Staphylococcus aureus isolation from the lesions, the hands, and anterior nares of patients with atopic dermatitis

Hand hygiene knowledge, attitude, practice and hand microflora analysis of staff nurses in a rural tertiary care hospital

Introduction:

Hand hygiene play crucial role in infectious control. The present research is on accessing Knowledge, attitude, and practice of nursing staff regarding hand washing. Human hands are covered with several commensal and pathogenic microorganism. Pathogenic bacterial species especially Staphylococcus species are the most common to participate in nosocomial infections.

Methods:

Total 300 hand swab samples were taken from 150 nursing staffs followed by filling the questionnaire form. Standard culture media (Blood agar and MacConkey agar) were used to isolate the microorganisms. Microbial identification was done by using standard biochemical tests.

Results:

Our study concluded that over all staff members had moderate knowledge and attitude regarding hand washing. Coagulase-negative Staphylococcus isolates were the most dominant bacteria. Occurrence of Staphylococcus aureus was relatively less.

Conclusions:

Creating awareness and education regarding hand hygiene would definitely increase the attitude and practice of health care workers to minimizing the nosocomial infection.

Prevalence of Staphylococcus spp. nasal colonization among doctors of podiatric medicine and associated risk factors in Spain

Background

This study aimed to estimate the prevalence of methicillin-susceptible and -resistant Staphylococcus aureus (MSSA and MRSA) and methicillin-resistant Staphylococcus epidermidis (MRSE) nasopharyngeal carriage among Doctors of Podiatric Medicine (Podiatrists) and to determine the potential risk factors.

Methods

A cross-sectional study was carried out in 2016-2017 among 239 podiatrists in Spain. The presence of MSSA, MRSA, and MRSE was determined by microbiological analysis of nasal exudate and antimicrobial susceptibility was determined. Each podiatrist completed a questionnaire. The questionnaire comprised various parameters such as sex, age, podiatry experience duration, underlying diseases, prior antibiotic treatment, hospitalization during the last year, and use of a protective mask, an aspiration system, or gloves.

Results

The prevalence of MSSA, MRSA, and MRSE was 23.0%, 1.3%, and 23.8%, respectively. The MSSA prevalence was higher among podiatrists who did not use an aspiration system (32.3%) compared to those who did (19.3%; p = 0.0305), and among podiatrists with respiratory diseases (36.8%) compared to those without (20.8%; p = 0.0272). The MRSE prevalence was higher among men (33.7%) compared to women (8.6%; p = 0.0089), podiatrists aged ≥50 (38.5%) compared to ≤35 (17.8%; p = 0.0101), and podiatrists with ≥15 (39.3%) compared to ≤5 years of podiatry experience (12.5%; p = 0.0015). Among the S. aureus strains, 84.5% were resistant to penicillin, 22.4% to erythromycin, 20.7% to clindamycin, and 12.7% to mupirocin. The MRSE strains were resistant to penicillin (93.0%), erythromycin (78.9%), and mupirocin (73.7%).

Conclusions

The prevalence of S. aureus and S. epidermidis nasal carriage is low among Spanish podiatrists compared to other health professionals.

Skin Barrier Function and Staphylococcus aureus Colonization in Vestibulum Nasi and Fauces in Healthy Infants and Infants with Eczema: A Population-Based Cohort Study

Atopic eczema (AE) is associated with Staphylococcus aureus (S. aureus) colonization and skin barrier dysfunction, often measured by increased transepidermal water loss (TEWL). In the present study, the primary aim was to see whether S. aureus colonization in the vestibulum nasi and/or fauces was associated with increased TEWL in infants with healthy skin and infants with eczema. Secondarily, we aimed to investigate whether TEWL measurements on non-lesional skin on the lateral upper arm is equivalent to volar forearm in infants. In 167 of 240 infants, recruited from the general population, TEWL measurements on the lateral upper arm and volar forearm, using a DermaLab USB, fulfilled our environmental requirements. The mean of three TEWL measurements from each site was used for analysis. The infants were diagnosed with no eczema (n = 110), possible AE (n = 28) or AE (n = 29). DNA samples were analysed for mutations in the filaggrin gene (FLG). Bacterial cultures were reported positive with the identification of at least one culture with S. aureus from vestibulum nasi and/or fauces. S. aureus colonization, found in 89 infants (53%), was not associated with increased TEWL (i.e. TEWL in the upper quartile), neither on the lateral upper arm or volar forearm (p = 0.08 and p = 0.98, respectively), nor with AE (p = 0.10) or FLG mutation (p = 0.17). TEWL was significantly higher on both measuring sites in infants with AE compared to infants with possible AE and no eczema. FLG mutation was significantly associated with increased TEWL, with a 47% difference in TEWL. We conclude that S. aureus in vestibulum nasi and/or fauces was not associated with TEWL, whereas TEWL measurements on the lateral upper arm and volar forearm appear equally appropriate in infants.

Innate immunity and the role of the antimicrobial peptide cathelicidin in inflammatory skin disease

Cathelicidin antimicrobial peptide is an important mediator of the innate immune response. In addition to its potent antimicrobial activity, cathelicidin has been shown to have chemoattractant and angiogenic properties. Recent research has demonstrated that, in addition to its aforementioned functions, cathelicidin plays an important role in the complex pathogenesis of several chronic inflammatory skin diseases. This review will present a concise overview of the role of cathelicidin in infection and in the development of atopic dermatitis, psoriasis, and rosacea. This understanding will direct future research efforts to identify therapeutic approaches that use cathelicidin as a novel drug itself, or aim to modify its expression and regulation.

Antimicrobial compounds from Alpinia conchigera

ETHNOPHARMACOLOGICAL RELEVANCE

The rhizome of Alpinia conchigerahas been used as a condiment in the northern states of Peninsular Malaysia and occasionally in folk medicine in the east coast to treat fungal infections. In some states of Peninsular Malaysia, the rhizomes are consumed as a post-partum medicine and the young shoots are prepared into a vegetable dish. This study aimed to investigate the chemical constituents of the pseudostems and rhizomes of Malaysian Alpinia conchigera and to evaluate the antimicrobial activity of the dichloromethane (DCM) extracts of the pseudostems, rhizomes and the isolated compounds against three selected fungi and five strains of Staphylococcus aureus.

MATERIALS AND METHODS

The dried and ground pseudostems (0.8kg) and rhizomes (1.0kg) were successively extracted in Soxhlet extractor using n-hexane, dichloromethane (DCM) and methanol. The n-hexane and DCM extracts of the pseudostem and rhizome were subjected to isolation and purification using column chromatography on silica gel using a stepwise gradient system (n-hexane to methanol). Briefly, a serial two fold dilutions of the test materials dissolved in DMSO were prepared prior to addition of 100μl overnight microbial suspension (108 cfu/ml) followed by incubation at 37°C (bacteria) or 26°C (dermatophytes and candida) for 24h. The highest concentration of DMSO remaining after dilution (5%, v/v) caused no inhibition to bacterial/candida/dermatophytes' growth. Antibiotic cycloheximide was used as reference for anticandidal and antidermatophyte comparison while oxacilin was used as reference for antibacterial testing. DMSO served as negative control. Turbidity was taken as indication of growth, thus the lowest concentration which remains clear after macroscopic evaluation was taken as the minimum inhibitory concentration (MIC).

RESULTS

The isolation of n-hexane and DCM extracts of the rhizomes and pseudostems of Alpinia conchigera via column chromatography yielded two triterpenes isolated as a mixture of stigmasterol and β-sitosterol: caryophyllene oxide, chavicol acetate 1, p-hydroxy cinnamaldehyde 2, 1'S-1'-acetoxychavicol acetate 3, trans-p-coumaryl diacetate 4, 1'S-1'-acetoxyeugenol acetate 5, 1'-hydroxychavicol acetate 6, p-hydroxycinnamyl acetate 7 and 4-hydroxybenzaldehyde. The DCM extract of the rhizome of Alpinia conchigera indicated potent antifungal activity against Candida albicans, Microsporum canis and Trycophyton rubrum with MIC values of 625μg/ml, 156μg/ml and 156μg/ml, respectively. It also showed significant inhibitory activity with MIC values between 17.88 and 35.75μg/ml against the mutant Staphylococci isolates MSSA, MRSA and Sa7. Amongst the isolated compounds, the lowest inhibition observed were of 1'S-1'-acetoxyeugenol against the dermatophytes (MIC 313μg/ml) followed by trans-p-coumaryl diacetate against both dermatophytes and candida (MIC 625μg/ml). The compound p-hydroxycinnamyl acetate strongly inhibited Staphylococcusaureus strain VISA (MIC 39μg/ml) followed by trans-p-coumaryl diacetate and 1'-hydroxychavicol acetate with MIC value of 156μg/ml.

CONCLUSION

In conclusion, the observed antibacterial, anticandidal and antidermatophyte activity of the extracts and compounds obtained from the rhizome confirm the traditional use of Alpinia cochigera rhizome in the treatment of skin infection.

Epidemiology and risk factors for Staphylococcus aureus colonization in children in the post-PCV7 era

BACKGROUND

The incidence of community-associated methicillin-resistant Staphylococcus aureus (MRSA) has risen dramatically in the U.S., particularly among children. Although Streptococcus pneumoniae colonization has been inversely associated with S. aureus colonization in unvaccinated children, this and other risk factors for S. aureus carriage have not been assessed following widespread use of the heptavalent pneumococcal conjugate vaccine (PCV7). Our objectives were to (1) determine the prevalence of S. aureus and MRSA colonization in young children in the context of widespread use of PCV7; and (2) examine risk factors for S. aureus colonization in the post-PCV7 era, including the absence of vaccine-type S. pneumoniae colonization.

METHODS

Swabs of the anterior nares (S. aureus) were obtained from children enrolled in an ongoing study of nasopharyngeal pneumococcal colonization of healthy children in 8 Massachusetts communities. Children 3 months to <7 years of age seen for well child or sick visits in primary care offices from 11/03-4/04 and 10/06-4/07 were enrolled. S. aureus was identified and antibiotic susceptibility testing was performed. Epidemiologic risk factors for S. aureus colonization were collected from parent surveys and chart reviews, along with data on pneumococcal colonization. Multivariate mixed model analyses were performed to identify factors associated with S. aureus colonization.

RESULTS

Among 1,968 children, the mean age (SD) was 2.7 (1.8) years, 32% received an antibiotic in the past 2 months, 2% were colonized with PCV7 strains and 24% were colonized with non-PCV7 strains. The prevalence of S. aureus colonization remained stable between 2003-04 and 2006-07 (14.6% vs. 14.1%), while MRSA colonization remained low (0.2% vs. 0.9%, p = 0.09). Although absence of pneumococcal colonization was not significantly associated with S. aureus colonization, age (6-11 mo vs. > or =5 yrs, OR 0.39 [95% CI 0.24-0.64]; 1-1.99 yrs vs. > or =5 yrs, OR 0.35 [0.23-0.54]; 2-2.99 yrs vs. > or =5 yrs, OR 0.45 [0.28-0.73]; 3-3.99 yrs vs. > or =5 yrs, OR 0.53 [0.33-0.86]) and recent antibiotic use were significant predictors in multivariate models.

CONCLUSION

In Massachusetts, S. aureus and MRSA colonization remained stable from 2003-04 to 2006-07 among children <7 years despite widespread use of pneumococcal conjugate vaccine. S. aureus nasal colonization varies by age and is inversely correlated with recent antibiotic use.

Dermatology for the general surgeon

Preparation of the patient with preexisting skin disease for surgery can be challenging. In addition to encountering the skin with nearly every procedure, the surgeon will also likely experience skin-related conundrums, concerns, and associated conditions in the preoperative, perioperative, or postoperative periods. These concerns are reviewed using best available evidence.

Adherence of Staphylococcus intermedius to corneocytes of healthy and atopic dogs: effect of pyoderma, pruritus score, treatment and gender

Staphylococcal pyoderma occurs commonly in atopic dogs. Some studies have suggested that adherence of staphylococci to corneocytes of atopic dogs and humans is higher than to corneocytes of healthy individuals. This hypothesis and possible differences resulting from the presence or absence of pyoderma, the severity of pruritus or the effect of treatment or gender, were studied. Adherent bacteria (Staphylococcus intermedius) were quantified by computerized image analysis on corneocytes collected from healthy or atopic dogs using double-sided adhesive tape. The adherence of S. intermedius to the corneocytes of atopic dogs was significantly greater than to those of healthy dogs (P=0.005). Furthermore, adherence was significantly greater in dogs with high levels of pruritus compared to those with low scores. No significant differences were found between atopic dogs with no history of pyoderma, atopic dogs with a history of pyoderma and atopic dogs with pyoderma at the time of sampling (P=0.068), suggesting that factors other than adherence are necessary for clinical pyoderma to develop. Treatment did not generally influence the adherence of S. intermedius to corneocytes of atopic dogs and there was no gender difference in adherence in either healthy or atopic dogs.

Epidemiologic background of hand hygiene and evaluation of the most important agents for scrubs and rubs

The etiology of nosocomial infections, the frequency of contaminated hands with the different nosocomial pathogens, and the role of health care workers' hands during outbreaks suggest that a hand hygiene preparation should at least have activity against bacteria, yeasts, and coated viruses. The importance of efficacy in choosing the right hand hygiene product is reflected in the new Centers for Disease Control and Prevention guideline on hand hygiene (J. M. Boyce and D. Pittet, Morb. Mortal. Wkly. Rep. 51:1-45, 2002). The best antimicrobial efficacy can be achieved with ethanol (60 to 85%), isopropanol (60 to 80%), and n-propanol (60 to 80%). The activity is broad and immediate. Ethanol at high concentrations (e.g., 95%) is the most effective treatment against naked viruses, whereas n-propanol seems to be more effective against the resident bacterial flora. The combination of alcohols may have a synergistic effect. The antimicrobial efficacy of chlorhexidine (2 to 4%) and triclosan (1 to 2%) is both lower and slower. Additionally, both agents have a risk of bacterial resistance, which is higher for chlorhexidine than triclosan. Their activity is often supported by the mechanical removal of pathogens during hand washing. Taking the antimicrobial efficacy and the mechanical removal together, they are still less effective than the alcohols. Plain soap and water has the lowest efficacy of all. In the new Centers for Disease Control and Prevention guideline, promotion of alcohol-based hand rubs containing various emollients instead of irritating soaps and detergents is one strategy to reduce skin damage, dryness, and irritation. Irritant contact dermatitis is highest with preparations containing 4% chlorhexidine gluconate, less frequent with nonantimicrobial soaps and preparations containing lower concentrations of chlorhexidine gluconate, and lowest with well-formulated alcohol-based hand rubs containing emollients and other skin conditioners. Too few published data from comparative trials are available to reliably rank triclosan. Personnel should be reminded that it is neither necessary nor recommended to routinely wash hands after each application of an alcohol-based hand rub. Long-lasting improvement of compliance with hand hygiene protocols can be successful if an effective and accessible alcohol-based hand rub with a proven dermal tolerance and an excellent user acceptability is supplied, accompanied by education of health care workers and promotion of the use of the product.

Presence of staphylococcal exfoliative toxin A in sera of patients with atopic dermatitis

BACKGROUND

It has been reported that the toxins that Staphylococcus aureus produces are associated with the exacerbation of atopic dermatitis (AD). It has been shown in many studies that staphylococcal enterotoxin (SE) A and SEB contribute to AD by humoral immunity through IgE production as a superantigen. On the other hand, little attention has been paid to the relationship between AD and exfoliative toxin x (ETx).

OBJECTIVE

We investigated the toxins that are frequently detected from the skin of patients and how these toxins affect AD.

METHODS

S. aureus, isolated from the skin of 100 patients with mild to severe AD, were examined for the producibility of toxins by polymerase chain reaction. Serum samples were obtained from 21 patients with mild and moderate AD. The levels of SEB, ETA, total IgE, specific IgE, and specific IgG in sera were measured by ELISA.

RESULTS

SEB was most frequently detected from S. aureus on the skin of these patients as previously reported. And ETx, to which little attention has been paid so far, was frequently detected next to SEB. Furthermore, ETA was detected from the sera of almost all the AD patients. SEB was not detected at all. Although the level of ETA in the AD group was significantly higher than that of controls, ETA-specific IgE was not detected from their sera. High levels of ETA tended to be detected from infantile patients. Although there were no significant differences in the levels of ETA-IgG between AD and the controls, its prevalence was more than twice as high as the controls in AD.

CONCLUSION

These results suggest that many AD patients were exposed to ETx. We conclude that ETx may contribute to exacerbation of AD, particularly in infants, by a mechanism that is not through specific IgE production, unlike SEB.

Genotypic and phenotypic characterization of Staphylococcus aureus strains isolated in subjects with atopic dermatitis. Higher prevalence of exfoliative B toxin production in lesional strains and correlation between the markers of disease intensity and colonization density

Staphylococcus aureus strains generally colonize eczematous lesions of subjects with atopic dermatitis much more frequently than in the skin of normal individuals. The aim of this study was to provide a detailed genotypic and phenotypic analysis of S. aureus strains colonizing four different sites (lesional and non-lesional skin areas, nasal and pharyngeal mucosas) of 49 patients with atopic dermatitis. The 88 isolates were analyzed in duplicate by pulsed field gel electrophoresis and in their exfoliative toxin A or B production by latex test. The patients were characterized by age, sex, severity scoring of atopic dermatitis and serum eosinophil cationic protein. Fourteen (28.6%) of the patients were completely negative for S. aureus while 35 (71.4%) were positive in at least one site. The severity scores and eosinophil cationic protein levels were significantly correlated variables (P<0.001), linked to the colonization intensity (P ranging between 0.05 and <0.001 depending on the site) and to the number of colonized sites (P at least <0.01). The genotypic patterns, widely heterogeneous, showed no restriction to peculiar patterns. Only eight strains produced exfoliative toxin B which was significantly restricted to the lesional isolates (P=0.012).