Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is an important cause of healthcare-associated infections. Healthcare workers (HCWs) are regularly exposed to MRSA at work and, thus, at higher risk for MRSA colonization than the general population. Colonized HCWs are usually asymptomatic but may rarely develop an infection by their own MRSA carriage strains. Work-related hand eczema is common among HCWs because of the necessity for wearing of occlusive gloves and frequent hand hygiene procedures during patient care. The associated skin barrier impairment may increase the risk for MRSA acquisition which is even more enhanced in those suffering from atopic dermatitis. Apart from healthcare, animal farming and meat production have become other occupational sectors with increasing exposure to MRSA and colonization of the involved workforce. This chapter will highlight the significance of occupational MRSA colonization and infection, its predisposition and inoculation, prevention, and current treatment modalities.
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References
Aberg KM, Man MQ, Gallo RL et al (2008) Co-regulation and interdependence of the mammalian epidermal permeability and antimicrobial barriers. J Invest Dermatol 128(4):917–925
Albrich WC, Harbarth S (2008) Health-care workers: source, vector, or victim of MRSA? Lancet Infect Dis 8(5):289–301
Ammerlaan HS, Kluytmans JA, Wertheim HF et al (2009) Eradication of methicillin-resistant Staphylococcus aureus carriage: a systematic review. Clin Infect Dis 48(7):922–930
Ammerlaan HS, Kluytmans JA, Berkhout H et al (2011) Eradication of carriage with methicillin-resistant Staphylococcus aureus: determinants of treatment failure. J Antimicrob Chemother 66(10):2418–2424
Asher MI, Montefort S, Bjorksten B et al (2006) Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC phases one and three repeat multicountry cross-sectional surveys. Lancet 368(9537):733–743
Berthelot P, Grattard F, Fascia P et al (2003) Implication of a healthcare worker with chronic skin disease in the transmission of an epidemic strain of methicillin-resistant Staphylococcus aureus in a pediatric intensive care unit. Infect Control Hosp Epidemiol 24(4):299–300
Blok HE, Troelstra A, Kamp-Hopmans TE et al (2003) Role of healthcare workers in outbreaks of methicillin-resistant Staphylococcus aureus: a 10-year evaluation from a Dutch university hospital. Infect Control Hosp Epidemiol 24(9):679–685
Boguniewicz M, Leung DY (2011) Atopic dermatitis: a disease of altered skin barrier and immune dysregulation. Immunol Rev 242(1):233–246
Boost M, Ho J, Guardabassi L et al (2013) Colonization of butchers with livestock-associated methicillin-resistant Staphylococcus aureus. Zoonoses Public Health 60(8):572–576
Bootsma MC, Wassenberg MW, Trapman P et al (2011) The nosocomial transmission rate of animal-associated ST398 meticillin-resistant Staphylococcus aureus. J R Soc Interf 8(57):578–584
Brans R, Kolomanski K, Mentzel F et al (2016) Colonisation with methicillin-resistant Staphylococcus aureus and associated factors among nurses with occupational skin diseases. Occup Environ Med 73:670–675
Bunikowski R, Mielke ME, Skarabis H et al (2000) Evidence for a disease-promoting effect of Staphylococcus aureus-derived exotoxins in atopic dermatitis. J Allergy Clin Immunol 105(4):814–819
Cardona ID, Cho SH, Leung DY (2006) Role of bacterial superantigens in atopic dermatitis: implications for future therapeutic strategies. Am J Clin Dermatol 7(5):273–279
Caubet C, Jonca N, Brattsand M et al (2004) Degradation of corneodesmosome proteins by two serine proteases of the kallikrein family, SCTE/KLK5/hK5 and SCCE/KLK7/hK7. J Invest Dermatol 122(5):1235–1244
Coenraads PJ, Diepgen TL (1998) Risk for hand eczema in employees with past or present atopic dermatitis. Int Arch Occup Environ Health 71(1):7–13
Cork MJ, Robinson DA, Vasilopoulos Y et al (2006) New perspectives on epidermal barrier dysfunction in atopic dermatitis: gene-environment interactions. J Allergy Clin Immunol 118(1):3–21 quiz 22–23
Cuny C, Kock R, Witte W (2013) Livestock associated MRSA (LA-MRSA) and its relevance for humans in Germany. Int J Med Microbiol 303(6–7):331–337
Daeschlein G, von Podewils S, Bloom T et al (2015) Risk factors for MRSA colonization in dermatologic patients in Germany. J Dtsch Dermatol Ges 13(10):1015–1022
Dubin G (2005) Proteinaceous cysteine protease inhibitors. Cell Mol Life Sci 62(6):653–669
Duckworth GJ, Lothian JL, Williams JD (1988) Methicillin-resistant Staphylococcus aureus: report of an outbreak in a London teaching hospital. J Hosp Infect 11(1):1–15
Dulon M, Haamann F, Nienhaus A (2013) Involvement of occupational physicians in the management of MRSA-colonised healthcare workers in Germany – a survey. J Occup Med Toxicol 8(1):16
Dulon M, Peters C, Schablon A et al (2014) MRSA carriage among healthcare workers in non-outbreak settings in Europe and the United States: a systematic review. BMC Infect Dis 14:363
Egelrud T (2000) Desquamation. Loden M, Maibach HI Dry skin and moisturizers: chemistry and function. CRC Press. Boca Raton, 109–117
Elias PM (2005) Stratum corneum defensive functions: an integrated view. J Invest Dermatol 125(2):183–200
Elston DM (2009) Topical antibiotics in dermatology: emerging patterns of resistance. Dermatol Clin 27(1):25–31
Emmett EA (2003) Occupational contact dermatitis II: risk assessment and prognosis. Am J Contact Dermatitis 14(1):21–30
European Centre for Disease Prevention and Control (ECDC) (2017) Surveillance of antimicrobial resistance in Europe 2016. Annual report of the European Antimicrobial Resistance Surveillance Network (EARS-Net). https://doi.org/10.2900/296939
Fluit AC (2012) Livestock-associated Staphylococcus aureus. Clin Microbiol Infect 18(8):735–744
Frickmann H, Schwarz NG, Hahn A, et al (2018) Comparing a single-day swabbing regimen with an established 3-day protocol for MRSA decolonization control. Clin Microbiol Infect 24(5):522–527
Fridkin SK, Hageman JC, Morrison M et al (2005) Methicillin-resistant Staphylococcus aureus disease in three communities. N Engl J Med 352(14):1436–1444
Goerge T, Lorenz MB, van Alen S et al (2017) MRSA colonization and infection among persons with occupational livestock exposure in Europe: prevalence, preventive options and evidence. Vet Microbiol 200:6–12
Gong JQ, Lin L, Lin T et al (2006) Skin colonization by Staphylococcus aureus in patients with eczema and atopic dermatitis and relevant combined topical therapy: a double-blind multicentre randomized controlled trial. Br J Dermatol 155(4):680–687
Gonzalez T, Biagini Myers JM, Herr AB et al (2017) Staphylococcal biofilms in atopic dermatitis. Curr Allergy Asthma Rep 17(12):81
Graveland H, Wagenaar JA, Bergs K et al (2011) Persistence of livestock associated MRSA CC398 in humans is dependent on intensity of animal contact. PLoS One 6(2):e16830
Haamann F, Dulon M, Nienhaus A (2011) MRSA as an occupational disease: a case series. Int Arch Occup Environ Health 84(3):259–266
Hachem JP, Roelandt T, Schurer N et al (2010) Acute acidification of stratum corneum membrane domains using polyhydroxyl acids improves lipid processing and inhibits degradation of corneodesmosomes. J Invest Dermatol 130(2):500–510
Haslund P, Bangsgaard N, Jarlov JO et al (2009) Staphylococcus aureus and hand eczema severity. Br J Dermatol 161(4):772–777
Hawkins G, Stewart S, Blatchford O et al (2011) Should healthcare workers be screened routinely for meticillin-resistant Staphylococcus aureus? A review of the evidence. J Hosp Infect 77(4):285–289
Howell MD, Novak N, Bieber T et al (2005) Interleukin-10 downregulates anti-microbial peptide expression in atopic dermatitis. J Invest Dermatol 125(4):738–745
Ibler KS, Jemec GB, Flyvholm MA et al (2012) Hand eczema: prevalence and risk factors of hand eczema in a population of 2274 healthcare workers. Contact Dermatitis 67(4):200–207
Jappe U, Petzoldt D, Wendt C (2004) Methicillin-resistant Staphylococcus aureus colonization in inflammatory versus non-inflammatory skin diseases: who should be screened? Acta Derm Venereol 84(3):181–186
Kato T, Takai T, Mitsuishi K et al (2005) Cystatin A inhibits IL-8 production by keratinocytes stimulated with Der p 1 and Der f 1: biochemical skin barrier against mite cysteine proteases. J Allergy Clin Immunol 116(1):169–176
Khanna T, Friendship R, Dewey C et al (2008) Methicillin resistant Staphylococcus aureus colonization in pigs and pig farmers. Vet Microbiol 128(3–4):298–303
Koch-Institute CfHHaIPatR (2009) Recommendations for the prevention and control of methicillin-resistant Staphylococcus aureus isolates (MRSA) in hospitals and other healthcare facilities. GMS Krankenhhyg Interdiszip 4(1):Doc01
Kratzer C, Tobudic S, Macfelda K et al (2007) In vivo activity of a novel polymeric guanidine in experimental skin infection with methicillin-resistant Staphylococcus aureus. Antimicrob Agents Chemother 51(9):3437–3439
Lassok B, Tenhagen BA (2013) From pig to pork: methicillin-resistant Staphylococcus aureus in the pork production chain. J Food Prot 76(6):1095–1108
Lederer JW Jr, Best D, Hendrix V (2009) A comprehensive hand hygiene approach to reducing MRSA health care-associated infections. Jt Comm J Qual Patient Saf 35(4):180–185
Lode H (2009) Therapie von Infektionen durch Methicillin-resistente Staphylokokken (MRSA). Z Chemother 3:21–24
Lowy FD (1998) Staphylococcus aureus infections. N Engl J Med 339(8):520–532
Malik E, Dennison SR, Harris F et al (2016) pH dependent antimicrobial peptides and proteins, their mechanisms of action and potential as therapeutic agents. Pharmaceuticals (Basel) 9(4):E67
Marschall J, Muhlemann K (2006) Duration of methicillin-resistant Staphylococcus aureus carriage, according to risk factors for acquisition. Infect Control Hosp Epidemiol 27(11):1206–1212
Mauro T, Holleran WM, Grayson S et al (1998) Barrier recovery is impeded at neutral pH, independent of ionic effects: implications for extracellular lipid processing. Arch Dermatol Res 290(4):215–222
McFadden JP, Noble WC, Camp RD (1993) Superantigenic exotoxin-secreting potential of staphylococci isolated from atopic eczematous skin. Br J Dermatol 128(6):631–632
Meding B, Swanbeck G (1990) Predictive factors for hand eczema. Contact Dermatitis 23(3):154–161
Mele T, Madrenas J (2010) TLR2 signalling: at the crossroads of commensalism, invasive infections and toxic shock syndrome by Staphylococcus aureus. Int J Biochem Cell Biol 42(7):1066–1071
Mernelius S, Carlsson E, Henricson J et al (2016) Staphylococcus aureus colonization related to severity of hand eczema. Eur J Clin Microbiol Infect Dis 35(8):1355–1361
Miedzobrodzki J, Kaszycki P, Bialecka A et al (2002) Proteolytic activity of Staphylococcus aureus strains isolated from the colonized skin of patients with acute-phase atopic dermatitis. Eur J Clin Microbiol Infect Dis 21(4):269–276
Millar BC, Loughrey A, Elborn JS et al (2007) Proposed definitions of community-associated meticillin-resistant Staphylococcus aureus (CA-MRSA). J Hosp Infect 67(2):109–113
Miller LG, Diep BA (2008) Clinical practice: colonization, fomites, and virulence: rethinking the pathogenesis of community-associated methicillin-resistant Staphylococcus aureus infection. Clin Infect Dis 46(5):752–760
Monecke S, Coombs G, Shore AC et al (2011) A field guide to pandemic, epidemic and sporadic clones of methicillin-resistant Staphylococcus aureus. PLoS One 6(4):e17936
Morizane S, Yamasaki K, Kajita A et al (2012) TH2 cytokines increase kallikrein 7 expression and function in patients with atopic dermatitis. J Allergy Clin Immunol 130(1):259–261 e251
Mulders MN, Haenen AP, Geenen PL et al (2010) Prevalence of livestock-associated MRSA in broiler flocks and risk factors for slaughterhouse personnel in The Netherlands. Epidemiol Infect 138(5):743–755
Nakatsuji T, Gallo RL (2012) Antimicrobial peptides: old molecules with new ideas. J Invest Dermatol 132(3 Pt 2):887–895
Nomura I, Goleva E, Howell MD et al (2003) Cytokine milieu of atopic dermatitis, as compared to psoriasis, skin prevents induction of innate immune response genes. J Immunol 171(6):3262–3269
Osadebe LU, Hanson B, Smith TC et al (2013) Prevalence and characteristics of Staphylococcus aureus in Connecticut swine and swine farmers. Zoonoses Public Health 60(3):234–243
Otto M (2004) Virulence factors of the coagulase-negative staphylococci. Front Biosci 9:841–863
Park HY, Kim CR, Huh IS et al (2013) Staphylococcus aureus colonization in acute and chronic skin lesions of patients with atopic dermatitis. Ann Dermatol 25(4):410–416
Pedersen LK, Held E, Johansen JD et al (2005) Less skin irritation from alcohol-based disinfectant than from detergent used for hand disinfection. Br J Dermatol 153(6):1142–1146
Peters C, Dulon M, Kleinmuller O et al (2017) MRSA prevalence and risk factors among health personnel and residents in nursing homes in Hamburg, Germany – a cross-sectional study. PLoS One 12(1):e0169425
Reich-Schupke S, Geis G, Reising M et al (2010) MRSA in dermatology – prospective epidemiological study in employees and patients of a dermatological department of a university hospital. J Dtsch Dermatol Ges 8(8):607–613
Rioux C, Armand-Lefevre L, Guerinot W et al (2007) Acquisition of methicillin-resistant Staphylococcus aureus in the acute care setting: incidence and risk factors. Infect Control Hosp Epidemiol 28(6):733–736
Robert-Koch-Institut (2014) Empfehlungen zur Prävention und Kontrolle von Methicillin-resistenten Staphylococcus aureus-Stämmen (MRSA) in medizinischen und pflegerischen Einrichtungen. Bundesgesundheitsbl 57:696–732
Sandilands A, Sutherland C, Irvine AD et al (2009) Filaggrin in the frontline: role in skin barrier function and disease. J Cell Sci 122(Pt 9):1285–1294
Sassmannshausen R, Deurenberg RH, Kock R et al (2016) MRSA prevalence and associated risk factors among health-care workers in non-outbreak situations in the Dutch-German EUREGIO. Front Microbiol 7:1273
Schmithausen RM, Schulze-Geisthoevel SV, Stemmer F et al (2015) Analysis of transmission of MRSA and ESBL-E among pigs and farm personnel. PLoS One 10(9):e0138173
Schroder JM, Harder J (2006) Antimicrobial skin peptides and proteins. Cell Mol Life Sci 63(4):469–486
Sievert DM, Rudrik JT, Patel JB et al (2008) Vancomycin-resistant Staphylococcus aureus in the United States, 2002–2006. Clin Infect Dis 46(5):668–674
Skiest DJ, Brown K, Cooper TW et al (2007) Prospective comparison of methicillin-susceptible and methicillin-resistant community-associated Staphylococcus aureus infections in hospitalized patients. J Inf Secur 54(5):427–434
Skudlik C, Dulon M, Wendeler D et al (2009) Hand eczema in geriatric nurses in Germany – prevalence and risk factors. Contact Dermatitis 60(3):136–143
Solberg CO (2000) Spread of Staphylococcus aureus in hospitals: causes and prevention. Scand J Infect Dis 32(6):587–595
van Belkum A, Verkaik NJ, de Vogel CP et al (2009) Reclassification of Staphylococcus aureus nasal carriage types. J Infect Dis 199(12):1820–1826
Van Cleef BA, Broens EM, Voss A et al (2010) High prevalence of nasal MRSA carriage in slaughterhouse workers in contact with live pigs in The Netherlands. Epidemiol Infect 138(5):756–763
van Cleef BA, van Benthem BH, Verkade EJ et al (2014) Dynamics of methicillin-resistant Staphylococcus aureus and methicillin-susceptible Staphylococcus aureus carriage in pig farmers: a prospective cohort study. Clin Microbiol Infect 20(10):O764–O771
van Duijkeren E, Hengeveld P, Zomer TP et al (2016) Transmission of MRSA between humans and animals on duck and turkey farms. J Antimicrob Chemother 71(1):58–62
Verkade E, Kluytmans J (2014) Livestock-associated Staphylococcus aureus CC398: animal reservoirs and human infections. Infect Genet Evol 21:523–530
Weese JS, Archambault M, Willey BM et al (2005) Methicillin-resistant Staphylococcus aureus in horses and horse personnel, 2000–2002. Emerg Infect Dis 11(3):430–435
Wertheim HF, Melles DC, Vos MC et al (2005) The role of nasal carriage in Staphylococcus aureus infections. Lancet Infect Dis 5(12):751–762
Winnefeld M, Richard MA, Drancourt M et al (2000) Skin tolerance and effectiveness of two hand decontamination procedures in everyday hospital use. Br J Dermatol 143(3):546–550
Witte W, Braulke C, Cuny C et al (2005a) Emergence of methicillin-resistant Staphylococcus aureus with Panton-Valentine leukocidin genes in central Europe. Eur J Clin Microbiol Infect Dis 24(1):1–5
Witte W, Wiese-Posselt M, Jappe U (2005b) Community-based MRSA. A new challenge for dermatology. Hautarzt 56(8):731–738
Witte W, Strommenger B, Stanek C et al (2007) Methicillin-resistant Staphylococcus aureus ST398 in humans and animals, Central Europe. Emerg Infect Dis 13(2):255–258
Wulf MW, Tiemersma E, Kluytmans J et al (2008) MRSA carriage in healthcare personnel in contact with farm animals. J Hosp Infect 70(2):186–190
Yamasaki O, Yamaguchi T, Sugai M et al (2005) Clinical manifestations of staphylococcal scalded-skin syndrome depend on serotypes of exfoliative toxins. J Clin Microbiol 43(4):1890–1893
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Brans, R., Kaup, O., Schürer, N.Y. (2020). Occupational MRSA Infection: Risk Factor, Disposition, Prevention, and Therapy. In: John, S., Johansen, J., Rustemeyer, T., Elsner, P., Maibach, H. (eds) Kanerva’s Occupational Dermatology. Springer, Cham. https://doi.org/10.1007/978-3-319-68617-2_98
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