Hostname: page-component-78c5997874-lj6df Total loading time: 0 Render date: 2024-11-18T16:24:15.213Z Has data issue: false hasContentIssue false
  • English
  • Français

Risk of Methicillin-Resistant Staphylococcus aureus Transmission in the Dental Healthcare Setting: A Narrative Review

Published online by Cambridge University Press:  02 January 2015

Stefano Petti  and
Antonella Polimeni
Stefano Petti*
Affiliation:
Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy
Antonella Polimeni
Affiliation:
Department of Dental and Maxillofacial Sciences, Sapienza University, Rome, Italy
*
Department of Public Health and Infectious Diseases, Sanarelli Hygiene Building, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy (stefano.petti@uniroma1.it)
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

Information on the risk of methicillin-resistant Staphylococcus aureus (MRSA) infection transmission in dental healthcare settings was incomplete only few years ago; therefore, MRSA infection control guidelines were necessarily based on data extrapolated from other fields. Recently, publication of specific studies have made it possible to review such risk.

Methods.

Studies of MRSA infection in dentistry were searched for using EMBASE, MEDLINE, and Google and were allocated into the following sections: (1) direct evidence: documented cases of MRSA transmission in dentistry; (2) indirect evidence: carriage rates among dental healthcare providers (DHCPs) and patients (high carriage rates suggest that transmission is likely); (3) speculative evidence: MRSA occurrence in the dental environment (high environmental contamination probably increases the risk of infection); and (4) speculative evidence: MRSA carriage in human dental plaque and saliva (oral carriers may spread MRSA in the environment during dental therapy, with consequent environmental contamination and probable increased risk of infection).

Results.

Our findings were as follows. First, transmission has been ascertained during surgical interventions, particularly in surgical units and among head and neck cancer patients. Second, carriage rates among DHCPs were lower than those among other healthcare workers. Carriage rates among adult patients were low, whereas among pedodontic and special care patients rates were higher than those in the general population. Third, MRSA has been detected in the environment of emergency and surgical units and in dental hospitals. Some individuals in poor general condition were oral MRSA carriers.

Conclusions.

The occupational risk of MRSA infection among DHCPs is minimal. Among special patients (eg, special care, hospitalized and cancer patients) the risk of infection is high, whereas among the remaining patients undergoing conventional therapy such risk is probably low.

Type
Review Article
Information
Infection Control & Hospital Epidemiology , Volume 32 , Issue 11 , November 2011 , pp. 1109 - 1115
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Deurenberg, RH, Stobberingh, EE. The evolution of Staphylococcus aureus. Infect Genet Evol 2008;8:747–763.Google Scholar
2.Noskin, GA, Rubin, RJ, Schentag, JJ, et al. National trends in Staphylococcus aureus infection rates: impact on economic burden and mortality over a 6-year period (1998–2003). Clin Infect Dis 2007;45:1132–1140.Google Scholar
3.Köck, R, Becker, K, Cookson, B, et al. Methicillin-resistant Staphylococcus aureus (MRSA): burden of disease and control challenges in Europe. Euro Surveill 2010;1 5:19688.Google Scholar
4.Calfee, DP, Salgado, CD, Classen, D, et al. Strategies to prevent transmission of methicillin-resistant Staphylococcus aureus in acute care hospitals. Infect Control Hosp Epidemiol 2008;29(suppl 1):S62–S80.CrossRefGoogle Scholar
5.Shah, SM, Merchant, AT, Dosman, JA. Percutaneous injuries among dental professionals in Washington State. BMC Public Health 2006;6:269.CrossRefGoogle ScholarPubMed
6.Cleveland, JL, Barker, LK, Cuny, EJ, Panlilio, AL; National Surveillance System for Health Care Workers Group. Preventing percutaneous injuries among dental health care personnel. J Am Dent Assoc 2007;138:169–178.CrossRefGoogle ScholarPubMed
7.Micik, RE, Miller, RL, Mazzarella, MA, Ryge, G. Studies on dental aerobiology. I. Bacterial aerosols generated during dental procedures. J Dent Res 1969;48:49–56.CrossRefGoogle ScholarPubMed
8.Miller, RL, Micik, RE, Abel, C, Ryge, G. Studies on dental aerobiology. II. Microbial splatter discharged from the oral cavity of dental patients. J Dent Res 1971;50:621–625.CrossRefGoogle ScholarPubMed
9.Kohn, WG, Collins, AS, Cleveland, JL, et al. Guidelines for infection control in dental health-care settings—2003. MMWR Recomm Rep 2003;52(RR-17):1–61.Google Scholar
10.Duffy, RE, Cleveland, JL, Hutin, YJ, Cardo, D. Evaluating infection control practices among dentists in Välcea, Romania, in 1998. Infect Control Hosp Epidemiol 2004;25:570–575.Google Scholar
11.Elkarim, IA, Abdulla, ZA, Yahia, NA, Al Qudah, A, Ibrahim, YE. Basic infection control procedures in dental practice in Khartoum-Sudan. Int Dent J 2004;54:413–417.CrossRefGoogle ScholarPubMed
12.Chidzonga, M, Makoni, F, Mahomva, L. Infection control among dental therapists in Zimbabwe. Cent Afr J Med 2006;52:83–87.Google Scholar
13.Al Negrish, A, Al Momani, AS, Al Sharafat, F. Compliance of Jordanian dentists with infection control strategies. Int Dent J 2008;58:231–236.Google Scholar
14.Uti, OG, Agbelusi, GA, Jeboda, SO, Ogunbodede, E. Infection control knowledge and practices related to HIV among Nigerian dentists. J Infect Dev Ctries 2009;3:604–610.Google Scholar
15.Petti, S, Polimeni, A. The rationale of guidelines for infection control in dentistry: precautionary principle or acceptable risk? Infect Control Hosp Epidemiol 2010;31:1308–1310.CrossRefGoogle ScholarPubMed
16.Smith, AJ, Jackson, MS, Bagg, J. The ecology of Staphylococcus species in the oral cavity. J Med Microbiol 2001;50:940–946.CrossRefGoogle ScholarPubMed
17.British Dental Association. Infection Control in Dentistry: BDA Advice Sheet 12. London: British Dental Association, 2003.Google Scholar
18.Klevens, RM, Gorwitz, RJ, Collins, AS. Methicillin-resistant Staphylococcus aureus: a primer for dentists. J Am Dent Assoc 2008;139:1328–1337.CrossRefGoogle ScholarPubMed
19.Albrich, WC, Harbarth, S. Health-care workers: source, vector, or victim of MRSA? Lancet Infect Dis 2008;8:289–301.Google Scholar
20.Martin, MV, Hardy, P. Two cases of oral infection by methicillin-resistant Staphylococcus aureus. Br Dent J 1991;170:63–64.CrossRefGoogle ScholarPubMed
21.Kurita, H, Kurashina, K, Honda, T. Nosocomial transmission of methicillin-resistant Staphylococcus aureus via the surfaces of the dental operatory. Br Dent J 2006;201:296–300.CrossRefGoogle ScholarPubMed
22.Valand, K, McLoughlin, PM. MRSA infection. Br Dent J 2009;207:304.Google Scholar
23.Fox, C. Evidence summary: what “cost of illness” evidence is there about cross-infection related infections in dental practice? Br Dent J 2010;209:87–88.Google Scholar
24.Ishiwada, N, Niwa, K, Tateno, S, Yoshinaga, M, Terai, M, Nakazawa, M. Causative organism influences clinical profile and outcome of infective endocarditis in pediatric patients and adults with congenital heart disease. Circ J 2005;69:1266–1270.CrossRefGoogle ScholarPubMed
25.Parton, M, Beasley, NJP, Harvey, G, Houghton, D, Jones, AS. Four cases of aggressive MRSA wound infection following head and neck surgery. J Laryngol Otol 1997;111:874–876.CrossRefGoogle ScholarPubMed
26.Mitchell, TE, Pickles, JM. Four cases of aggressive MRSA wound infection following head and neck surgery. J Laryngol Otol 1998;112:422.CrossRefGoogle ScholarPubMed
27.Supriya, M, Shakeel, M, Santangeli, L, Ah-See, KW. Controlling MRSA in head and neck cancer patients: what works? Otolaryngol Head Neck Surg 2009;140:224–227.Google Scholar
28.Jeannon, JP, Orabi, A, Manganaris, A, Simo, R. Methicillin resistant Staphylococcus aureus infection as a causative agent of fistula formation following total laryngectomy for advanced head and neck cancer. Head Neck Oncol 2010;2:14.Google Scholar
29.Morimoto, Y, Sugiura, T, Tatebayashi, S, Kirita, T. Reduction in incidence of methicillin-resistant Staphylococcus aureus (MRSA) after radical surgery for head and neck cancer. Spec Care Dent 2006;26:209–213.CrossRefGoogle ScholarPubMed
30.Rogers, SN, Proczek, K, Sen, RA, Hughes, J, Banks, P, Lowe, D. Which patients are most at risk of methicillin resistant Staphylococcus aureus: a review of admissions to a regional maxillofacial ward between 2001 and 2005. Br J Oral Maxillofac Surg 2008;46:439–444.Google Scholar
31.Cohen, MA, Embil, JM, Canosa, T. Osteomyelitis of the maxilla caused by methicillin-resistant Staphylococcus aureus. J Oral Maxillofac Surg 2003;61:387–390.Google Scholar
32.Tuzuner-Oncul, AM, Ungor, C, Dede, U, Kisnisci, RS. Methicillin-resistant Staphylococcus aureus (MRSA) osteomyelitis of the mandible. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009;107:e1–e4.Google Scholar
33.Suga, Y, Tsuboi, R, Kobayashi, S, Ogawa, H. A case of Behcet's disease aggravated by gingival infection with methicillin-resistant Staphylococcus aureus. Br J Dermatol 1995;133:319–321.CrossRefGoogle ScholarPubMed
34.Sa-Leao, R, Sanches, IS, Couto, I, Alves, CR, de Lencastre, H. Low prevalence of methicillin-resistant strains among Staphylococcus aureus colonizing young and healthy members of the community in Portugal. Microb Drug Resist 2001;7:237–245.CrossRefGoogle Scholar
35.Karapsias, S, Piperaki, ET, Spiliopoulou, I, Katsanis, G, Tseleni-Kotsovili, A. Methicillin-resistant Staphylococcus aureus nasal carriage among healthy employees of the Hellenic Air Force. Euro Surveill 2008;13:18999.CrossRefGoogle ScholarPubMed
36.MIa, Rijnders, Nys, S, Driessen, C, et al. Staphylococcus aureus carriage among GPs in the Netherlands. Br J Gen Pract 2010;60:902–906.Google Scholar
37.Akhtar, N. Staphylococcal nasal carriage of health care workers. J Coll Physicians Surg Pak 2010;20:439–443.Google Scholar
38.Kjerulf, A, Skov, RL, Forsberg, C, Larsen, T, Fiehn, NE. The prevalence of carriers of methicillin resistant Staphylococcus aureus in Copenhagen. http://www.copanswabs.com/studies/download.php?id = 713. Accessed March 27, 2011.Google Scholar
39.Negrini Tde, C, Duque, C, Mascarenhas de Oliveira, AC, Hebling, J, Spolidorio, LC, Spolidorio, DMP. Staphylococcus aureus contamination in a pediatric dental clinic. J Clin Pediatr Dent 2009;34:13–18.Google Scholar
40.Horiba, N, Yoshida, T, Suzuki, K, et al. Isolation of methicillin-resistant staphylococci in the dental operatory. J Endod 1995;21:21–25.CrossRefGoogle ScholarPubMed
41.Pereira, ML, do Carmo, LS, Souki, MQ, dos Santos, EJ, de Carvalho, MA, Bergdoll, MS. Staphylococci from dental personnel. Braz Dent J 1999;10:39–45.Google ScholarPubMed
42.Reddy, Y. Prevalence of methicillin-resistant Staphylococcus aureus (MRSA) nasal colonization among dental professionals [MPH thesis]. Ann Arbor, MI: ProQuest, 2010.Google Scholar
43.Tawara, Y, Honma, K, Naito, Y. Methicillin-resistant Staphylococcus aureus and Candida albicans on denture surfaces. Bull Tokyo Dent Coll 1996;37:119–128.Google Scholar
44.Kitada, K, de Toledo, A, Oho, T. Increase in detectable opportunistic bacteria in the oral cavity of orthodontic patients. Int J Dent Hyg 2009;7:121–125.Google Scholar
45.Buonavoglia, A, Latronico, F, Greco, MF, et al. Methicillin-resistant staphylococci carriage in the oral cavity, a study conducted in Bari (Italy). Oral Dis 2010;16:465–468.Google Scholar
46.Miyake, Y, Iwai, T, Sugai, M, Miura, K, Suginaka, H, Nagasaka, N. Incidence and characterization of Staphylococcus aureus from the tongues of children. J Dent Res 1991;70:1045–1047.CrossRefGoogle ScholarPubMed
47.Schlesinger, Y, Yahalom, S, Raveh, D, et al. Methicillin-resistant Staphylococcus aureus nasal colonization in children in Jerusalem: community vs. chronic care institutions. Isr Med Assoc J 2003;5:847–851.Google ScholarPubMed
48.Zimmerli, M, Widmer, AF, Dangel, M, Filippi, A, Frei, R, Meyer, J. Methicillin-resistant Staphylococcus aureus (MRSA) among dental patients: a problem for infection control in dentistry? Clin Oral Investig 2009;13:369–373.CrossRefGoogle ScholarPubMed
49.Abe, S, Ishihara, K, Okuda, K. Prevalence of potential respiratory pathogens in the mouths of elderly patients and effects of professional oral care. Arch Gerontol Geriatr 2001;32:45–55.CrossRefGoogle ScholarPubMed
50.Stout, FW, Lado, EA, Broumand, V. Identification of pathogens in the condensates from air pressure systems in dental offices. Dent Today 1991;10:26–29.Google ScholarPubMed
51.Barbeau, J, ten Bokum, L, Gauthier, C, Prevost, AP. Cross-contamination potential of saliva ejectors used in dentistry. J Hosp Infect 1998;40:303–311.Google Scholar
52.El-Maaytah, M, Drydaki, M, Jerjes, W, et al. Evaluation of airborne contamination with Staphylococcus aureus and MRSA at the Eastman Dental College. Br J Oral Maxillofac Surg 2007;45:e24–e25.CrossRefGoogle Scholar
53.Motta, RH, Groppo, FC, Bergamaschi Cde, C, Ramacciato, JC, Baglie, S, de Mattos-Filho, TR. Isolation and antimicrobial resistance of Staphylococcus aureus isolates in a dental clinic environment. Infect Control Hosp Epidemiol 2007;28:185–190.CrossRefGoogle Scholar
54.Cuesta, A, Nastri, N, Bernat, M, et al. Survival of Staphylococcus aureus on fomites. Acta Odontol Latinoam 2008;21:141–146.Google ScholarPubMed
55.van der Reijden, WA, Rood, M, Heijers, JM, CMJE, Vanderbroucke-Grauls, de Soet, JJ. Survival of bacteria on uniforms in relation to risk management in dental clinics. J Hosp Infect 2009;73:283–285.Google Scholar
56.Bernardo, WL, Boriollo, MFG, Goncalves, RB, Höfling, JF. Staphylococcus aureus ampicillin-resistant from odontological clinic environment. Rev Inst Med Trop S Paulo 2005;47:19–24.Google Scholar
57.Lauderdale, TL, Wang, JT, Lee, WS, et al. Carriage rates of methicillin-resistant Staphylococcus aureus (MRSA) depend on anatomic location, the number of sites cultured, culture methods, and the distribution of clonotypes. Eur J Clin Microbiol Infect Dis 2010;29:1553–1559.Google Scholar
58.Kuehnert, MJ, Kruszon-Moran, D, Hill, HA, et al. Prevalence of Staphylococcus aureus nasal colonization in the United States, 2001-2002. J Infect Dis 2006;193:172–179.CrossRefGoogle ScholarPubMed
59.Scannapieco, FA, Stewart, EM, Mylotte, JM. Colonization of dental plaque by respiratory pathogens in medical intensive care patients. Crit Care Med 1992;20:740–745.CrossRefGoogle ScholarPubMed
60.Tada, A, Watanabe, T, Yokoe, H, Hanada, N, Tanzawa, H. Oral bacteria influenced by the functional status of the elderly people and the type and quality of facilities for the bedridden. J Appl Microbiol 2002;93:487–491.Google Scholar
61.Tada, A, Senpuku, H, Motozawa, Y, Yoshihara, A, Hanada, N, Tanzawa, H. Association between commensal bacteria and opportunistic pathogens in the dental plaque of elderly individuals. Clin Microbiol Infect 2006;12:776–781.CrossRefGoogle ScholarPubMed
62.Smith, AJ, Brewer, A, Kirkpatrick, P, et al. Staphylococcal species in the oral cavity from patients in a regional burns unit. J Hosp Infect 2003;55:184–189.CrossRefGoogle Scholar
63.Binkley, CJ, Haugh, GS, Kitchens, DH, Wallace, DL, Sessler, DI. Oral microbial and respiratory status of persons with mental retardation/intellectual and developmental disability: an observational cohort study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009;108:722–731.CrossRefGoogle ScholarPubMed
64.Krasse, B. The relationship between lactobacilli, Candida and streptococci and dental caries: examination of saliva and plaque material collected on the same occasion. Odontol Revy 1954;5:241–261.Google ScholarPubMed
65.de Carvalho, MJ, Pimenta, FC, Hayashida, M, et al. Prevalence of methicillin-resistant and methicillin-susceptible S. aureus in the saliva of health professionals. Clinics 2009;64:295–302.Google Scholar
66.Egusa, H, Watamoto, T, Abe, K, et al. An analysis of the persistent presence of opportunistic pathogens on patient-derived dental impressions and gypsum casts. Int J Prosthodont 2008;21:62–68.Google ScholarPubMed
67.Zuanazzi, D, Souto, R, Mattos, MB, et al. Prevalence of potential bacterial respiratory pathogens in the oral cavity of hospitalised individuals. Arch Oral Biol 2010;55:21–28.CrossRefGoogle ScholarPubMed
68.Owen, MK. Prevalence of oral methicillin-resistant Staphylococcus aureus in an institutionalized veterans population. Spec Care Dent 1994;14:75–79.Google Scholar
69.Smith, AJ, Robertson, D, Tang, MK, Jackson, MS, MacKenzie, D, Bagg, J. Staphylococcus aureus in the oral cavity: a three-year retrospective analysis of clinical laboratory data. Br Dent J 2003; 195:701–703.Google Scholar
70.Mattner, F, Biertz, F, Ziesing, S, Gastmeier, P, Chaberny, IF. Long-term persistence of MRSA in re-admitted patients. Infection 2010;38:363–371.Google Scholar
71.Millar, MR, Walsh, TR, Linton, CJ, et al. Carriage of antibiotic-resistant bacteria by healthy children. J Antimicrob Chemother 2001;47:605–610.CrossRefGoogle ScholarPubMed
72.Kaklamanos, EG, Charalampidou, M, Menexes, G, Topitsoglou, V, Kalfas, S. Transient oral microflora in Greeks attending day centres for the elderly and residents in homes for the elderly. Gerodontology 2005;22:158–167.Google Scholar
73.Jackson, MS, Bagg, J, Gupta, MN, Sturrock, RD. Oral carriage of staphylococci in patients with rheumatoid arthritis. Rheumatology (Oxford) 1999;38:572–575.CrossRefGoogle ScholarPubMed
74.Kamaguchi, A, Nakayama, K, Ichiyama, S, et el. Effect of Porphyromonas gingivalis vesicles on coaggregation of Staphylococcus aureus to oral microorganisms. Curr Microbiol 2003;47:485–491.CrossRefGoogle ScholarPubMed
75.Uehara, Y, Kikuchi, K, Nakamura, T, et al. HM202 produced by viridans group streptococci may contribute to inhibition of methicillin-resistant Staphylococcus aureus colonization of oral cavities in newborns. Clin Infect Dis 2001;32:1408–1413.Google Scholar
76.Uehara, Y, Agematsu, K, Kikuchi, K, et al. Secretory IgA, salivary peroxidase, and catalase-mediated microbicidal activity during hydrogen peroxide catabolism in viridans streptococci: pathogen coaggregation. J Infect Dis 2006;194:98–107.Google Scholar
77.Uehara, Y, Kikuchi, K, Nakamura, T, et al. Inhibition of methicillin-resistant Staphylococcus aureus colonization of oral cavities in newborns by viridans group streptococci. Clin Infect Dis 2001;32:1399–1407.Google Scholar