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A Comparative Study of Methicillin Resistant Staphylococcus aureus Nasal Carriage Rates Between Veterinarians and Veterinary Technicians Diane Hartman, DVM Tamarah Adair, PhD Amanda Hartman, BS Purpose 1. Determine the prevalence of MRSA carriage among veterinarians,

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Diane hartman dvm tamarah adair phd amanda hartman bs l.jpg

A Comparative Study of Methicillin Resistant Staphylococcus aureusNasal Carriage Rates Between Veterinarians and Veterinary Technicians

Diane Hartman, DVM

Tamarah Adair, PhD

Amanda Hartman, BS


Purpose l.jpg

Purpose

1. Determine the prevalence of MRSA carriage among veterinarians,

veterinary technicians and others

at a Fall 2008 veterinary conference.

  • Determine antibiotic sensitivity patterns of Staphylococcus aureus isolates.

  • Determine the oxacillin MIC for each MRSA sample.

    4. Distinguish between HA-MRSA and CA-MRSA based on PCR and gel electrophoresis.


Introduction l.jpg

CDC reports

25-30% of the population harbors Staphylococcus aureus in their nasal passages

1-3% carry MRSA.

Introduction


Methicillin resistant staphylococcus aureus l.jpg

Methicillin Resistant Staphylococcus aureus

  • Emerging opportunist in human and veterinary medicine

    skin and soft tissue infections

  • Transferred by direct contact with carriers or infected individuals

  • Antibiotic resistance is common

  • Reverse zoonosis


Hospital associated mrsa or community associated mrsa l.jpg

Hospital Associated MRSA or Community Associated MRSA?

Determined by:

source of exposure

patient history

antibiograms

PCR/Pulse field gel electrophoresis


Hospital associated mrsa l.jpg

Hospital Associated MRSA

Risk Factors

Hospitalization

Dialysis

Prolonged antibiotic use

Long-term care

Multidrug Resistant

Reuters

http://www.msc.navy.mil/comfort/katrina/graphics/Dialysis.jpg


Community associated mrsa l.jpg

Community Associated-MRSA

Cases arise sporadically

At risk groups

prisoners

young children

contact sports participants

Immune compromised

usually susceptible to many different antibiotics

Panton-Valentine leukocidin


Background l.jpg

Background

  • In a 2007-2008 study the prevalence of MRSA was 4X greater in a Texas veterinary population than in an undergraduate population

  • Veterinarian MRSA carriage rate higher than normal population (DVM News 2007)

  • Canine-Human MRSA transmission (EID2004)

  • Feline-Human MRSA transmission (NEJM 2008)

  • Equine-Human transmission of MRSA (EID 2006)


Survey and consent forms l.jpg

Survey and Consent Forms

Surveys

determine possible sources of exposure

recent surgery or hospitalization

volunteer in hospital, day care, nursing home

analyze common risk factors

travel, antibiotic use, recent skin infection, public gym, contact sports

JMP computer program was used to evaluate potential risk factors

Consent forms - required for each participant


Methods l.jpg

Methods

Nasal swabs to

mannitol salt agar

Identify Mannitol fermenters that are Gram + cocci

Catalase +

Coagulase +


Antibiotic sensitivity testing kirby bauer method l.jpg

Antibiotic Sensitivity TestingKirby-Bauer Method

  • Antibiotics tested:

    Amikacin Neomycin

    Ciprofloxacin Nitrofurantoin

    Clindamycin Oxacillin

    Doxycycline Penicillin

    ErythromycinRifampin

    Gentamicin Trimethoprim/Sulfa

  • ATCC Staphylococcus aureus 25923


Kirby bauer oxacillin r l.jpg

Oxacillin MIC/E Strips

Kirby BauerOxacillin R


Molecular analysis l.jpg

Molecular Analysis

MEC

CCR-all ccr type 2

B

A

LADDER


Mssa and mrsa carriage rates l.jpg

MSSA and MRSA Carriage Rates


Survey results l.jpg

SurveyResults

  • Average age group was 30-39(32%)

  • Average time in practice was <10 years (45%)

  • 74 males (26%) and 203 females (74%)

  • 227 (82%) treated mainly small animals or Small animal with exotics

  • 13 (4.7%) treated mainly large animals

  • 15 (5.4%) were in education

  • 21 ( 7.6%) were in the “other” category


Carriers based on gender role and practice type l.jpg

Carriers Based on Gender, Role, and Practice Type


Carriage based on general risk factors l.jpg

Carriage Based on General Risk Factors


Antibiograms l.jpg

Antibiograms

  • All MRSA isolates were sensitive to Amikacin, Gentamicin, Doxycycline, and Trimethoprim/Sulfamethoxazole.

  • All MRSA isolates were resistant to oxacillin and penicillin.

  • MRSA isolates demonstrated 7 antibiogram patterns.


Oxacillin mic e strips l.jpg

Oxacillin MIC/E Strips


Molecular analysis ha or ca mrsa l.jpg

Molecular Analysis - HA or CA MRSA?

MEC

16 were type 2 ccr.

3 were Class A mec

13 were Class B mec

Class A mec with type 2 ccr are Type II - HA strains

Class B mec with type 2ccr are Type IV -CA strains

CCR

B

A

LADDER


Ha or ca mrsa l.jpg

HA or CA MRSA?

  • Samples 4, 10, 16 were HA strains

    • All 3 Vet Techs

    • R to 5 or more antibiotics

    • MIC all 128 µg/ml or greater

  • 13 samples were CA strains

    • 9 R to 4 or fewer antibiotics

    • MIC 32-192 µg/ml

  • 1 strain was not typeable with the primers used (vet tech with MIC>256 µg/ml and R to 6 antibiotics)


Discussion l.jpg

Discussion

  • None of the survey risk factors were significantly correlated with carriage rates for MSSA or MRSA

  • Veterinary Technicians are

    • 10 times more likely than the general population and more than 3 times as likely as veterinarians to carry MRSA.

    • 3 technician samples were HA-MRSA (Type II)

    • 6 technician samples were CA-MRSA (Type IV)

    • 1 tech sample was not typed

  • All 4 vet samples were CA-MRSA (Type IV)

  • 2 “other” were CA-MRSA (Type IV)


Discussion24 l.jpg

Discussion

Potential Risk Factors for Technicians?

1. Spend more time in the exam room with

clients and pets

2. Spend more time with their face close to the

patient/pet

3. Spend more time face to face with clients in

the exam room and waiting area

4. More likely to interact with client’s children

5. More likely to perform dental prophys on pets

6. More likely to clean cages/kennels

7. More likely to clean ears and/or bathepets


Prevention l.jpg

Prevention

WASH YOUR HANDS!

Don’t share towels or other personal items.

Cleanse fresh wounds and keep wounds covered.

Wear appropriate PPE for the task,

e.g. dentals - lab coats, gloves, mask/face shield.


Funding l.jpg

Supported by the Baylor Undergraduate Research and Scholarly Activities Small Grant Program

and the Vice Provost for Research

Department of Biology Baylor University

FUNDING


Acknowledgements l.jpg

Acknowledgements

STUDENT LAB ASSISTANTS:

Amanda Hartman

Ly Nguyen

Trevin Rube

Brooklyn Sandvall

Ayla Farris

Kevin Farquar


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