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Open access

Irena Grmek Košnik, Andreja Krt Lah, Urška Dermota and Tatjana Frelih

Izvleček

Izhodišče: Oktobra 2010 smo imeli na Gorenjskem v eni izmed osnovnih šol z vrtcem izbruh stafilokokne zastrupitve s hrano.

Metode: Izvedli smo retrospektivno kohortno epidemiološko raziskavo in izračunali stopnjo obolevnosti v izbruhu ter relativno tveganje (RT) za vsako živilo. Pri obolelih smo kultivirali blato in izbruhanino. Opravili smo terenski ogled z odvzemom vzorca hrane, brisov delovnih površin na snažnost in brisa rok zaposlenih v kuhinji. V okviru usmerjenega pregleda smo trem zaposlenim v kuhinji odvzeli kužnine za mikrobiološke preiskave. Izolatom bakterije Staphylococcus aureus smo določili enterotoksine s testom aglutinacije SET RPLA (Oxoid). Za primerjavo sorodnosti bakterije S. aureus iz živila in humanih vzorcev smo opravili tipizacijo izolatov s pulzno elektroforezo (PFGE).

Rezultati: Obolelo je 73 oseb od 374 izpostavljenih. Stopnja obolevnosti je bila 19,5-odstotna. Najpogostejši bolezenski znaki so bili: bruhanje (87,7 %), bolečine v trebuhu (75,3 %), driska (64,2 %) in slabost (59,3 %). Največje relativno tveganje (RT) za zastrupitev je bilo povezano z uživanjem mesnega sira (RT= 24,2 (95 % CI 12,1-48,5; p<0,001) in krompirjeve solate (RT= 19,4 (95 % CI 10,7-35,2; p<0,001). S kože rok osebe, zaposlene v kuhinji, iz vzorca hrane in kužnin obolelih otrok smo izolirali bakterijo S. aureus, ki je izločala enterotoksina A; po občutljivosti za antibiotike se ni razlikovala od drugih; z metodo PFGE se je pokazala 96,3-odstotna sorodnost med sevi.

Zaključki: Opisana raziskava je vzorčen primer dela in ukrepanja področnega epidemiologa in mikrobiologa ob pojavu izbruha. V izbruhu smo dokazali epidemiološko povezane izolate in opredelili pomen posameznih preiskav.

Open access

Irena Grmek Kosnik, Alenka Storman, Ziva Petrovic, Slavica Robnik, Urska Dermota and Tjasa Zohar Cretnik

Abstract

Introduction

The identification of patients infected and/or colonised by methicillin resistant Staphylococcus aureus (MRSA) is necessary for the timely introduction of measures for infection control. We compared the diagnostic efficacy of combinations of MRSA surveillance swabs routinely taken by health institutions in the country.

Methods

All surveillance samples, which were sent for a microbiological analysis to detect MRSA with the culture method in 2014, in the three departments for medical microbiology of the National Laboratory for Health, Environment and Food, were included in this study.

Results

Among 65,251 surveillance cultures from 13,274 persons, 1,233 (2.1%) were positive (490 positive persons). Prevailing positive surveillance cultures were throat swabs (31.3%), followed by nose swab (31.2%), skin swab (18.9%), perineum (16.4%) and wound swabs (1.4%). The contribution of other samples, such as aspirate, urine and excreta, was under 1%. We found no statistically significant differences in the frequency of detection of a positive patient, if the combination of samples NTS (nose, throat, skin) or NTP (nose, throat, perineum) was analysed. However, statistically significant differences were confirmed when any of the anatomic sites would be omitted from the sets of NTP and NTS (chi square; p<0.01). Adding additional samples resulted in only 24 additional positive patients (4.9%).

Conclusions

The results indicate that increasing the number of surveillance cultures above three does not add much to the sensitivity of MRSA surveillance, the exception could be wound. The swabs from the perineum and from the skin are exchangeable.

Open access

Tanja Torkar, Irena Grmek Košnik and Brigita Skela Savič

Izvleček

Izhodišča: V šoli otroci preživijo velik del dneva, zato ima šola pomembno vlogo pri zdravju otrok in mladostnikov pa tudi pri sodelovanju z zdravstvenimi službami.

Namen: Ugotoviti stališče ravnateljev o pomenu, smotrnosti in o možnosti umestitve šolske medicinske sestre v osnovne šole.

Preiskovanci in metode: Podatki so zbrani s strukturiranim anketnim vprašalnikom. Vzorec zajema 55,6 % (n = 266) celotne populacije ravnateljev osnovnih šol. Uporabljena je deskriptivna statistika. Soodvisnost je analizirana z multiplo regresijsko in dimenzije odvisne spremenljivke s faktorsko analizo.

Rezultati: Na osnovnih šolah najpogosteje ukrepajo zaradi akutnega bolezenskega stanja (PV = 3,48), psihosomatskih (PV = 3,42) in kroničnih bolezni (PV = 3,22) (lestvica 1-6). Ravnatelji prepoznavajo potrebo po nalogah šolske medicinske sestre iz promocije zdravja in zdravstvenih storitev, saj je 11 od 13 predlogov dobilo v povprečju oceno nad 4 (lestvica 1-5). Najprimernejšo umestitev šolske medicinske sestre vidijo deloma v zdravstvenem domu, deloma v šoli (60,2 %); najprimernejši delodajalec je zdravstveni dom (59,4 %). Mnenja se ne razlikujejo glede na velikost šole in vključitev v mrežo Zdravih šol. Ravnatelji s šol, v katerih je telesnih poškodb učencev več, izražajo značilno večjo potrebo po šolski medicinski sestri (b = 0,208, p < 0,014), kar velja tudi za ravnatelje z mnenjem, da je usposabljanje učiteljev za prepoznavanje in ukrepanje ob zdravstvenih težavah v odgovornosti zdravstvenega doma (b = 0,270, p < 0,000).

Zaključki: Ravnatelji menijo, da se v šolah srečujejo z zdravstvenimi težavami učencev, a učitelji za ukrepanje nimajo dovolj znanja niti kompetenc. Pozitivno prepoznavajo umestitev šolske medicinske sestre v šolo.

Open access

Andreja Krt Lah, Tatjana Frelih and Irena Grmek Košnik

Abstract

Background. An outbreak of gastroenteritis of etiologically unspecified origin and an outbreak of Salmonellosis occurred simultaneously in September 2011 in Tržič. The purpose of the investigation of both outbreaks was to identify the most probable source and the mode of transmission and to implement preventive measures.

Methods. In two retrospective case-control studies, the association between gastroenteritis of etiologically unspecified origin or Salmonellosis and food from a restaurant or drinking tap water were tested by univariate and multivariate analysis. The subject in the first study was a sick person with salmonellosis, and the subject in the second study was a resident that developed diarrhoea and/ or vomiting. Cases were reported by doctors, and controls were selected from healthy persons who responded to the questionnaire.

Results. A person exposed to food from the restaurant had a 24.8 times higher odds ratio (univariate analysis OR 24.8, 95% CI 7.5 to 82.3, p <0.05; multivariate analysis OR 14.7, 95% CI 3.5 - 61.3, p <0.05) for salmonellosis than non-exposed. A resident exposed to tap water from specific water source had a 3.4 times higher odds ratio (univariate analysis of OR 3.4, 95% CI 2.2 to 5.1 is p <0.05, multivariate analysis of RO 2.9, 95% CI 1, 7 to 5.3, p <0.05), for gastroenteritis of unspecific etiology than non-exposed. The dose response relationship was also statistically significant.

Conclusion. Analytical cases - controls studies confirmed a causal relationship between salmonellosis and food from the specific restaurant and the causal relationship between gastroenteritis of etiologically unspecified origin and drinking tap water from specific water source. Salmonella enteritidis may have entered into the restaurant through tap water

Open access

Urška Dermota, Tomaž Jurca, Tatjana Harlander, Marta Košir, Urška Zajc, Majda Golob, Irena Zdovc and Irena Grmek Košnik

Abstract

Introduction

According to the existing literature, a heterogeneous sequence type (ST) or clones of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) circulate in Europe. In Europe, the European clone that belongs to sequence type ST80 is predominant.

Methods

The aim of the study was to investigate the phenotypic and genotypic characteristics and epidemiological data of CA-MRSA ST80 and its occurrence in Slovenia. We retrospectively analyzed those CA-MRSA isolates that were isolated during microbiological procedures in microbiological laboratories between 2006 and 2013. Only CA-MRSA isolates from the national collection of CA-MRSA strains that belonged to ST80 (European clone) were analyzed. We determined the Pantone-Valentine leukocidin (PVL), mec A genes, exfoliative toxin genes and type of staphylococcal cassette chromosome (SCCmec) by polymerase chain reaction (PCR). We determined also spa type and sequence type.

Results

ST80 was confirmed in only 2 (0.5%) out of 385 CA-MRSA isolates, collected in a national collection of CAMRSA. Both isolates were positive for the PVL genes, mec A gene, exfoliative toxin type D gene and SCCmec IV. One CA-MRSA isolate was confirmed in a wound swab taken from a 47-year-old male, and the second was isolated from blood cultures of a 69-year-old female. No epidemiological connections between them were found.

Conclusions

In Slovenia CA-MRSA infections caused by ST80 are rare. In the future, it is necessary that a surveillance study of CA-MRSA at the national level continues and CA-MRSA be considered as a public health threat.