الفهرس 
Nosocomial InfectionsOnly 14 pages are availabe for public view
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Abstract
Staphylococcus aureus (S.aureus) is a frequent cause of infections in both the community and hospital. Worldwide, the increasing resistance of this pathogen to various antibiotics complicates treatment of S.aureus infections. Effective measures to prevent S.aureus infections are therefore urgently needed. It has been shown that nasal carriers of S.aureus have an increased risk of acquiring an infection with this pathogen.
The nose is the main ecological niche where S.aureus resides in human beings. Eradication of S.aureus from nasal carriers prevents infection in specific patient categories as in hemodialysis and general surgery patients. Thus, we must elucidate the mechanisms behind S aureus nasal carriage and infection to be able to develop new preventive strategies. In this work an overview of the current knowledge of the determinants (both human and bacterial) and risks of S aureus nasal carriage is presented.
The aim of this study is to screen Methicillin resistant staphylococcus aureus (MRSA) nasal carriage in preoperative pediatric cardiac patients before and after hospital admission and to decolonize MRSA positive carriers using nasal antibiotic called Bactroban (muprocin 2%).
This study was conducted on six hundred pediatric patients subjected to heart surgery whose ages less than eighteen years old. The cases were selected from Misr Children Hospital.
The following subjects were excluded from the study:
1. Transcatheter closure of atrial septal defects and ventricular septal defects. 2. Patent ductus arteriosus (PDA).
3. Balloon atrial septectomy.
All subjects were subjected to our intervention program as the following:
• Medical history were taken (recent surgery or hospitalization, antibiotic taken prior admission , frequent or recurrent boils)
• Swab from the nasal cavity would be taken on admission and after three days of admission.
• Rapid MRSA identification using Oxacillin Resistance Screening Agar Base (ORSAB).
• Decolonization MRSA carriers using Bactroban® nasal ointment.
• After a fifth day of MRSA decolonization, rescreening the affected patients and culture on ORSAB media.
After a period of six months of application our intervention program. The results showed that eighty four patients were carried hospital acquired MRSA (HA-MRSA) with a mean age of 3.18± 2.497years while one hundred thirty six patients were suffering from community acquired MRSA (CA-MRSA) with a mean age of 3.43 ± 3.23 years.
Several risk factors for acquisition of MRSA have been identified. The results revealed that skin infection was significantly higher in CA-MRSA carriers compared to non-carriers.
Patients with skin lesion were 24.7 more susceptible to CA-MRSA than other patients. On the other hand, a higher percentage of skin infection among infants (children below or equal two years of age) compared to older children was obtained, also there was a higher percentage of CA-MRSA among younger age group compared to older children, where infants susceptible to harbor CA-MRSA showed an increase by 2.8 times than others.
One of the risk factor that had been documented in MRSA outbreaks was recent surgery or hospitalization which was in agreement with the results obtained in this thesis, where patients susceptible to harbor HA-MRSA showed an increase by 9.5 times than others.
This study revealed that there was no significant difference between MRSA carriers and non-carriers regarding antibiotic administration two weeks prior to hospitaliztion.
The results in this study revealed that rapid detection of S. aureus nasal carriage followed by immediate decolonization of nasal with mupirocin nasal ointment significantly reduced 96.4% of hospital acquired MRSA carriage and 95.6% of community MRSA carriage in Preoperative pediatric cardiac surgery.
In order to carry out an effective program to eradicate colonization that will actually reduce nosocomial infections with S. aureus, the hospital required better protocols and precautions tools than those currently in process. Ideally, all patients admitted to the hospital, regardless of their presumed risk for colonization, should be screened for nasal colonization, followed by appropriate action to diminish infection.