Isolation of methicillin-resistant Staphylococci in the dental operatory

doi:10.1016/S0099-2399(06)80552-2

Journal of Endodontics

Volume 21, Issue 1, January 1995, Pages 21-25

https://doi.org/10.1016/S0099-2399(06)80552-2 Get rights and content

The state of contamination by methicillin-resistant Staphylococci, including methicillin-resistant Staphylococcus aureus (MRSA) at the conservative dentistry section of the School of Dentistry, Aichi-Gakuin University, was investigated. Methicillin-resistant coagulase-negative Staphylococci (MRCNS) were detected in 8 (20.5%) of 39 dental staff (28 dentists, 8 dental hygienists, and 3 dental assistants), but MRSA was not detected. MRCNS was also detected in locations such as the dental chair, dental bracket, dental cabinet, and floor, as well as in airborne samples. The presence of the same strain in both the oral cavity of staff persons and the dental chair/floor locations was determined by biochemical properties, antibiotic sensitivity tests, and electrophoretic patterns.

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Cited by (18)

Staphylococcus aureus nasal colonization among dental health care workers in Northern Germany (StaphDent study)
2021, International Journal of Medical Microbiology
Citation Excerpt :
Risk factors for MRSA acquisition outside the hospital settings include direct contact to persons from countries with high MRSA rates and intensive husbandry (Buenaventura-Alcazaren et al., 2020; Köck et al., 2016; van Dulm et al., 2020). MRSA may also be carried by dental healthcare workers (DHCWs), students and patients, and can be recovered from dental surfaces (Apolonio-Alonso et al., 2011; Horiba et al., 1995; Kurita et al., 2006; Martínez-Ruíz et al., 2014; Petti and Polimeni, 2011; Roberts et al., 2011). However, studies on the prevalence of MRSA and methicillin-susceptible S. aureus (MSSA) among DHCW are scarce (Albrich and Harbarth, 2008; Petti and Polimeni, 2011; Reddy, 2010).
Methicillin-resistant Staphylococcus aureus (MRSA) can colonize dental patients and students, however, studies on the prevalence of MRSA and methicillin-susceptible S. aureus (MSSA) among dental health care workers (DHCW) including use of personal protective equipment (PPE) are scarce. We conducted an observational study (StaphDent study) to (I) determine the prevalence of MRSA and MSSA colonization in DHCW in the region of Mecklenburg Western-Pomerania, Germany, (II) resolve the S. aureus population structure to gain hints on possible transmission events between co-workers, and (III) clarify use of PPE. Nasal swabs were obtained from dentists (n = 149), dental assistants (n = 297) and other dental practice staff (n = 38). Clonal relatedness of MSSA isolates was investigated using spa typing and, in some cases, whole genome sequencing (WGS). PPE use was assessed by questionnaire. While 22.3% (108/485) of the participants were colonized with MSSA, MRSA was not detected. MSSA prevalence was not associated with size of dental practices, gender, age, or duration of employment. The identified 61 spa types grouped into 17 clonal complexes and four sequence types. Most spa types (n = 47) were identified only once. In ten dental practices one spa type occurred twice. WGS data analysis confirmed a close clonal relationship for 4/10 isolate pairs. PPE was regularly used by most dentists and assistants. To conclude, the failure to recover MRSA from DHCW reflects the low MRSA prevalence in this region. Widespread PPE use suggests adherence to routine hygiene protocols. Compared to other regional HCW MRSA rates the consequent usage of PPE seems to be protective.
Detection of Staphylococcus aureus (MRSA/MSSA) in surfaces of dental medicine equipment
2020, Saudi Journal of Biological Sciences
Citation Excerpt :
Published data varies in accordance with the analysed surfaces. In the study of Horiba et al. (1995) no MRSA positive samples were detected, however these researchers observed MSSA in the chair and in samples collected from the air and floor. Williams et al. (2003) stated as the most contaminated surfaces the floor, the head board, the light and also the working uniform.
Methicillin-Resistant Staphylococcus aureus (MRSA) represents one of the major causes of nosocomial infections, leading to high mortality. Surfaces in clinics, as well as the attending uniform and the hands of the dental doctor can be MRSA reservoirs. Having this in mind, the purpose of this study was to evaluate the presence of Methicillin-Sensitive Staphylococcus aureus (MSSA) and MRSA on dental medicine equipment surfaces. 354 Samples were collected from six equipment surfaces in six attendance areas before and after patient consultation and cultured in a selective medium. Polymerase Chain Reaction (PCR) was used to confirm the identity of bacterial strains as MRSA or MSSA. Data analysis was performed with chi-square tests with Bonferroni correction. It was observed 55.6% of uncontaminated samples. Contamination was: 17.5% MRSA (5.9% of samples collected before patient attendance and 11.6% after); 39.3% MSSA (14.1% collected before and 25.2% after). The prevalence of MRSA and MSSA was significantly higher after patient care. Integrated Clinic represented the most contaminated attendance area (MRSA − 41.7%, MSSA − 51.2%), the chair arm rest was the most contaminated surface for MRSA (29.7%) and the dental spittoon the most contaminated surface for MSSA (23.5%). Although a low level of contamination was observed, dental clinics, through patients possibly carrying bacteria, may be reservoirs for MRSA and MSSA transmission, and might contribute to potential nosocomial infections.
Higher nasal carriage rate of methicillin-resistant Staphylococcus aureus among dental students who have clinical experience
2016, Journal of the American Dental Association
Citation Excerpt :
MRSA is most frequently transmitted via the transiently contaminated hands of HCPs, including DHCPs.11,18,19 Investigators have suggested that contaminated environmental surfaces can play a minor role in MRSA transmission.8,9,11,15,19 Thus, direct or indirect contact with a patient or the environment are the main routes of MRSA transmission.11,20
Methicillin-resistant Staphylococcus aureus (MRSA) has been isolated from dental clinical surfaces, dental patients, and dental health care professionals. The authors conducted a study to determine the prevalence rate of nasal MRSA colonization among dental school students and to identify the characteristics of the isolated strains.
The authors collected nasal samples from 159 dental students. The authors performed mecA gene detection, staphylococcal cassette chromosome mec (SCCmec) typing, and antimicrobial susceptibility tests on each sample. The authors compared the results of 2 groups (students who had clinical experience and students who did not have clinical experience).
Five (3.1%) dental students had MRSA colonization, as confirmed by the presence of the mecA gene in the nasal cavity. Prior clinical experience was associated significantly with nasal MRSA carriage (P < .05). Four of the strains were SCCmec type IV, and 1 strain was SCCmec type I. All isolates were resistant to amoxicillin and clavulanic acid, imipenem, and oxacillin, but were susceptible to several antimicrobial agents including mupirocin, trimethoprim and sulfamethoxazole, and rifampin. The nasal MRSA colonization was eradicated with the use of mupirocin ointment.
Nasal MRSA colonization occurs in some dental students, especially those who have clinical experience.
Education about MRSA colonization and transmission, as well as infection prevention and control measures is necessary for dental students, especially when they participate in clinical practice.
Multisystem complications following endodontic therapy
2012, Journal of Oral and Maxillofacial Surgery
Citation Excerpt :
Although MRSA colonize the oral cavity and denture surfaces, reports of serious odontogenic infection are rare. In 1995, Horiba et al14 identified methicillin-resistant coagulase-negative staphylococci contamination on multiple surfaces, including more than 20% of health care providers tested, in a dental school setting in Japan. Mehra et al15 in 1999 described a case of MRSA infection leading to acute sinusitis and orbital cellulitis after tooth extraction.
Methicillin-resistant Staphylococcus aureus from dental school clinic surfaces and students
2011, American Journal of Infection Control
Citation Excerpt :
The remaining 7 students’ MRSA isolates had 7 different ST types, including 2 new ST types, ST1474 and ST1475, and by PFGE patterns represented distinct strains (Table 1). This is the first isolation and characterization of MRSA strains from dental clinic surfaces not associated with hospital setting, although a 1995 study found methicillin-resistant, coagulase-negative Staphylococcus spp from some of the same dental clinic surfaces as the current study.17 A more recent study indicates that dental operatories within the hospital may also become contaminated and be a potential reservoir for a nosocomial multidrug-resistant MRSA outbreak in hospitalized patients.18
Methicillin-resistant Staphylococcus aureus (MRSA) isolated from frequently touched dental school clinic surfaces were compared with MRSA isolated nasal cultures of dental students.
Sixty-one dental students and 95 environmental surfaces from 7 clinics were sampled using SANICULT (Starplex Scientific Inc, Etobicoke, Ontario, Canada) swabs. Antimicrobial susceptibility testing was performed, and pulsed-field gel electrophoresis analysis, the mecA gene, multilocus sequence type, and SCCmec type were determined by polymerase chain reaction and sequencing.
Thirteen (21%) dental students and 8 (8.4%) surfaces were MRSA positive. Three MRSA strains were SCCmec type IV, whereas 3 were nontypeable isolates and Panton-Valentine leukocidin positive (PVL+), and none were USA300. One surface and 1 student isolate shared the same multilocus sequence type ST 8 and were 75% related. Two groups of students carried the same MRSA strains.
The MRSA-positive samples were from 4 of 7 dental clinics. In addition, 21% of the dental students carried MRSA, which is > 10 times higher than the general public and twice as frequent as in other university students. This is the first study to characterize MRSA from dental clinic surfaces and dental students and suggests that both may be reservoirs for MRSA. Further studies are needed to verify this premise.
Bacterial resistance and the dental professionals' role to halt the problem
2008, Journal of Dentistry
In the present review, background information on bacterial antibiotic resistance is presented to dental practitioners. The review provides practical advice for dental professionals to combat and halt bacterial resistance.
Antibiotic use over time has led to the emergence of infectious bacteria that are resistant to several antibiotics. Bacterial resistance is now considered a major threat to public health, and control of resistance is an international priority. Here, we present the current basic knowledge on bacterial antibiotic resistance to dental professionals, and discuss their role in combating and halting resistance.
The material presented in this review is primarily based on peer-reviewed literature searches in Medline using the phrase “antibiotic resistance” and the following key words: natural, acquired, mechanisms, use, dentists, and role.
Antibiotic resistance is a global problem, and dentists must be involved in halting it. Prudent and judicious use of antibiotic by dentists is an essential method for combating bacterial resistance. Health authorities are encouraged to monitor trends in antibiotic prescriptions by dentists and measure antibiotic consumption in order to assess and limit antibiotic use.

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¹: Drs. Horiba, Yoshida, Suzuki, Maekawa, Ito, Matsumoto, and Nakamura are in the Department of Endodontics, School of Dentistry, Aichi-Gakuin University, Nagoya, Japan.

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Journal of Endodontics

References (12)

Epidemiology of nosocomial infections caused by methicillin-resistant Staphylococcus aureus

Ann Intern Med

Effectiveness of simple measures to control an outbreak of nosocomial methicillin-resistant Staphylococcus aureus infections in an intensive care unit

Infect Control Hosp Epidemiol

Genomic DNA fingerprinting by pulsed-field gel electrophoresis as an epidemiological marker for study of nosocomial infections caused by methicillin-resistant Staphylococcus aureus

J Clin Microbiol

Isolation and characterization of staphylococci from human skin. I. Amended descriptions of S. epidermidis and S. saprophyticus and descriptions of three new species: S. cohnii, S. haemolyticus and S. xylosus

Int J Syst Bacteriol

Isolation and characterization of staphylococci from human skin. II. Descriptions of four new species; S. warneri, S. capitis, S. hominis and S. simulans

Int J Syst Bacteriol

Coagulase-negative staphylococci resistant to β-lactam antibiotics in vivo produce penicillin-binding protein 2a

Antimicrob Agents Chemother

Cited by (18)

Staphylococcus aureus nasal colonization among dental health care workers in Northern Germany (StaphDent study)

Detection of Staphylococcus aureus (MRSA/MSSA) in surfaces of dental medicine equipment

Higher nasal carriage rate of methicillin-resistant Staphylococcus aureus among dental students who have clinical experience

Multisystem complications following endodontic therapy

Methicillin-resistant Staphylococcus aureus from dental school clinic surfaces and students

Bacterial resistance and the dental professionals' role to halt the problem