complications after surgery.
Gram stain for clue cells and ...Gardnerella vaginalis culture methods were evaluated retrospectively in a microbiological medical laboratory for the first half of 2015. We were interested in the proportion of G. vaginalis bacteria isolated from genital samples, correlation with Gram-staining presence of clue cells, referral clinical diagnosis, and pregnancy.
In the first half of 2015 we received 358 vaginal specimens; 82% of them had a referral clinical diagnosis of colpitis, cervicitis, or vaginal discharge; 40% were pregnant women. G. vaginalis was isolated from 14% of vaginal specimens, and 52% of these came from pregnant patients. Gram stain clue cells and isolation of G. vaginalis matched in 86%.
For diagnosing bacterial vaginosis in clinical practice, standard clinical criteria, Gram staining of vaginal discharge smear, and/or isolation of G. vaginalis are used. Isolation of G. vaginalis without clue cells is reported only in cases in which bacterial growth is predominant. The results of our studies confirm that isolating G. vaginalis helps confirm the diagnosis of bacterial vaginosis.
Objectives: The pandemic caused by the novel coronavirus (SARS-CoV-2) affected a disproportionately high percentage of healthcare workers (HCWs). The aim of the study was to assess the seroprevalence ...of SARS-CoV-2-specific IgG antibodies in nurses and clinicians working in 2 Slovenian regional hospitals, and to identify the factors associated with seropositivity. Material and Methods: The study was designed as a cross-sectional study. Clinicians and nurses were invited to participate in November-December 2020. The respondents (813, 65.8%) completed a questionnaire and consented to provide 10 ml of blood for determining the presence of SARS-CoV-2 IgG antibodies. Results: The authors observed a seroprevalence rate of 20.4%. The results of the univariate analysis proved that the age of a nurse or clinician was the factor most strongly associated with seropositivity--in fact, the youngest nurses and clinicians were 8.33 times more likely to be seropositive than those in the oldest age group (p = 0.041). Being in contact with a family/household member who was SARS-CoV-2-positive was also a very important factor. In the work-related factors group, being in the contact with a SARS-CoV-2-positive colleague (OR = 2.35, p = 0.026) or being in contact with a COVID-19 patient (OR = 1.96, p = 0.004) correlated with seropositivity. In the primary work location/department group, the only significant association appeared among those working in surgical, ENT or ophthalmology departments. The results of the multivariate analysis further supported the thesis that the age of nurses and clinicians was the factor most strongly associated with seropositivity. The youngest nurses and clinicians were 12.5 times more likely to be seropositive than those in the oldest age group (p = 0.024). Being in contact with a SARS-CoV-2-positive family/household member remained the second most important factor. Conclusions: A significant number of clinicians and nurses working in secondary healthcare were infected in the first 9 months of the pandemic. Int J Occup Med Environ Health. 2022;35(5):571 -84 Key words: seroprevalence, nurse, clinician, healthcare professional, COVID-19, SARS-CoV-2
An outbreak of gastroenteritis of etiologically unspecified origin and an outbreak of Salmonellosis occurred simultaneously in September 2011 in Tržič. The purpose of the investigation of both ...outbreaks was to identify the most probable source and the mode of transmission and to implement preventive measures.
In two retrospective case-control studies, the association between gastroenteritis of etiologically unspecified origin or Salmonellosis and food from a restaurant or drinking tap water were tested by univariate and multivariate analysis. The subject in the first study was a sick person with salmonellosis, and the subject in the second study was a resident that developed diarrhoea and/ or vomiting. Cases were reported by doctors, and controls were selected from healthy persons who responded to the questionnaire.
A person exposed to food from the restaurant had a 24.8 times higher odds ratio (univariate analysis OR 24.8, 95% CI 7.5 to 82.3, p <0.05; multivariate analysis OR 14.7, 95% CI 3.5 - 61.3, p <0.05) for salmonellosis than non-exposed. A resident exposed to tap water from specific water source had a 3.4 times higher odds ratio (univariate analysis of OR 3.4, 95% CI 2.2 to 5.1 is p <0.05, multivariate analysis of RO 2.9, 95% CI 1, 7 to 5.3, p <0.05), for gastroenteritis of unspecific etiology than non-exposed. The dose response relationship was also statistically significant.
Analytical cases - controls studies confirmed a causal relationship between salmonellosis and food from the specific restaurant and the causal relationship between gastroenteritis of etiologically unspecified origin and drinking tap water from specific water source. Salmonella enteritidis may have entered into the restaurant through tap water.
Methicillin-resistant Staphylococcus aureus (MRSA) is a major human pathogen and an important cause of hospitalassociated (HA-MRSA) infections. MRSA infections significantly increase morbidity and ...mortality, affect the increased use of antibiotics and the cost of treatment. During the last decade MRSA has emerged as a significant pathogen also in the community (community-associated; CA-MRSA). In recent years, livestock has been proven to be a source of human infections with the MRSA sequence type (ST) 398 (livestock-associated; LA-MRSA). During the year 2010 all the regional microbiological laboratories took part in the task of monitoring CA-MRSA infections in Slovenia. We included all patients harbouring a MRSA strain that was susceptible to at least two of the following four antibiotics: ciprofloxacin, erythromycin, clindamycin or gentamicin. Altogether we collected 151 MRSA isolates of which 15 (9.9%) belonged to a spa type known to be associated with the clone ST398 respectively. Among them 12 isolates belonged to spa type t011, 2 isolates to t034 and 1 isolate to t108. We found the staphylococcal cassette chromosome - SCCmec type IV or V, and regulatory genes - agr type I. None of the isolates were positive for Panton - Valentine leukocidin (PVL), the toxic shock syndrome toxin (tst) and leukocidin LukM. All MRSA isolates were resistant to tetracycline and penicillin. Some of them were also resistant to erythromycin and clindamycin. Most of the LA-MRSA ST398 were isolated from screening specimens of patients from Murska Sobota and Maribor, which are the most important agricultural regions with intensive livestock breeding. Evidence of the presence of LA-MRSA in humans requires a close cooperation of human and veterinary microbiologists. Our goal is to find the epidemiological relation between human and animal hosts, to obtain information on the phenotypic and genotypic characteristics and monitor infections caused by LA - MRSA strains.
Background: In October 2010 an outbreak of staphylococcal food poisoning occurred in an elementary school with a kindergarten in Gorenjska. Methods: Using a questionnaire we performed a retrospective ...cohortanalytical epidemiological study. We calculated attack rate (AR) and relative risk for each food item. In patients we cultivated stools and vomit. We performed an onsite audit where the food samples, environmental samples, and swabs of the hands of the cooks were taken. We performed medical examination of those employed in the kitchen where specimens were taken for microbiological examination. Staphylococcal enterotoxins were detected with agglutination test SET RPLA (Oxoid) and genotypes determined by the pulsed-field gel electrophoresis (PFGE). Results: Out of 374 exposed 73 subjects got ill. Attack rate in the outbreak was 19,5 %. The most frequent symptoms were vomiting (87,7 %), stomach ache (75,3 %), diarrhea (64,2 %) and nausea ( 59,3 %). The highest relative risk (RR) were found for the meatloaf (RR= 24,2 (95 % CI 12,1-48,5; p<0,001)) and potato salad (RR= 19,4 (95 % CI 10,7 - 35,2; p<0,001)). Enterotoxin A producing S. aureus was isolated from hand of a cook, from potato salad and meatlof, from vomit and stools of patients. These strains had the same antibiotic sensitivity and were genetically closely related (96,3 %). Conclusions: In the article an optimal team approaches of a community epidemiologist and microbiologist in the occasion of outbreak are described. We confirmed epidemiologically related isolates and determined the importance of individual methods.
Izhodišča: V šoli otroci preživijo velik del dneva, zato ima šola pomembno vlogo pri zdravju otrok in mladostnikov pa tudi pri sodelovanju z zdravstvenimi službami.
Ugotoviti stališče ravnateljev o ...pomenu, smotrnosti in o možnosti umestitve šolske medicinske sestre v osnovne šole.
Podatki so zbrani s strukturiranim anketnim vprašalnikom. Vzorec zajema 55,6 % (n = 266) celotne populacije ravnateljev osnovnih šol. Uporabljena je deskriptivna statistika. Soodvisnost je analizirana z multiplo regresijsko in dimenzije odvisne spremenljivke s faktorsko analizo.
Na osnovnih šolah najpogosteje ukrepajo zaradi akutnega bolezenskega stanja (PV = 3,48), psihosomatskih (PV = 3,42) in kroničnih bolezni (PV = 3,22) (lestvica 1-6). Ravnatelji prepoznavajo potrebo po nalogah šolske medicinske sestre iz promocije zdravja in zdravstvenih storitev, saj je 11 od 13 predlogov dobilo v povprečju oceno nad 4 (lestvica 1-5). Najprimernejšo umestitev šolske medicinske sestre vidijo deloma v zdravstvenem domu, deloma v šoli (60,2 %); najprimernejši delodajalec je zdravstveni dom (59,4 %). Mnenja se ne razlikujejo glede na velikost šole in vključitev v mrežo Zdravih šol. Ravnatelji s šol, v katerih je telesnih poškodb učencev več, izražajo značilno večjo potrebo po šolski medicinski sestri (b = 0,208, p < 0,014), kar velja tudi za ravnatelje z mnenjem, da je usposabljanje učiteljev za prepoznavanje in ukrepanje ob zdravstvenih težavah v odgovornosti zdravstvenega doma (b = 0,270, p < 0,000).
Ravnatelji menijo, da se v šolah srečujejo z zdravstvenimi težavami učencev, a učitelji za ukrepanje nimajo dovolj znanja niti kompetenc. Pozitivno prepoznavajo umestitev šolske medicinske sestre v šolo.
Background: Children spend most of their days in schools, therefore schools play an important role in children’s inter-institutional health care.
To identify views of school principals on the importance, relevance and possible placement of school nurses in Slovenian schools.
A structured questionnaire was used. The sample consisted of 55.6% (n=266) of the total population of elementary school principals; descriptive statistics was used. Interdependence was analysed with multiple regression, while dependent variable dimensions were obtained with factor analysis.
The most frequent interventions in schools are the result of acute medical conditions (M=3.48), psychosomatic disorders (M=3.42) and chronic diseases (M=3.22) (1-6 scale). Principals ranked the need for suggested services of school nurses highly, as 11 out of 13 suggestions received a mean value of over 4 (on a 1-5 scale), not only in health promotion/education but also in other medical services. The most appropriate work location of school nurses is partly in primary health centres and partly in schools (60.2%); the most appropriate employer is the primary health centre (59.4%). Opinions of principals do not differ according to the size of school or participation in the network ‘Schools for health’. Principals of schools with a higher number of interventions due to children’s injuries expressed a significantly higher need for school nurse services in the school (b=0.208, p<0.014); the same also goes for principals who feel that training teachers to recognise and act upon children’s health problems has to be organised by a primary health centre (b=0.270, p<0.000).
In school principals’ view, schools are faced with children’s health problems but teachers do not have enough knowledge or competences to take appropriate measures. They positively recognise the placement of school nurses in schools.
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