It is possible not to treat staphylococcus aureus in a weak form. Research on bacteriocarrier. Diseases caused by staphylococcus aureus

In nature, there are more than 27 types of staphylococci. Most of them are absolutely harmless to humans. A separate "sad" niche in this variety of staphylococcal bacteria is occupied by Staphylococcus aureus as one of the common causes of purulent-septic lesions of the human body at any age.

Facts about Staphylococcus aureus:

ROUTES OF INFECTION

The source of infection with staphylococcal infection can be a sick person or a bacteriocarrier.

Risk factors for staph infection:

• Any damage to the skin and mucous membranes - cracks, abrasions, punctures, etc.
• Failure to comply with basic rules of personal hygiene.
• Primary or secondary immunodeficiency, such as AIDS.
• Prematurity.
• Long-term use of antibacterial, hormonal or immunosuppressive drugs.
• Adverse environmental factors.
• Chronic somatic pathology, such as diabetes mellitus, thyroid disease, etc.
• Acute and chronic infectious diseases of any localization, as well as other pathological conditions.

SYMPTOMS

Manifestations of infection with Staphylococcus aureus depend on the place of introduction and aggressiveness of the pathogen, as well as the state of the patient's immune system.

Staphylococcus aureus can affect almost all tissues of the body - from the skin to the peritoneum and internal organs. It can also cause general blood poisoning.

The most common diseases caused by S. aureus are:

• Various pustular skin lesions - pyoderma. According to the depth of the inflammatory lesion, folliculitis, boils, carbuncles, abscesses and phlegmon are distinguished.
• Purulent mastitis in lactating women.
• Damage to the upper respiratory tract - rhinitis, sinusitis, pharyngitis, laryngitis, etc. The main symptom of Staphylococcus aureus in these cases is the presence of purulent discharge from the nasopharynx.
• Bronchitis, pneumonia and pleurisy. Staphylococcal pneumonia is especially difficult. Intoxication symptoms, pain in the chest are expressed, since the pleura is often involved in the pathological process. The formation of purulent foci (abscesses) in the lung tissue is characteristic, which can break through into the pleural cavity - empyema.
• This pathogen is the leading cause of purulent lesions of the musculoskeletal system (osteomyelitis and arthritis). Such pathological conditions develop more often in adolescents. In adults, staphylococcal arthritis often develops against the background of existing rheumatism or after joint replacement.
• Damage to the inner lining of the heart - endocarditis. Occurs in approximately one in ten patients with bacteremia. In this case, in a short time, the destruction of the heart valves occurs with the occurrence of severe complications and a high frequency of deaths.
• The toxins produced by Staphylococcus aureus sometimes cause severe intoxication of the human body - food poisoning, TSS and some others.
• The first symptoms of Staphylococcus aureus in food poisoning usually appear within a few hours after eating contaminated food. Appears nausea, vomiting, spastic pain in the abdomen, watery stools. These symptoms usually disappear on their own within a day.

DIAGNOSTICS

It is impossible to reliably state that this is Staphylococcus aureus, only on the basis of clinical manifestations in most cases, since the symptoms of such an infection are nonspecific.

An accurate diagnosis allows you to establish a bacteriological culture of discharge from pathological foci, followed by microscopic examination. At the same time, the sensitivity of the microbe to the effects of antibacterial agents is also determined.

On nutrient media, Staphylococcus aureus forms smooth convex cloudy colonies with a diameter of about 4-5 mm. Such colonies are colored in various shades of yellow, which determines the name of the pathogen.

TREATMENT

Treatment of Staphylococcus aureus is complex.

Principles of treatment of Staphylococcus aureus:

• Inhibition of microbial growth. Various antibacterial drugs and staphylococcal bacteriophages are used.
• Antibacterial agents form the basis of treatment. It is highly desirable, if possible, to use those antibiotics to which the identified type of Staphylococcus aureus is sensitive.
• The most commonly used drugs are the penicillin group (semi-synthetic, combined with clavulanic acid, etc.). Also widely used are aminoglycosides, fluoroquinolones, macrolides, tetracyclines, etc.
• Be sure to carry out local treatment with antibacterial drugs in the form of ointments, creams, lotions, etc. Usually, such procedures are prescribed after surgical sanitation of foci of infection and evacuation of purulent contents.
• Correction of violations of the immune status is carried out by the appointment of immunomodulators, antioxidants, vitamin complexes, etc.
• For specific immunotherapy, antistaphylococcal immunoglobulins and plasma are used.
• Be sure to carry out a full treatment of concomitant pathology, which reduces the reactivity of the body.

Curing Staphylococcus aureus is a very difficult task. This microbe very quickly forms resistance (resistance) to many antibacterial agents. This is also due to the uncontrolled use of antibiotics in cases where they are not needed.

It is important to remember that antibacterial treatment of staphylococcal infection should be carried out only in the presence of its manifestations. A “positive” test for Staphylococcus aureus in an apparently healthy person is not a reason to prescribe antibiotics.

COMPLICATIONS

The main complication of Staphylococcus aureus is the formation of purulent foci of various localization. The entry of the pathogen into the systemic circulation is fraught with the development of serious conditions that seriously threaten health and even life (sepsis, endocarditis, meningitis, etc.).

For example, with the localization of pustular formations on the skin of the face, Staphylococcus aureus with blood flow can be brought into the meninges and brain with the formation of meningitis or brain abscess.

PREVENTION

The basis for preventing the occurrence of staphylococcal infection is to increase nonspecific immunity. It is necessary to lead a healthy lifestyle, observe the rules of personal hygiene, eat right and give up bad habits.

It is important to diagnose and treat all somatic and infectious pathologies in time.

PROGNOSIS FOR RECOVERY

The prognosis depends on the location of the pathological focus of staphylococcal infection, the severity of the disease and the effectiveness of treatment.

With mild lesions of the skin and mucous membranes, the prognosis is almost always favorable. With the development of bacteremia with damage to internal organs, the prognosis deteriorates sharply, since in more than half of the cases such conditions end in death.

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The content of the article

Staphylococci

Morphology and physiology

Antigens

pathogenicity

toxins

Staphylococcus aureus can form histotoxins, which include enterotoxins that cause food intoxication. There are 6 known enterotoxins (A, B, C, D, E, F) that differ in their antigenic properties. Some staphylococci produce an exotoxin that causes toxic shock syndrome. Most often, these staphylococci are inhabitants of the urinary tract of women. The mechanism of action of this toxin is hyperactivation of monocytes and macrophages, followed by hyperproduction of IL-1, TNF (tumor necrotizing factor). Thus, this toxin has all the properties inherent in superantigens. It is a protein, the formation of which is encoded by chromosomal and plasmid genes (prophage) located in the bacterial chromosome. Along with the indirect action, this exotoxin has a direct effect on blood capillaries, increasing their permeability. The disease often ends in death.

Pathogenesis

Immunity

Upon contact with staphylococci widespread in the environment, as well as as a result of past diseases, a humoral immune response is induced, as a result of which antibodies are formed against antigens of microbial cells, toxins and enzymes. The cellular immune response is manifested in the suppression of phagocytosis. Resistance to phagocytosis in virulent strains of S. aureus is possibly associated with their ability to form a capsule in vivo, as well as with the production of coagulase, which forms fibrin around bacteria. Protein A prevents phagocytosis by binding to the Fc regions of IgG. In some cases, specific sensitization of organisms is observed. Of certain importance in staphylococcal infections are secretory IgA, which provide local immunity of the mucous membranes. Ecology and epidemiology. Staphylococci are widely distributed in nature. They are found on the skin and mucous membranes of humans, are found in animals. Each type of staphylococcus is subdivided into ecological variants (ecovars). The species S. aureus includes 6 ecovars: A, B, C, D, E, and F. The main hosts of these ecovars are, respectively, humans, pigs, poultry, cattle, sheep, hares, dogs, and pigeons. Healthy carriers and patients with various staphylococcal lesions serve as a reservoir for Staphylococcus aureus. The greatest danger in terms of the spread of staphylococci is represented by bacteria carriers in which pathogenic staphylococci are found on the mucous membrane of the upper respiratory tract, especially the anterior nasal passages, as well as sick people with skin lesions. Staphylococci are quite resistant to environmental factors. They tolerate drying well and remain viable in dust for a long time.

Staphylococcal infections

Among epidemiologists, microbiologists and clinicians, it is a fairly common belief that non-pathogenic staphylococci do not exist today. Increasingly, cases of isolation from the blood, tissues and organs of cultures of staphylococci without any markers of pathogenicity are becoming more frequent. However, when they are eliminated from the body, all the symptoms of the disease disappear. All this must be taken into account when conducting laboratory diagnosis of staphylococcal infections. Unfortunately, in the routine bacteriological laboratories of our country, only S. aureus, S. epidermidis, and S. saprophyticus can be identified so far.

Staphylococci often affect the skin, its appendages and subcutaneous tissue. They cause boils, carbuncles, felons, paronychia, abscesses, phlegmon, mastitis, lymphadenitis, suppuration of wounds, including operating ones. In children, staphylococci are the causative agents of staphyloderma, epidemic puffy, impetigo. they are isolated in pleurisy, bronchitis, pneumonia, peritonitis. They can cause tonsillitis, tonsillitis, sinusitis, otitis media, conjunctivitis, and somewhat less often - meningitis, brain abscesses, myocarditis, endocarditis, arthritis, infections of vascular prostheses. Very dangerous food poisoning, enterocolitis, cholecystitis, cystitis, pyelitis, pyelonephritis. When penetrating into the blood or bone marrow, they cause sepsis, osteomyelitis, toxic shock syndrome. However, all diseases of staphylococcal etiology are not considered as acutely contagious.

Taking material for research

From open purulent lesions, the material is taken with a sterile cotton swab after removal of wound plaque, which may contain saprophytic microflora from the air, skin, etc. When the abscess is closed, a puncture is made with a syringe. Mucus from the oropharynx and nasopharynx is taken with a sterile swab. Sputum and urine are taken into sterile test tubes, jars. Blood (10 ml) taken from the cubital vein, and cerebrospinal fluid - with a puncture of the spinal canal, with asepsis, are sown at the patient's bedside in 100 ml of sugar broth. Blood is recommended to be quickly (before its coagulation) to be added directly from the syringe into a bottle of broth, mix thoroughly, preventing the formation of a clot. Blood samples must not be frozen. In 25% of cases with staphylococcal sepsis, the number of bacteria in the blood (CFU) may be less than 1/ml. If such a situation is suspected, 25-30 ml of blood should be inoculated.

Bacterioscopic research

Recently, due to the widespread use of antibiotics, the morphology of staphylococci has changed and their typical location in smears from pus is often not observed. In this regard, it is often almost impossible to distinguish staphylococci from streptococci by their morphology and relative position. Therefore, it is necessary to do sowing, isolate a pure culture and identify it. But even primary microscopy can give a preliminary answer in case of detection of typical gram-positive cocci of the correct round shape, arranged in clusters and with a large number of bacteria in the field of view. It also allows you to choose the elective media necessary for sowing, to conduct a direct determination of the sensitivity to antibiotics of the microflora of manure even before isolating a pure culture.

Bacteriological research

All types of colonies are smeared, Gram-stained and microscopically showing typical Gram-positive staphylococci. At least two typical or suspicious staphylococcal colonies are subcultured onto the agar slant. First of all, colonies with hemolysis and those that gave a positive lecitovitelase reaction are sifted out. In the absence of such colonies, at least two pigmented colonies are examined, microscopy of which revealed typical staphylococci. Test tubes with crops are placed in a thermostat at 37 ° C for 18-20 hours.
In the following days, the isolated pure cultures are identified, for which their morphological and tinctorial properties (Gram stain), plasma-coagulant activity and other tests characteristic of staphylococci are checked.

Plasmocoagulase

If the isolated culture causes hemolysis, coagulates the plasma, and gives a positive lecitovite lase reaction, a result for the presence of S. aureus can be issued as early as the third day. If the culture has only plasmacoagulase or only vitelase activity, in order to finally establish the type of staphylococcus, it is necessary to determine additional pathogenicity criteria: mannitol fermentation under anaerobic conditions, DNase activity, production of lysozyme, phosphatase, and also determine sensitivity to novobiocin.

Mannitol fermentation

DNase determination

Hyaluronidase activity

Lysozyme activity

Determination of phosphatase

Novobiocin resistance

Voges-Proskauer reaction

biological research

Serological study

Research on bacteriocarrier

When determining the massiveness of contamination with staphylococci of the nasal mucosa, a swab with the investigated mucus is introduced into a test tube with 0.5 ml of a sterile isotonic sodium chloride solution, rinsed in liquid by shaking for 10 minutes, squeezed against the walls and removed. The liquid is repeatedly mixed with a pipette. Separately, 0.1 ml of wash is applied with a pipette to a cup with HSA and carefully triturated with a spatula. Plates with crops are incubated at 37°C for 48 h, after which the number of colonies is counted. If out of 50 colonies of S.aureus that have grown, two are assigned to the same phage type, it is legitimate to assume that all other colonies that are identical in morphology and pigment belong to S. aureus of a similar phage type.
Calculation example: After inoculation of 0.1 ml washout, 50 colonies of S.aureus have grown. So, in 0.5 ml there will be 50 * 5 = 250 colonies or 2.5 * 10B2. The massiveness of staphylococcal seeding, which is expressed by the number of 102 microbial cells, is moderate, with it the pathogen is not released into the environment. With the release of> 10v3 bacterial cells, the level of contamination is defined as high, at which the pathogen is released into the external environment not only during coughing and sneezing, but during calm breathing. Under such circumstances, it is necessary to sanitize the bacteria carriers.

Prevention and treatment of staphylococcal infections

Prevention of diseases caused by staphylococci includes several areas. These include measures to combat the source of infection, which are people suffering from purulent-inflammatory processes and bacteria carriers, in the treatment of which there are certain difficulties. Particularly important in the complex of preventive measures is the prevention of staphylococcal diseases in medical institutions. This is primarily the organization of the mode of operation of hospital departments. Departments in which there are patients with open purulent-inflammatory processes should be served by separate personnel. To prevent the occurrence of staphylococcal diseases in persons at risk of injury or infection, it is recommended to use the method of immunization with sorbed toxoid or the introduction of immunoglobulin.

Special problem- prevention of staphylococcal diseases in newborns. They still have staphylococcus aureus is one of the main causative agents of infection. In this case, prevention includes immunization of parturient women with staphylococcal toxoid, as well as a quantitative and qualitative analysis of the contamination of the milk of puerperas in order to more strictly approach the transfer of a newborn to feeding with boiled breast milk. Normally, human milk contains three classes of immunoglobulins - IgG, IgM and IgA, which are destroyed by boiling.

For the treatment of staphylococcal infections, antibiotics are used, the choice of which is determined by the sensitivity of the isolated culture to certain drugs. Of these, p-lactam preparations (oxycillin, methicillin, etc.) are of the greatest importance. In recent years, methicillin-resistant strains have emerged. Their resistance, unlike other strains, is not controlled by R-plasmids, but is explained by chromosomal mutations. For the treatment of such patients, vancomycin and fluoroquinolones are used. In addition, cephalosporins of the 1st and 2nd generation are used to treat staphylococcal infections, less often tetracyclines. In sepsis, anti-staphylococcal Ig is administered along with antibiotics. For the treatment of chronic staphylococcal infections (chronic sepsis, furunculosis, etc.), toxoid, autovaccine, which stimulate the synthesis of antitoxic and antimicrobial antibodies, are used.

Staphylococcus aureus- a bacterium whose cells (spherical shape) affect various organs, including internal ones, as well as the heart. The name staphylococcus comes from the Greek - "staphilè" which means "groups". These are colored, bright purple bacteria combined with each other.

If a person feels unwell, perhaps this is it. They can be very diverse. It all depends on the severity of the infection. It manifests itself depending on the place in which the painful process takes place, the presence of a bacterial strain.

In order to understand how staphylococcus appears, its signs and what it is, it is necessary to understand everything in order. Infection is quite common due to microbes that are constantly present not only in the environment, but also in our body.

Staphylococci colonize us - 80-90% of healthy people are carriers of strains.

They are found on the skin, mucous membranes (oral mucosa, nasal mucosa, intestinal mucosa and genital mucosa) and in the ears.

Microorganisms are abundant everywhere. Especially common in the home. It can be an infection transmitted directly or indirectly from a sick person to a healthy one.

Inflammation affects people of all ages. Most often occurs in people with weakened immune systems, in newborns; in people undergoing radiation therapy, chemotherapy, or drugs.

There is a serious risk of contracting this ailment for people with especially serious diseases, such as cancer, diabetes and lung disease.

Therefore, it is necessary to be especially vigilant and careful when you are dealing with a sick person, especially with a weakened immune system, with someone whose immunity is to some extent depleted.

Bacteria can spread through the air, but inflammation almost always results from direct contact with open wounds or fluids through an infected body.

Staphylococcal strains often enter the body through inflamed hair follicles or sebaceous glands, otherwise they enter the skin through burns, cuts and scrapes, infections, insect bites, or wounds.

A staph infection in the blood (bacteremia) develops when strains from a local infection enter the lymph nodes and bloodstream. All of these can lead to high temperatures. They can cause shock. In severe cases, lead to sudden death.

Varieties of strains of staphylococcal infection

epidermal. The main cause of occurrence is a bacterial infection in the patient. Basically, this strain affects people with cancer, whose immune system is weakened, as well as blood poisoning, during operations. The disease can remind of itself a year after the operation.

Second view- saprophytic staphylococcus aureus causes diseases of the genitourinary system in women, for example, causing cystitis. Bacteria are localized in the urethra, affecting it.

Staphylococcal infection, predominantly purulent, in most cases occurs through the skin in the form of growths, boils, honeycombs, pimple-like red spots.

Accompanied by pain inside the ear. There are spots and purulent formations on the scalp. Such manifestations are especially not rare when an infection occurs due to one strain of bacteria. Localization can be deep - in the respiratory system, in the bones, the heart.

Staphylococcus aureus(saprophyticus) is a common cause of diseases in women, the causative agent of vaginitis and cystitis. It can cause, if the strain is in the gastrointestinal tract, a urinary tract infection.

causes the following diseases:

1. arthritis;
2. the development of bacteria in the blood (bacteremia);
3. the occurrence of foci of infection and pus under the skin (carbuncles);
4. inflammation of tissues that spreads under the skin, causing pain and swelling (cellulitis);
5. inflammation of the valves, walls of the heart (endocarditis), tissue that surrounds and protects the spinal cord and brain (meningitis);
6. on bone tissue and bone marrow (osteomyelitis);
7. pneumonia.

Accompanied by a green dangerous and pronounced staphylococcus fever, vomiting, intoxication of the body, general malaise, weakness. Manifested in the form of damage to the nasopharynx, lungs.

Often localized- at the level of the central nervous and urinary systems. In different situations, the manifestations of the disease can be detected if the infection is at the level of the epidermis, as in the case of acne, or small lesions on the skin.

Symptoms of a staph infection

If the infection becomes organic, then the signs of the disease may be of a different type.

How does staphylococcus manifest itself:

1. boils around the mouth;
2. pustules (acne) at the level of the nose, lips;
3. the presence of wounds, tears in the skin;
4. pus in the throat;
5. ear infections;
6. an increase in lymph nodes at the level of the neck, armpits, groin with progressive edema;
7. peeling on the skin;
8. the appearance of reddish, itchy spots in the face;
9. chills and fever;
10. pneumonia;
11. abscesses in the kidneys and liver;
12. infection in the lower urinary tract;
13. problems with the gastrointestinal tract

When the first signs appear, you do not need to think that the disease has arisen recently. Often in such situations, the disease has already been, but in an inactive phase. As a rule, the disease is asymptomatic. To avoid various complications, you must immediately, as soon as possible, consult a doctor.

Complications of the disease can be very different. Also, strains can penetrate the circulatory processes and reach important organs such as the liver, kidneys, heart and brain.

Proper therapy can sometimes be difficult and complicated. Often, doctors diagnose Staphylococcus aureus when the bacteria have already penetrated into healthy organs. The patient and his family should know that the infection is treatable.

Only 80% of people (registered in recent years) are sensitive to certain antibiotics and therapies.

Serious staph infection

Such an ailment as staphylococcus can appear suddenly, the symptoms can manifest themselves as follows:

1. The appearance of boils or pustules on the skin. Pus-filled or inflamed skin is one of the most common signs of disease and a dangerous form of infection today. Let's say you have a mosquito bite on your hand and staph on your finger. In such a case, if you scratch that bite, the bacteria on your finger can penetrate further into the wound and cause large, red, and painful, pus-filled spots. The patient may develop a rash or blisters, which are more commonly referred to as "impetigo".
2. Food poisoning. When food is exposed to a staph infection, bacteria multiply and release toxins that can turn you into a sick person. As a result of infection, the following symptoms occur: vomiting, diarrhea and abdominal pain. These signs of infection usually appear within 6 hours. The key thing to remember is that cooking kills bacteria, not the toxins that make you sick. Therefore, it is very important to handle food, as well as vegetables, fruits or meat with clean hands.
3. Fever can manifest itself in a hospital setting. For example, when you went to surgery, staph bacteria could enter the bloodstream. It can be caused by a blood infection known as bacteremia, which can initially lead to fever and low blood pressure. Once you have dangerous bacteria in your blood, it can spread to your heart, bones, and other organs, and even be fatal. These include pneumonia, as well as a type of bone infection called osteomyelitis, which causes swelling in the infected area. Also, dangerous forms of strains cause heart infections. Symptoms can manifest in many ways: muscle and joint pain, night sweats, fever, pale skin, nausea, and other symptoms. It is very important to consult a doctor in a timely manner.
4. Toxic shock syndrome. As a result of the appearance of staphylococcus, the toxin accumulates. They, in turn, can lead to a certain type of blood poisoning. This can lead to sudden fever, vomiting, diarrhea, muscle pain, and a burn-like rash on the palms of your hands and the soles of your feet.
5. Signs of scalded skin- occur most often in newborns and other children under the age of five. A localized infection begins on the skin, the temperature rises, an unexpectedly bright red rash appears, which spreads from the face to other parts of the body, after which scales form. Large blisters develop at the site of infection. When they burst, the skin becomes more inflamed and looks like it has been scorched.

Diagnosis, treatment and prevention of the disease

After a person has symptoms. For example, such as various boils on the skin, lymph nodes in the armpits, in the groin, pain, swelling in areas of the skin, you should consult a doctor as soon as possible.

Doctors will immediately order blood tests that will show, in the event of an illness, an unusually high concentration of white blood cells. The diagnosis can be made only on the basis of a laboratory analysis - blood and urine.

In addition, an additional examination may be prescribed to assess the severity of the disease. For example, a needle biopsy (removing tissue with a needle, then examining it under a microscope) can be used to assess which bones are infected.

Most healthy people who are exposed to this ailment fully recover within a short time. Others develop re-infections. Some are seriously ill. In the latter case, longer therapy and emergency care are required.

Superficial staph infections can be treated with compresses applied to the affected area for twenty to thirty minutes three or four times a day.

Severe or recurrent infections require longer treatment - from seven to ten days of treatment course. Antibiotic treatment may also be prescribed.

For a more serious infection, antibiotics may be given intravenously for up to six weeks. A similar treatment is also used by doctors to treat staph around the eyes or on other parts of the face. Surgery may be required to remove abscesses that form on internal organs.

Prevention is carried out as follows: Doctors and patients should always wash their hands thoroughly with warm water and soap after treating a staph infection or touching an open wound or pus.

Pus that oozes at the site of infection should be removed immediately. After that, the affected area should be cleaned with an antiseptic or antibacterial soap. To prevent the transmission of infection from one part of the body to another, it is important to take a shower, wash more often.

Since it is easy to get infected with this insidious disease, it is quickly transmitted from one family member to another, and hygiene should be monitored more often at home. Use separate washcloths, towels, bed linen. Wash personal hygiene items frequently and change them.

Doctors and scientists are increasingly concerned about staph infection because of its resistance to antibiotics.

According to medical centers around the world, quite a serious control over this disease is working today. However, local outbreaks of this infection occur annually.

Therefore, it is very important for every person to take their health and well-being seriously, to observe personal hygiene measures. As you know, the disease is easier to prevent than to treat later. In this case, it is important to consult experienced doctors.

Staphylococcal infections are a separate group of diseases that are caused by staphylococcus aureus. The problem of this pathology is relevant all over the world. Because the number of diseases of similar etiology is increasing every year.

Statistical data

Staphylococci are the cause of many diseases of community and hospital groups. These include staph infection in children in the form of pneumonia, bone and joint infections, various infections, nosocomial bacteremia.

Staphylococci that are not sensitive to methicillin (MRSA) are considered important for medicine. There are also strains with reduced sensitivity to vancomycin and oxacillin. In connection with their existence, it is quite difficult to choose the treatment of a particular infection.

In Russia, MRSA strains are common in 33.3% of inpatient institutions, and there is a difference in distribution by department profiles. MRSA is most common in burn units.

Epidemiology and etiology

Staphylococci are gram-positive microbes, aerobic and facultative anaerobic bacteria. Their shape is a ball, which is why they are called "cocci". Arranged mainly in the form of bunches of grapes. For example, Staphylococcus aureus is able to produce toxins, mannitol, hemolysin and thus has the greatest biochemical activity. Epidermal and saprophytic staphylococcus are also considered clinically significant. Golden and epidermal are distinguished using phage typing, sensitivity to antibacterial substances, and biotyping.

Epidermal and saprophytic staphylococci are part of the normal microflora of the skin and mucous membranes. In addition, the carriage of Staphylococcus aureus occurs in 70-90% of cases without any clinical manifestations and harm to health. In a fifth of such people, the carriage of this microorganism can last for years.

The risk group for the carriage of Staphylococcus aureus are medical workers.

Ways of transmission of staphylococcus:

• Airborne way;
• Contact - through the dirty hands of medical personnel;
• Endogenous route of infection in the presence of a persistent internal bacterial infection;
• Instrumental. Transmission occurs through medical instruments;
• Food.

Risk factors for MRSA infection

1. Unfavorable social conditions;
2. Injuries of the skin;
3. Childhood;
4. Non-compliance with the rules of personal hygiene.

Pathogenetic features

The main role in the formation of pathogenesis is played by toxins and enzymes that are synthesized by microbes and released into the environment, that is, into the body of a child or an adult.

Pathogenicity factors include:

• Elements of the cell wall;
• Microcapsule;
• Protein A;
• Leukocidin and hyaluronidase;
• Catalase and kinases;
• Hemolysins.

Also of direct importance in the nature of the development of pathogenesis is the resistance of the microorganism to antibiotics. For example, most strains of Staphylococcus aureus are resistant to penicillin.

Symptoms of a staph infection

The latent period from the moment of infection to manifestation is several days. Symptoms of a staphylococcal infection are divided into groups:

1. 
   

   Diseases of the skin and subcutaneous fat. This group includes boils, pyoderma, punctate scarlet-like exanthema, hydradenitis, staphylococcal erysipelas. This section also includes burn-like syndrome, or "scalded babies" syndrome. In another way, this syndrome is called Ritter von Ritterstein's disease. This pathology often develops in newborns who are infected with strains of Staphylococcus aureus. Pathology begins sharply and violently. The skin becomes covered with foci of erythema, after which huge blisters form at the site of erythema. Bubbles open with exposure of the weeping wound surface. This disease is similar to Lyell's syndrome, but Lyell's syndrome occurs in older children. In secondary prevention, self-limitation of foci of infection occurs;

2. Damage to joints and bones. Manifestations of this group are mainly in septic diseases. With toxic shock syndrome, reddening of the skin occurs in the form of a sunburn, the body temperature rises. The skin subsequently flakes off. In addition to these signs, blood pressure decreases and symptoms of intoxication increase;
3. Staphylococcal angina. Its differences from streptococcal are hardly noticeable, but its treatment is more difficult, and in some cases small punctate rashes are found on the body. Only bacteriological examination helps to differentiate these diseases from each other;
4. Staphylococcal endocarditis. Occurs with hematogenous spread of infection. Staphylococcus aureus causes endocarditis with an enviable frequency and this etiology ranks second in frequency of all other etiological factors of endocarditis in adolescents who use drugs;
5. Pleurisy and pneumonia. They develop against the background of the main infectious pathology, for example, against the background of a viral infection caused by the influenza virus. Staphylococcal pneumonias are more severe. Here there is cyanosis, shortness of breath, purulent complications in the form of abscesses, empyema can develop. On radiographic images, staphylococcal pneumonias are distinguished by emphysematous expansions in the form of round cysts and vesicles;
6. Acute enteritis and enterocolitis of staphylococcal etiology. They occur in the form of a cholera-like disease in patients on the background of broad-spectrum antibiotic therapy. The disease manifests suddenly on the 5-6th day of treatment. In this case, fever appears, intestinal disorders occur, general intoxication of the body. The stool during the acute period is profuse and can lead to the development of dehydration with hypovolemic shock in a short time. This disease is referred to as antibiotic-associated diarrhea;
7. Enterotoxin poisoning produced by staphylococcus aureus;
8. Meningitis and brain abscess of a staphylococcal nature develop as a secondary pathology. Brain abscesses may appear sooner if the child has a "blue" congenital heart disease;
9. Staphylococcal lesions of the urinary system. These diseases are caused by saprophytic staphylococcus aureus;
10. Staphylococcal sepsis.

Diagnostic possibilities of staphylococcal infection

In modern medicine, several methods are used:

1. Cultural. The material is sown on differential diagnostic media. Separate colonies are isolated and a pure culture is screened out. The sensitivity of this culture to antibiotics, to certain bacteriophages is determined;
2. Gene diagnostics is not of particular importance, since there are a huge number of forms of staphylococcus aureus;

Treatment of staph infection

Any treatment will depend on the form of the disease. If it is impetigo, the affected areas of the skin should only be treated with an antiseptic solution. Also, with superficial lesions of the skin, you can use bacitracin, mupirocin.

Systemic therapy with antibacterial drugs should be carried out depending on the severity of the disease and the resistance of the microorganism to antimicrobial agents.

If a staphylococcal infection occurs outside the hospital, macrolides, lincosamides, tetracyclines, aminoglycosides, rifampicin, fluoroquinolones can be used. When isolating a strain of MRSA, it is better to use fluoroquinolones, vancomycin, oxazalidenones, rifampicin.

Feature of oxazalidenones

This group of drugs includes linezolid, ranbezolid. They penetrate better than vancomycin into all tissues of the body. They are especially tropic to the tissues of the lungs, muscles, skin, while having fewer adverse reactions, and this property is very important in pediatrics. However, vancomycin also has the advantage of developing insensitivity very slowly.

That is why the drugs of choice in the treatment of infection caused by strains of MRSA are oxazalidenones and vancomycin.

Other antibacterial agents in the treatment of staphylococcal infections

In addition to the above antibacterial drugs, levofloxacin, ciprofloxacin, moxifloxacin are effective.

In addition, combinations of drugs are used:

• Beta-lactams and aminoglycosides;
• Rifampicin and co-trimoxazole;
• Rifampicin and ciprofloxacin;
• Fusidin and rifampicin.

The duration of treatment for purulent arthritis is at least 3 weeks, for endocarditis about 1.5 months, for osteomyelitis the course is the same in duration as for endocarditis.

Immunoglobulins, antistaphylococcal plasma are also used.

Bacteria play an important role in the development and functioning of the human body. This domain of living organisms was one of the first to appear on Earth, and played a key role in the evolutionary development of all beings. Most prokaryotic microorganisms are defenders of people, participating in the development of immunity and digestion processes, but there are also dangerous species that pose a threat to life. Staphylococci belong simultaneously to both groups.

General concept of staphylococcus

The number of bacterial cells in the human body significantly exceeds the number of cells in the body itself. Colonies of unicellular microbes inhabit the gastric tract, skin, mucous membranes and are necessary for many processes (digestion, formation of the immune system, etc.). In total, several thousand varieties of bacteria live in the human body, some of them play an important role in biological processes, others cause a large number of diseases.

Staphylococci (Staphylococcus) are representatives of the genus of bacteria Micrococcaceae, family Staphylococcaceae. These immobile microorganisms have a spherical (spherical) structure and are located on nutrient media in bunches in the form of grapes. Staphylococci, like all microorganisms, are divided into opportunistic, pathogenic and saprophytes. The pathogenic properties of representatives of this genus are manifested in toxin formation (the ability of bacteria to produce exo-endotoxins and aggression enzymes).

Being representatives of the normal human microflora, staphylococci in relation to the human body are opportunistic in nature and under certain conditions become dangerous to health. The characteristic microbiological features of this genus are:

• facultative anaerobic type of respiration (can develop both in the presence and in the absence of oxygen);
• antigenic structure;
• lack of flagella, protective capsules;
• gram-positive (preservation of color when washed by the Gram method);
• good tolerance to various temperature conditions, high resistance in the external environment, quick adaptability to antibiotics (the optimum temperature for growth is 37 degrees, but under freezing conditions, bacteria can live for several years, they do not tolerate direct sunlight, heating over 70 degrees and the action of chemicals);
• ability to produce endotoxins.

pathogenicity factors

For the development of an infectious disease, penetration into the body of an infectious agent with pathogenicity is necessary (in this case, all pathogens have their own spectrum of organisms susceptible to their action). The virulence of staphylococci (the degree of pathogenicity characterizes the ability of the pathogen to have a detrimental effect on the cells of a living organism) is associated with two groups of factors - invasiveness and toxigenicity.

Invasiveness characterizes the ability of microorganisms to overcome protective immunological barriers, penetrate into organs and tissues, multiply there and resist the immunity of macroorganisms. This ability is provided by the production of enzymes (hyaluronidase, fibrinolysin, collagenase, etc.), the presence of a capsule and mucous substance (protecting bacterial cells from phagocytosis), flagella that promote attachment to cells.

The toxigenicity of staphylococci determines their ability to produce toxic substances that have a detrimental effect on the macroorganism by changing its metabolism and inhibiting the activity of immune cells. Toxic substances released by pathogenic strains of microorganisms include:

• leukocidins - membrane-damaging toxins, have a detrimental effect on human leukocytes;
• enterotoxins - cause food poisoning, allergic reactions, resistant to the action of digestive enzymes and formalin;
• plasmacoagulase - provoke blood plasma coagulation;
• hyaluronidase - break down the main element of connective tissue (hyaluronic acid);
• fibrinolysin - dissolve fibrin protein;
• phosphatase - split off salts of phosphoric acids from nucleotides, proteins and alkaloids.

Types of staphylococcus

In the course of bacteriological studies, about 27 species of microorganisms belonging to the genus Micrococcaceae were found. Most of them do not have a genetic factor of pathogenicity, and they do not pose a danger to human health, but there are 3 types of pathogenic staphylococci that cause the development of a dangerous staphylococcal infection.

To determine the belonging of bacteria to a particular species, specific determinants are used, of which, since 1974, the Bergi classifier has been considered generally accepted. According to this determinant, microorganisms belonging to the family of staphylococci are differentiated into 3 types depending on their pathogenic properties:

Due to the presence of all pathogenicity factors, Staphylococcus aureus (staphylococcus aureus) poses the greatest danger to the body of people of all age categories. The high virulence of the microorganism and its wide distribution in the environment determine the fact that this pathogen causes the development of more than 100 diseases. Staphylococcus aureus has several varieties that cause certain diseases. To determine the culture of bacteria, phage typing is used to help identify the infectious source.

The other two species do not have all the significant pathogenicity factors, therefore they rarely become the cause of infection and affect mainly certain groups of people and areas of the body. So, epidermal staphylococcus aureus (staphylococcus epidermidis) poses an increased danger to premature or weakened newborns, patients with an immunodeficiency state or oncological disease. This type of bacteria is localized on the skin and mucous membranes, rarely spreads to internal organs.

Saprophytic staphylococcus aureus (staphylococcus saprophyticus) lives in the leathery layers of the external genital organs, the urethra (in the mucous membranes) and is less virulent than other members of the family. Women are at risk of infection with this type of microorganism (manifestation is acute cystitis, inflammation of the kidneys), in men, diseases caused by saprophytes are rarely diagnosed (mainly acute urethritis).

In modern microbiology, another new type of pathogenic microbes of the genus Micrococcaceae is distinguished - hemolytic (haemolyticus). This type of bacteria is characterized by a high ability to hemolysis (destruction of red blood cells). By their nature, hemolytic microorganisms are conditionally pathogenic, but when favorable conditions are created, they become pathogenic and can lead to the development of inflammatory processes with the formation of ulcers on the internal organs, skin and mucous membranes.

Ways of transmission of staphylococcus

Bacteria are an integral part of the human microflora, constantly being in the body and on the surface of the skin. Mucous membranes and skin perform protective functions, preventing the penetration of potentially dangerous agents into the internal microenvironment. If the integrity of the protective membranes is violated, microbes enter the body and (if conditions are favorable for development) manifest their pathogenic properties.

Staphylococcal infection is transmitted to humans in several ways, both exogenous and endogenous. The main methods of transmission of an infectious agent are:

• airborne - the transmission mechanism is implemented through the air, where the bacteria located on the mucous membrane of the respiratory tract enter during sneezing or coughing, introduction into the body occurs by inhaling contaminated air;
• air-dust - the source of infection is dried microbes (due to the ability of staphylococci to remain viable for a long time when dried), which, together with dust particles, enter the body during inhalation;
• contact household - infection occurs through direct contact with the carrier (direct route) or with household items contaminated with infectious pathogens (indirect route);
• alimentary (fecal-oral) - while in the intestines of an infected person, bacteria are excreted with feces, after which they enter the water and spread by water, infection occurs during the ingestion of contaminated water, the consumption of raw vegetables or fruits washed under contaminated water, after which the microbe is localized in the digestive tract of a new macroorganism;
• blood contact - pathogenic microorganisms are transmitted during medical procedures, injections (including narcotic substances).

Factors that increase the risk of infection

The penetration of pathogenic bacteria into the body does not mean that this will cause the development of an infectious disease. The immune system of a healthy person has a high resistance to the action of staphylococci, even those with high virulence. In the protective mechanism, the main role is played by the barrier properties of the epidermis, phagocytosis (the process of capturing and digesting pathogenic agents), and the presence of specific antibodies.

Under the influence of certain factors, the defenses weaken, immunity decreases, and it becomes easier for pathogenic microorganisms to penetrate and gain a foothold in the body. Due to the weakened immune system, staphylococcus very often develops in a child (due to the still unformed immunity) and in an elderly person (due to natural processes of suppression of immune cells).

After a staphylococcal infection, specific immunity is acquired, due to the humoral factor - the production of anti-staphylococcal antibodies. The acquired defense mechanism does not differ in durability and duration, therefore, diseases caused by this type of pathogen often recur. Factors contributing to the weakening of the immune system and facilitating the penetration of pathogenic bacteria into the body are:

• pathological processes occurring in a chronic or acute form - against their background, the risk of secondary diseases increases, the most dangerous are conditions such as influenza, tonsillitis, tracheitis, laryngitis, bronchitis, pneumonia, colds, tuberculosis;
• autoimmune disorders, pathologies of the endocrine system, malignant neoplasms - with disorders caused by diseases such as diabetes mellitus, hyperthyroidism, human immunodeficiency virus, irreversible changes occur in immune cells;
• adherence to bad habits (smoking tobacco, drugs, alcohol abuse, psychotropic substances, drug use) - the use of harmful substances has a detrimental effect on the body, inhibiting its resistance to infectious agents;
• physical inactivity - a sedentary lifestyle negatively affects the work of all body systems, leading to a decrease in the production of necessary hormones and enzymes;
• hypovitaminosis - a deficiency of vitamins leads to a violation of the efficiency of internal organs, incl. glands responsible for the production of lymphocytes;
• unbalanced diet - the lack of all the necessary nutrients in the daily menu contributes to the development of hypovitaminosis;
• prolonged emotional overstrain, disruption of sleep and wakefulness - a high level of stress disrupts the functioning of the nervous system, provoking the development of psychosomatic diseases;
• uncontrolled intake of drugs - antibacterial drugs systemically affect the body, inhibiting the activity of the immune response, vasoconstrictor drugs can disrupt the integrity of the mucous membranes, which will reduce their protective properties;
• damage to the skin and mucous membranes - in most cases, the cause of a staphylococcal infection is a violation of the integrity of the epidermis or mucous membrane;
• high concentration of carbon dioxide in places of frequent stay - the result of rare ventilation of the premises is the accumulation of exhaled carbon dioxide, which has a toxic effect on the body;
• being in conditions of increased air pollution without the use of special protective equipment;
• eating food without proper processing.

At-risk groups

The fixation of bacteria and the beginning of their active reproduction becomes possible when favorable conditions are created, which include a general suppression of the activity of immune cells, an increase in body temperature to the optimum for development (37 degrees). The high-risk zone includes people whose professional activities involve being in public places (doctors, service workers, etc.). Factors contributing to the onset of the pathological process appear at certain stages of a person's life, such as:

• pregnancy - 6-8 and 20-28 weeks are considered especially dangerous periods for the development of diseases, at which time the embryo is actively developing and takes a lot of strength from a pregnant woman, which leads to the development of hypovitaminosis and a decrease in immunity;
• old age - the natural aging processes of the body contribute to a decrease in the activity of the production of hormones, enzymes, the production of antibodies, the risk of diseases is especially high in people with diseases such as diabetes mellitus, rheumatism, oncological pathologies;
• the first year of life - the immune system of newborns is not yet fully formed, which makes them vulnerable to viruses and infectious agents.

What diseases does staphylococcus cause?

Infection with bacteria leads to the development of more than 100 diseases - from acne and boils to diseases with a high degree of mortality (sepsis, peritonitis, endocarditis), most of which are provoked by Staphylococcus aureus. Pathogenic staphylococcus has many mechanisms of distribution and development, ranking second after Pseudomonas aeruginosa in terms of the incidence of the disease. The most frequently reported diseases caused by streptococcal infection are:

• rhinitis - one of the most common diseases, inflammation of the nasal mucosa;
• sinusitis - inflammation of the maxillary and frontal sinuses;
• meningitis - an inflammatory disease that affects the spinal cord or brain;
• septic arthritis (in children) - inflammation of the joints with a high risk of irreversible loss of function;
• pharyngitis - an inflammatory process localized in the pharyngeal mucosa;
• inflammation of the lungs (pneumonia) - damage to the lung tissue;
• bronchitis - infection of the larynx, trachea, bronchi;
• laryngitis - pathology of the larynx in combination with inflammation of the trachea;
• osteomyelitis - bacterial damage to the bones and bone marrow of a purulent-necrotic nature;
• food poisoning - characterized by rapid manifestation (may occur 30 minutes after eating contaminated foods);
• scalded skin syndrome - acute epidermolysis, characterized by the appearance of blisters and eroded ulcers on the skin;
• pyoderma is a skin disease provoked by the introduction of purulent cocci into the epidermis.

Staphylococcus symptoms

Clinical medicine under the concept of "streptococcal infection" means all ailments that develop as a result of infection of the body with bacteria of the Staphylococcaceae family. Symptoms of infectious diseases are especially pronounced in newborns. Signs of staphylococcus aureus have many manifestations, which depend on the type of microbe, its location and the general state of the patient's immunity. Common characteristic symptoms of the disease include:

• increase in body temperature;
• the appearance on the body of areas of increased sensitivity to touch, characterized by swelling and hyperemia;
• the appearance of a rash containing pus (on the face, body, ears, mouth);
• there are symptoms of general intoxication (nausea, lethargy, loss of strength, decreased psycho-emotional background, lack of appetite);
• impaired sense of smell;
• frequent inflammation of the hair follicles of the eyelashes (barley).

Signs of skin lesions

The severity of symptoms of infection of the skin depends on the degree of bacterial prevalence. Staphylococcus on the skin with a limited spread of the inflammatory process manifests itself in local symptoms (may be observed on the skin, glands, follicles of hair or ciliary follicles or subcutaneous fat), with extensive - in systemic (general):

For diseases of the upper respiratory tract

A sign that distinguishes staphylococcal infection of the upper respiratory tract from other types of diseases is the presence of serous-purulent discharge. Recognition of bacterial colonization of the nasal cavity, upper nasopharynx or oropharynx is based on the following specific symptoms:

• voice change - manifested in the distortion of timbre, strength, height, increased fatigue during a conversation, a complete loss of voice may occur;
• the appearance of pain in the throat when swallowing, difficulty breathing through the nose;
• sleep disturbance;
• the occurrence of signs of sinusitis - frequent headaches, discharge of copious purulent discharge from the nasal sinuses, low-grade fever;
• decreased sense of smell, change in taste sensations;
• difficulty swallowing food associated with sore throat;
• the appearance of a cough, sore throat;
• enlargement of the lymph nodes.

Infection of the lower respiratory tract

When a virus or infection enters the epithelial cells of the mucous membrane of the lower respiratory tract, they are destroyed, which contributes to the rapid colonization of tissues by cocci bacteria. Joining the viral defeat, pathogenic staphylococci interfere with the regenerative and recovery processes, and the disease becomes chronic. The presence of coccal pathogens in the bronchial tree and tissues of the lungs is evidenced by the following signs:

• cough with the release of purulent substances;
• expectoration of sputum with blood impurities (hemoptysis);
• severe pain syndrome (it is difficult to inhale deeply);
• increase in body temperature to subfebrile;
• a sharp deterioration in well-being.

With food intoxication

The basis of the changes that occur during food intoxication provoked by cocci is the effect of enterotoxins on the intestines of an infected person. Excessive production of interleukin-2 (a protein involved in inflammatory reactions) leads to increased excitation of smooth muscle cells, which manifests itself in the following symptoms:

• stomach ache;
• watery diarrhea;
• nausea;
• urge to vomit, vomiting;
• stool change;
• slight rise in temperature.

Signs of food poisoning of an infectious nature are difficult to identify due to their low specificity. A characteristic feature can only be called the speed of their manifestation after eating contaminated food (more often these are confectionery products with creamy filling, canned foods, purchased meat salads). The manifestation of intoxication is observed after 30-60 minutes. and is protracted.

Diagnosis of staphylococcus

Determination of the type of pathogen of infectious diseases and its phage typing is carried out using microscopic and cultural studies. In view of the ability of a pathogenic microorganism to infect many organs and tissues, samples of blood, purulent discharge, sputum, nasal lavage, vomit, feces, urine, smears of genitourinary system secretions are material for diagnosis.

Staphylococcus in the blood is detected by examining a sample for coagulase, examining a Gram-stained material. To establish the pathogenicity of the detected bacteria, they are isolated by inoculation on a nutrient medium (meat-peptor agar, blood agar, saline broth). After identifying signs of pathogenicity, the test material is populated in test tubes with mannitol to determine the degree of fermentation.

If cultures during diagnostics showed the ability to coagulate plasma, ferment mannitol in the absence of oxygen, they are classified as pathogenic. Further studies are aimed at determining the sensitivity of the detected bacteria to antibacterial agents, for which a biochemical blood test is used in the laboratory.

Treatment of staphylococcus

To prevent complications (many of which are life-threatening) that can develop against the background of an infectious lesion with cocci, it is necessary to take therapeutic measures as soon as possible after the first signs appear. The basis of treatment is drug therapy with the use of antibiotics and antimicrobials. If there are indications, along with antibacterial agents, immunomodulatory and hormonal drugs can be prescribed.

Treatment of diseases caused by staphylococcal infection is carried out at home, the need for hospitalization occurs with a systemic lesion of the body (sepsis, toxic shock, meningitis, endocarditis). Surgical intervention is indicated for purulent-necrotic lesions of the skin, the formation of boils, carbuncles.

Antibiotic therapy

Conservative treatment of staphylococcus is based on the use of antibacterial agents active against a particular type of pathogen. The choice of drugs is based on the sensitivity of the detected bacterial culture to the active substances of the drugs, determined using an antibiogram. Antibiotics of the β-lactam series (penicillins, cephalosporins, etc.) are of the greatest importance for therapy, macrolides (Erythromycin, Clarithromycin), lincosamides (Clindamycin) are less often prescribed.

The most commonly prescribed drugs for diseases caused by cocci are beta-lactam antibiotics such as:

Other treatments

Along with mandatory antibiotic therapy, a number of therapeutic measures are being taken to eliminate pathological processes caused by the activity of pathogenic bacteria and restore the body's defenses. Additional treatments for staphylococcus include:

• surgical intervention - is carried out to remove purulent exudate from the places of accumulation, is carried out by draining and washing the opened abscesses with solutions containing antibiotics;
• the use of bacteriophages (viruses that have selective activity against bacterial cells) - external agents based on antibacterial components are used for treatment, penetrating into coccal cells, phages cause their dissolution (lysis);
• therapy with the use of immunomodulators - taking drugs containing natural or synthetic substances that have an immunostimulating effect (thymus drugs, interleukins, interferons) by stimulating the activity of immunocompetent cells;
• taking vitamin-mineral complexes - if the cause of a decrease in general immunity is a deficiency of vitamins, this method of treatment shows high efficiency, in other cases, additional intake of vitamins serves as a catalyst for recovery processes in the body;
• traditional medicine - homeopathic methods can only be used as ancillary, the most popular remedies include rinsing the mouth with a solution of chlorophyllipt, apple cider vinegar compresses, eating fresh currants, apricots, treating skin lesions with copper sulfate, taking decoctions of burdock and comfrey.

Prevention of staphylococcus aureus

Due to the widespread prevalence of bacteria of the Staphylococcaceae family, their resistance to environmental influences and the increased susceptibility of people with reduced immunity to them, a set of preventive measures should be carried out in several directions. The main measures to prevent staphylococcal infection include the following steps:

1. Impact on the source - isolation of carriers of pathogenic strains from healthy individuals, sanitation of infectious patients and personnel of medical institutions.
2. Reducing the ways of infection - compliance with sanitary and hygienic standards, aseptic and antiseptic rules when in contact with infected persons, careful processing of products before eating, timely antibacterial treatment of wounds and cuts.
3. Strengthening the body's immune defenses - maintaining a balanced diet, taking general tonic herbal remedies, specific medications (immunomodulators), vitamin and mineral complexes.

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