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EV ACVD Study > MRSP Consensus Statement > Flashcards

MRSP Consensus Statement Flashcards

1
Q

T or F: Staphylococcus schleiferi is the only CoNS that can cause true infection

A

False. CoNS should be assessed on a case-by-case basis

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2
Q

T or F: empiric drug selection for systemic tx is always contraindicated when an MRS infection is suspected

A

TRUE.
High prevalence of MDR in these strains

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3
Q

Veterinarians should not use glycopeptides, linezolid, and anti-MRSA cephalosporins for animals

A

True. WAVD consensus statement recommends “restriction-of-use” policy

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4
Q

Prognosis for MRS

A

Good, pending comorbidities and underlying cause

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5
Q

T or F: routine decolonization of MRS should be pursued in animals

A

F. Not enough evidence

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6
Q

Research tool to investigate epidemiology of MRS outbreaks

A

Molecular strain typing

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7
Q

Best method to prevent personal MRS infection

A

Hand hygiene

Also consider labcoat/gown, disposable gloves

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8
Q

Recommendations to owners when a pet has MRS

A

*Social distancing from “at risk” individuals
*Enhanced cleaning for occupants and the environment

Do this until clinical response to treatment is evident

MRS CAN be spread to other individuals in the home

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9
Q

Should we test healthy humans and animals for MRS carriage?

A

Nope. Legal issues. Very few justifiable actions from the results, anyway

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10
Q

What is the risk of MR CoNS

A

Can transfer resistance mechanisms to organisms with higher pathogenic potential

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11
Q

Penicillinase activity

A

Enzyme that deactivates natural penicillins (Penicillin G and V) and aminopenicillins (ampicillin, amoxicilin)
–> breaks the core structure of beta lactams

Methicillin is a penicillinase-resistant penicillin

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12
Q

Gene that encodes for PCP2a with low affinity for all beta lactams

A

mecA

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13
Q

Definition MDR

A

MRS that is resistant to 2+ other antimicrobial classes

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14
Q

Definition XDR

A

MRS only susceptible to 2 or fewer antimicrobial classes

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15
Q

How much does Staphylococcus like oxygen (aerobic vs anaerobic)

A

Facultative anaerobic cocci

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16
Q

T or F: Staphylococcus is a normal inhabitant on birds

A

True

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17
Q

Most common site for Staphylococcus carriage in dogs and cats

A

Mouth, then perineum

Sample these spot to assess longitudinal colonization

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18
Q

Where in the cat’s body are they most likely to harbor Staphylococcus from their humans?

A

Nasal

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19
Q

Definition of Staphylococcus colonization

A

Self-sustaining population for an extended time without disease

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20
Q

How can a Staphylococcal infection get to the bone

A

1) Spread through epithelial tracts
2) Penetrating wounds
3) Hematogenous spread

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21
Q

Adhesion virulence factor effect

A

Allows bacteria to bind to cells and extracellular matrix

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22
Q

Biofilm virulence factor effect

A

Protects bacteria from immune response

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23
Q

List of toxin virulence factors in Staphylococcus

A

*Cytolytic
*Exfoliative
*Enterotoxigenic
*Superantigenic

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24
Q

2 virulence factors to help Staphylococcus evade the host immune response

A

*Coagulase (coa gene)– promotes fibrin clot scaffold for tissue invasion –> abscessation, protection of bacterial clusters from neutrophils
*von Willebrand factor-binding protein– known as an indicator of pathogenic potential

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25
Q

T or F: expression of antimicrobial resistance genes is a virulence factor

A

FALSE.

Not necessarily more invasive or proinflammatory

May need to trade a virulence factor in order to have a resistance mechanism (fitness cost)

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26
Q

What are the 2 most common Staphylococcal species on cats

A

*Staphylococcus pseudintermedius
*Staphylococcus aureus

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27
Q

Major risk factor for MRSA for dogs and cats

A

Living with a human with MRSA

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28
Q

T or F: Staphylococcus schleiferi is commonly culture from healthy skin of dogs and cats

A

False.
But it is common on skin/ear canals of dogs with previous antibiotic exposure

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29
Q

What are the 3 most common pathogens in SA Dermatology

A

*Staphylococcus pseudintermedius
*Staphylococcus schleiferi
*Staphylococcus aureus

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30
Q

What are the 2 variants of S. schleiferi (one is coagulase +, one is coagulase -)

A

Coagulase +: S. schleiferi coagulans

Coagulase -: S. schleiferi schleiferi
No difference in pathogenic effects.

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31
Q

What are the 2 major clonal lineages of MRSP?

A

ST 71 (Europe, Japan)
ST 68 (USA)

Same mecA gene as MRSA. Probably came from the same CoNS.

32
Q

Is coagulase negative or coagulase positive Staphylococcus schleiferi more often associated with infections in humans

A

Both are RARE. But Coag negative is more common than positive! Weird!

33
Q

Is coagulase negative or coagulase positive Staphylococcus schleiferi more often associated with infections in humans

A

Both commonly cause pyoderma and OE in dogs!

34
Q

How can you speciate/ subspeciate Staphylococcus species effectively

A

PCR
or
MALDI-TOF mass spectrometry

34
Q

Is S. schleiferi more or less likely to be MR

A

HIGH prevalence of MR. >50% of isolates are MR according to 2 USA studies

35
Q

Gold standard method to find mecA gene

A

PCR amplification
or
Commercial Agglutination tests for PBP2a

36
Q

Can you use a cefoxitin disc instead of oxacillin for MRSP

A

No. Can use this for MRSA, but less accurate in MRSP

37
Q

If a S. pseudintermedius is R to oxacillin, which other antibiotics should be R (despite in vitro readings)

A

*Penicillins
*Cephalosporins (except IV 3rd/4th gen)
*Carbapenems
*Cephems

38
Q

Why may cefpodoxime appear S on an MRSP in vitro?

A

Poor expression of mecA for B-lactams other than oxacillin (which is why we use oxacillin as our tester!)

39
Q

Topicals best for canine pyoderma:

A

2-3% chlorhexidine

Benzoyl peroxide is ok, but not as good

Work within 3 weeks for majority of MSS pyoderma

40
Q

T or F: Chlorhexidine bath 2x/week + daily chlorhexidine spray is as good as oral Clavamox x4 weeks

A

True!

41
Q

T or F: there is genuine resistance to topical fusidic acid

A

True

But only approved in UK, Asia, Aus

42
Q

T or F: even if C&S says Staph may be resistant to mupirocin, it still may work

A

True. Can get a much higher topical concentration

Only approved in the US

43
Q

If MRSP is S to doxycycline, can you assume it is S to minocycline?

A

Y

44
Q

If MRSP is S to tetracycline, can you assume it is S to doxycycline

A

Y

45
Q

Are amoxicillin, FQs, Cefovicin and cefpodoxime considered critically important antimicrobials or highly important for human medicine

A

Critically important

46
Q

Are cephalexin, clindamycin, fusidic acid, tetracyclines, and sulfonamides considered critically important antimicrobials or highly important for human medicine

A

Highly important

47
Q

SIET

A

Exfoliative toxin made by Staphylococcus pseudintermedius

bullous impetigo exfoliative pyodermas

48
Q

Exfoliative toxin made by Staphylococcus pseudintermedius. Involved in bullous impetigo exfoliative pyodermas pathogenesis

A

SIET

49
Q

SHETA and SHETB
ExhA, ExhB, ExhC, ExhD

A

Exfoliative toxins made by Staphylococcus hyicus that causes exudative epidermitis in pigs

50
Q

Exfoliative toxins made by Staphylococcus hyicus that causes exudative epidermitis in pigs

A

SHETA, SHETB
ExhA, ExhB, ExhC, ExhD

51
Q

luk l (toxin gene)

A

Pore forming toxin made by S pseudintermedius

52
Q

T or F: S pseudintermedius can easily be transmitted to other dogs

A

True

53
Q

T or F: S pseudintermedius significantly adheres better to canine corneocytes than human

A

True

54
Q

T or F: S aureus significantly adheres better to canine corneocytes than human

A

False.

Adheres better the human squames

55
Q

In which circumstances can carrier swabbing and management of healthy carrier animals be beneficial

A

Places with low rates of MRSP

It’s a lost cause in the USA.

56
Q

T or F: MRSP carriage is common for up to 11 months after clinical cure of infection

A

True

57
Q

What causes “natural decolonization” of MRSP

A

Natural decolonization = loss of MRS carriage without treatment

It occurs 2’ competition within the bacterial microflora

58
Q

T or F: Resistance genes has a fitness cost, so MRS is more likely to decolonize then MSS microbes

A

True

(proven in MRSA in humans)

59
Q

T or F: A dog can recolonize with MRSP due to environmental contamination

A

True

60
Q

Why MAY it be beneficial to continue chlorhexidine baths after MRSP infection is cleared

A

You can decolonize with topical antimicrobials– at least for short periods

(shown with BID fusidic acid)

61
Q

Do we recommend natural decolonization (isolation and cleaning) for MRSP, or antimicrobial decolonization in dogs?

A

Currently not enough evidence for routine decolonization at all

But natural decolonization would be better than antimicrobial tx

62
Q

How do we establish a “strain concordance” in an outbreak situation?

A

“Typing”

-Next Generation Sequencing (NGS)
-Whole genome sequencing

Other options:
*Pulsed field gel electrophoresis
*Spa typing
*Dru typing
*Multi-locus sequence typing
*SCCmec typing

63
Q

T or F: S schleiferi can be a human pathogen

A

True

64
Q

What is the next step you should take after removing your gloves

A

Wash your hands!

Gloves alone aren’t enough

65
Q

T or F: Staphylococcus is resistant to quaternary ammonium disinfectants and accelerated hydrogen peroxide

A

False. Staph is readily inactivated by routine disinfectants

66
Q

Why do you have to clean before you disinfect?

A

Organic debris (dirt, hair, pus) and biofilm can inhibit disinfection efficacy

67
Q

MRS genes that offer resistance to disinfectants

A

1) norA (drug efflux pump. FQs, quaternary ammonium, antiseptics)
2) qacA/B (efflux pump. Chlorhexidine)

68
Q

What gene encodes for chlorhexidine resistance in Staphy

A

qaxA/B

69
Q

What gene encodes for an efflux pump that removes fluoroquinolones and antiseptics?

A

norA

70
Q

T or F: Dogs can shed MRSP for weeks after resolution of a clinical infection— making them a potential complication for control measures

A

True

71
Q

Which MRSP dogs are the highest risk of spreading to the community

A

Those with active infections–though no actual studies on this

(avoid dog parks, kennels, etc. Unknown for how long post-infection)

They recommend restriction from contact until some clinical response to abx treatment

72
Q

How should bedding with MRSP squames be cleaned

A

Normal, low temperature laundering w/ normal detergent is effective at killing MRSP

73
Q

In which case may it make sense to screen healthy dogs for MRSP carriers?

A

If they are going to undergo surgery

*higher risk with TPLO in dogs with MRSP carriage

74
Q

T or F: Veterinary personnel are at higher risk of MRSA and MRSP carriage

A

True

EV ACVD Study (52 decks)

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