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Epidémiologie de la colonisation digestive à Staphylococcus aureus

Abstract : Despite first description in the literature in the 1960s, Staphylococcus aureus intestinal colonization is not well known. Previous works mainly investigated the carriage of methicillin-resistant S. aureus. Overall, S. aureus intestinal colonization is associated with S. aureus nasal one but exclusive intestinal carriers are also described. The screening of this carriage is not standardized and different hypotheses about its physiopathology are debated. However, the origin of this colonization remains unclear and the interrelationship with nasal colonization has been poorly studied, particularly in patients colonized with methicillin-sensitive strains of S. aureus (MSSA). Unlike S. aureus nasal colonization, whose clinical impact is well described, the clinical impact of this reservoir in association or not with nose carriage is not well studied. We showed in intensive care unit patients, that there was in a same patient a significant genetic diversity between MSSA strains isolated from nasal and rectal mucosa. We also recorded a case of an endogenous infection in an exclusive rectal carrier suggesting a role of this reservoir during S. aureus infections. During the follow-up of community patients undergoing a colonoscopy, we identified, S. aureus strains in colonic biopsies suggesting the presence of this bacterium in the intestine mucosa. Additionally, we highlighted the potential role of bowel cleansing preparation to decolonize S. aureus carriers at several sites. Finally, compared to nose sampling only, our works showed the adding value of the intestinal screening that would detect up to 17% more S. aureus carriers.
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Julie Gagnaire. Epidémiologie de la colonisation digestive à Staphylococcus aureus. Médecine humaine et pathologie. Université de Lyon, 2019. Français. ⟨NNT : 2019LYSES040⟩. ⟨tel-02894030v2⟩

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