Molecular Epidemiology of Staphylococcus aureus and MRSA in Bedridden Patients and Residents of Long-Term Care Facilities

Clinical and genetic analysis of oral and nasal staphylococcus aureus isolates in dental patients

Staphylococcus aureus is a common bacterium that sometimes causes various pyogenic diseases. Methicillin resistant S. aureus (MRSA) infections are particularly difficult to treat. Recently, MRSA has been spreading in the community, so it is important to determine the prevalence of MRSA in the community and to conduct epidemiological studies from genetic and statistical perspectives. In this study, S. aureus/MRSA was isolated from the oral and nasal cavities of 504 dental patients (65 inpatients and 439 outpatients). Sixty-two S. aureus strains and 9 MRSA strains were isolated from the oral cavity, and 112 S. aureus strains and 21 MRSA strains were isolated from the nasal cavity. Multi-locus sequence typing (MLST) analysis showed ST8 was high (18 isolates) among 30 MRSA isolates, whereas among 144 methicillin sensitive isolates, ST15 (25 isolates) and ST8 (20 isolates) were high. Statistical analysis of the patients' clinical status revealed a correlation between oral S. aureus and denture use. Among the 34 patients from whom S. aureus was isolated from both sites, 25 had the same ST, and 23 showed below 40 single-nucleotide polymorphisms which are considered to be identical strains. Our study revealed various properties of S. aureus/MRSA in the oral and nasal cavities as commensals.

Becoming Bedridden and Being Bedridden: Implications for Nursing and Care for Older People in Long-Term Care: A Scoping Review

BACKGROUND

An increasing number of individuals aged 60 and older will rely on healthcare services, particularly due to increased physical limitations and mobility restrictions. This implies an increase in permanently immobile, often bedridden people who require targeted care. Mobility impairments progress gradually, leading to loss of autonomy and self-care skills, physical decline, functional deterioration, disability, etc. This review synthesises research findings on the implications of becoming and being bedridden for nursing care of older people in long-term care.

OBJECTIVES

The aim of this scoping review was to explore the current state of research on the topic of bedriddenness in older people in the context of long-term care and to identify research gaps.

METHODS

We analysed English and German language peer-reviewed publications from the electronic databases MEDLINE (PubMed), CINAHL, LIVIO and Scopus. Publications from 1998 to 2023 were included if they addressed 'bedriddenness', the 'process of becoming bedridden', 'prevention' and the 'consequences of bedriddenness', and the 'care of bedridden people'. The PRISMA-ScR guidelines were used.

RESULTS

We identified 250 publications based on the defined inclusion criteria. We included 47 in detail condensing their content and organising them according to developed categories, bedriddenness and its prevention, development, consequences and care, which were the subject of intensive research. Although researchers have focused on risk factors for the development of immobility and its negative consequences for those affected, they paid little attention to self-determination and the organisation of life in bed, which enables those affected to participate. Different ideas regarding the term 'bedriddenness' indicate the need for a consensus definition.

CONCLUSION

Our review shows that articles strongly focus on the process of becoming bedridden. Many publications examine bedridden people's care by emphasising the perspective of (informal) caregivers and the challenges they face. The perspective of bedridden people, together with the consideration of psychosocial dimensions of bedriddenness and the promotion of opportunities for participation, should be focused on in further research. Appropriate concepts for training and nursing practice would be helpful.

IMPLICATIONS FOR PRACTICE

Bedriddenness is a phenomenon that mainly affects older people, particularly those living in nursing homes. Concepts should be developed that reflect the reality of bedridden people's lives. Targeted interventions to improve the mobility of people with severe mobility impairments are important. Therefore, it is essential to establish educational modules for (informal) caregivers that consider mobility and rehabilitative practices as an integral part of care.

Oral colonization of antimicrobial-resistant bacteria in home health care participants and their association with oral and systemic status

Antimicrobial-resistant bacteria (ARBs) are serious global threat because they make it difficult to treat infections with antibiotics. Recently, it has been demonstrated that ARBs are isolated from the oral cavities of elderly individuals in long-term care facilities. Because oral ARBs can cause systemic diseases such as bacteraemia and aspiration pneumonia, more attention must be given to protect the overall health of elderly people. To understand the prevalence of oral ARBs, more studies are needed in addition to previous studies. In this study, we investigated oral ARBs in elderly people receiving home health care (HHC) who had different lifestyles as residents in long-term care facilities. Among 98 HHC participants, Staphylococcus aureus, including 8 methicillin-resistant S. aureus (MRSA) strains, was isolated from 31 participants (31.7%), and 3rd-generation cephalosporin-resistant gram-negative bacteria (GNARB) were isolated from 18 participants (17.8%). An analysis of the relationship between oral ARBs and clinical status revealed that S. aureus/MRSA isolation was correlated with denture condition, while GNARB isolation was correlated with tube feeding. This study is the first comprehensive analysis of ARB carriage in the oral cavities of elderly people in HHCs. These results demonstrate the potential risk of oral ARB carriage and the importance of infection control in HHCs.

[Bed confinement in old people-A literature review]

BACKGROUND

Particularly older people are affected by mobility restrictions and can go through the process of gradually becoming bedridden. This can potentially lead to extensive consequences for the individuals involved, which must be considered in their care.

AIMS

To bundle nursing implications related to the phenomenon of being bedridden in the field of long-term care and to provide impulses for research in nursing science.

METHODS

Research in relevant specialist databases (2003-2023) based on the criteria of a scoping review.

RESULTS

In Germany there is a standard for maintaining and promoting mobility that addresses bed and local confinements but German language studies on these phenomena are rare. In the international context, these issues are researched more intensively, focussing on risk factors for the development of immobility and the negative consequences for those affected. The publications focus on the reduction of these factors, while less attention is paid to the organization of life in bed and the participation and involvement of those affected.

DISCUSSION

The complexity of the phenomenon is not fully illustrated in current research. In order to develop a nursing perspective research projects that also include aspects of life in bed are a central aspect in order to take greater account of the reality of bedridden people's lives and their potential for participation and involvement.

Characterization of Methicillin-resistant Staphylococcus aureus (MRSA) isolated in Santa Catarina (SC), Brazil

The study investigated the characteristics of Methicillin-resistant Staphylococcus aureus (MRSA) isolated in Santa Catarina. Findings revealed prevalent SCCmecII and IV, multiresistance, Leucocidin ED genes, and one ST105 isolate. The results indicated that the in-state MRSA isolates showed the same characteristics as the out-of-state isolates among the investigated features.

Oral and rectal colonization of methicillin-resistant Staphylococcus aureus in long-term care facility residents and their association with clinical status

Staphylococcus aureus is a commensal bacterium in humans, but it sometimes causes opportunistic infectious diseases such as suppurative skin disease, pneumonia, and enteritis. Therefore, it is important to determine the prevalence of S. aureus and methicillin-resistant S. aureus (MRSA) in individuals, especially older adults. In this study, we investigated the prevalence of S. aureus and MRSA in the oral cavity and feces of residents in long-term care facilities (LTCFs). S. aureus was isolated from the oral cavity of 61/178 (34.3%) participants, including 28 MRSA-positive participants (15.7%), and from the feces of 35/127 (27.6%) participants, including 16 MRSA-positive participants (12.6%). S. aureus and MRSA were isolated from both sites in 19/127 individuals (15.0%) and 10/127 individuals (7.9%), respectively. Among 19 participants with S. aureus isolation from both sites, 17 participants showed the same sequence type (ST) type. Then, we analyzed the correlation of S. aureus and MRSA in the oral cavity and rectum with the participant's condition. S. aureus and MRSA positivity in the oral cavity was significantly related to tube feeding, while there was no correlation of rectal S. aureus/MRSA with any factors. Our findings regarding the oral inhabitation of MRSA and its risk factors indicate the importance of considering countermeasures against MRSA infection in LTCFs.

Detection of Staphylococcus aureus from nares of elderly living in a Brazilian nursing home

Asymptomatically nasal colonization by Staphylococcus aureus is a well-established risk factor for S. aureus infections. The aimed of the study was to identify the prevalence and factors associated with nasal carriage of S. aureus and Methicillin-resistant S. aureus (MRSA) from individuals residing in one Brazilian nursing home (NH). Three time-separate nasal swab collections were obtained from the elderly enrolled. The S. aureus isolates identified were submitted to Antimicrobial Susceptibility test (AST). The study showed a high prevalence of S. aureus (n = 9; 60%) and MRSA (n = 4; 26.7%) among elderly. Resistance to erythromycin was the most detected. S. aureus or MRSA colonization could not be associated to the data collected on demographics, personal habits, and medical history of the participants. Despite the small number of individuals enrolled, our study can contribute to improve the control of S. aureus and MRSA dissemination within the community, especially among the most vulnerable like the elderly.