[Examine The Literature That Exists To Determine If It Gives Health Care Professionals Enough Information To Make The Right Choices About Diagnosis And Treatment Of H-MRSA and C-MRSA]

by

ACKNOWLEDGEMENT

I would take this opportunity to thank my research supervisor, family and friends for their support and guidance without which this research would not have been possible.

DECLARATION

I, [type your full first names and surname here], declare that the contents of this dissertation/thesis represent my own unaided work, and that the dissertation/thesis has not previously been submitted for academic examination towards any qualification. Furthermore, it represents my own opinions and not necessarily those of the University.

Signed __________________ Date _________________

ABSTRACT

In this study we try to explore the concept of H-MRSA and C-MRSA in a holistic context. The main focus of the research is on H-MRSA and C-MRSA and its relation with diagnosis and treatment. The research also analyzes many aspects of H-MRSA and C-MRSA and tries to gauge its effect on diagnosis and treatment. Finally the research describes various factors which are responsible for H-MRSA and C-MRSA and tries to describe the overall effect of H-MRSA and C-MRSA on diagnosis and treatment.

Table of Contents

ACKNOWLEDGEMENTI

DECLARATIONI

ABSTRACTI

Purpose of Study3

CHAPTER 2: LITERATURE REVIEW4

HA-MRSA5

CA-MRSA5

Review of a MRSA Screening Study6

Staphylococcus Aureus8

General Characteristics8

S. Aureus Antibiotic Resistances9

Penicillin Resistance9

Methicillin Resistance10

Vancomycin Resistance10

Epidemiology11

Carriage11

Infection Risk Factors12

Disease13

Prevention of Nosocomial Infection14

Community-acquired MRSA (CA-MRSA)15

S. Aureusgenome Sequences16

Genome Structure17

The Core Genome Component17

The Accessory Genome20

Transposable Elements21

Insertion Sequences21

Transposons22

Plasmids22

The Staphylococcal Cassette Chromosomes (SCC)24

The Staphylococcal Cassette Chromosome mec (SCCmec)24

The Cassette Chromosome Recombinase (ccr) Complex25

The mec Complex The second standard S26

SCCmec Nomenclature28

SCCmec Family: Structural Variation29

SCCmec Type II (2A)30

SCCmec Type III (3A)32

SCCmec Type IV (2B)35

SCCmec Type V (5C)35

SCCmec Type VI (4B)37

MRSA present in Birmingham hospitals38

Other approaches to hospital infection rates41

Infection rates in UK hospitals43

Action to reduce MRSA44

Bacteriophages47

Genomic Islands50

Pathogenicity Islands51

CHAPTER 3: METHODOLOGY1

Materials and Methods1

Study duration and population1

Microbiological study1

Antimicrobial susceptibility testing2

SCCmec typing by multiplex PCR2

Genomic fingerprinting by PFGE3

Questionnaire and statistical analysis4

CHAPTER 4: DISCUSSION AND ANALYSIS1

Isolation of S. aureus from recruited subjects1

Risk factors for C-SA and C-MRSA colonization6

Antimicrobial susceptibility9

SCCmec gene typing of nasal colonization isolates and clinical isolates10

PFGE analysis of C-MRSA and H-MRSA isolates13

Colonization with S. aureus and MRSA among subjects without health care facility-related risk factors15

CHAPTER 5: CONCLUSION16

REFERENCES21

Chapter 1: Introduction

The high level of multiple-drug resistance among community MRSA strains in association with the previously reported excessive use of antibiotics in Taiwan highlights the importance of the problem of antibiotic selective pressure. Our results indicate that both the clonal spread of MRSA and the transmission of hospital isolates contribute to the high MRSA burden in the community.

A total of 1,838 subjects from the community and 393 subjects from health care-related facilities in Taiwan were evaluated for the prevalence of nasal Staphylococcus aureus colonization and to identify risk factors associated with S. aureus and methicillin-resistant S. aureus (MRSA) colonization. Among the community subjects, 3.5% had nasal MRSA colonization. Subjects from health care-related facilities had a lower S. aureus colonization rate (19.1%) than community subjects (25.2%) but had a significantly higher rate of colonization with MRSA (7.63%). Age (P < 0.001) was a significant risk factor for S. aureus colonization, with subjects under age ...