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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
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
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
CDC reports

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

1-3% carry MRSA.

Introduction
methicillin resistant staphylococcus aureus
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
Hospital Associated MRSA or Community Associated MRSA?

Determined by:

source of exposure

patient history

antibiograms

PCR/Pulse field gel electrophoresis

hospital associated mrsa
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
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
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
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
Methods

Nasal swabs to

mannitol salt agar

Identify Mannitol fermenters that are Gram + cocci

Catalase +

Coagulase +

antibiotic sensitivity testing kirby bauer method
Antibiotic Sensitivity TestingKirby-Bauer Method
  • Antibiotics tested:

Amikacin Neomycin

Ciprofloxacin Nitrofurantoin

Clindamycin Oxacillin

Doxycycline Penicillin

Erythromycin Rifampin

Gentamicin Trimethoprim/Sulfa

  • ATCC Staphylococcus aureus 25923
molecular analysis
Molecular Analysis

MEC

CCR-all ccr type 2

B

A

LADDER

survey results
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
antibiograms
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.
molecular analysis ha or ca mrsa
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
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
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
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
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
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
Acknowledgements

STUDENT LAB ASSISTANTS:

Amanda Hartman

Ly Nguyen

Trevin Rube

Brooklyn Sandvall

Ayla Farris

Kevin Farquar

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