| Abstract | Uvod: Ljudska koža normalno je naseljena raznim mikroorganizmima, no u određenim slučajevima oni mogu izazivati klinički manifestnu infekciju, pri čemu je – zbog svojeg patogenog potencijala – posebni interes u ovom istraživanju stavljen na bakteriju zlatni stafilokok (Staphylococcus aureus). Sportaši su populacija koja je, kao posljedica veće učestalosti ozljede kože i okolišnih uvjeta, pod povećanim rizikom od infekcije. Pandemija bolesti COVID-19 dovela je do velikih promjena u modalitetima treninga, kao i u higijensko-epidemiološkim postulatima. Glavni cilj istraživanja bio je utvrditi razliku u kliconoštvu zlatnim stafilokokom u odnosu na kontaktnost sporta i na pojavu pandemije bolesti COVID-19, kao i utvrditi postojanje razlike u pridržavanju higijensko-epidemioloških mjera prije i tijekom ove pandemije.
Ciljevi i hipoteze: Glavni cilj ovog istraživanja bio je napraviti analizu stopa kolonizacije zlatnim stafilokokom kod sportaša u uvjetima prije i tijekom pandemije COVID-19 u odnosu na kontaktnost sporta kojim se bave i njihove higijensko-životne navike. Prvi podcilj bio je utvrditi postoji li korelacija kliconoštva zlatnim stafilokokom s higijenskim čimbenicima ispitivanim u anketi. Drugi podcilj bio je utvrditi eventualnu sezonsku razliku između kliconoša. H1: U kontaktnim sportovima bit će veći postotak ispitanika koloniziranih zlatnim stafilokokom. H2: Kliconoštvo zlatnim stafilokokom bit će učestalije u gornjem dišnom sustavu nego u aksilarnoj regiji. H3: Ordinalno stupnjevanje kliconoštva pozitivno će korelirati s neadekvatnim provođenjem postulata istraživanih anketom, kao i sa stupnjem kontaktnosti određenog sporta. H4: Utvrdit će se sezonska razlika te razlika između pretpandemijskog i pandemijskog razdoblja u kliconoštvu neovisno o kontaktnosti samog sporta. H5: Pridržavanje higijenskih postulata bit će izraženije u skupini ispitanika tijekom pandemije COVID-19.
Materijali i metode: Provedena je presječna studija s prigodnim uzorkovanjem na 197 ispitanika – sportaša i sportašica koji prakticiraju kontaktne i nekontaktne sportove – u periodu prije i tijekom pandemije bolesti COVID-19. Ispitanici su podijeljeni u dvije glavne skupine prema dominantnoj kontaktnosti sporta koji prakticiraju, a dodatno s obzirom na razdoblje u vezi s pandemijom. Nakon potpisivanja informiranog pristanka i ispunjavanja ankete kojom su se utvrdile higijensko-epidemiološke navike ispitanika, sudionicima su učinjeni mikrobiološki brisevi predvorja nosa, ždrijela i aksile. Nakon provedene mikrobiološke analize uzoraka (koja je uključivala standardnu laboratorijsku obradu kao i napredne analitičke tehnologije poput
MALDI-TOF), učinjena je statistička obrada podataka dobivenih anketom i uzorkovanjem. Provedene su metode deskriptivne i inferencijalne statistike, poput t-testa, Wilcoxonovog testa sume rangova, Leveneovog testa sume varijanci, Shapiro-Wilkovog testa odstupanja oblika opažene raspodjele od normalne, Brunner-Munzelove generalizirane verzije Wilcoxonovog testa, Fisherovog egzaktnog testa s ordinalnim skaliranjem, kao i druge statističke metode.
Rezultati: Što se tiče kontaktnosti sporta, 49,75 % ispitanika prakticiralo je kontaktni, a 50,25 % nekontaktni sport. Zlatni stafilokok izoliran je kod 40,1 % svih ispitanika, a po kontaktnosti kod 58 % sportaša koji se bave kontaktnim i 42 % sportaša koji se bave nekontaktnim sportom (p = 0,071). Zlatni stafilokok je statistički značajno izoliran kod 48 % ukupnog broja muškaraca u odnosu na 27,6 % ukupnog broja žena (p = 0,0047). Ova je bakterija primarno izolirana iz predvorja nosa (64,56 % ukupnog broja kliconoša). Meticilin-rezistentni Staphylococcus aureus (MRSA) izoliran je kod 1,01 % ukupnog broja ispitanika. Osim zlatnog stafilokoka, izolirani su i drugi mikroorganizmi. Veći broj kolonija zlatnog stafilokoka porastao je iz uzoraka aksile sudionika koji su češće koristili teretanu te kod onih koji su rjeđe dezinficirali ruke, te iz uzoraka nosa ispitanika koji su češće dijelili zavojni materijal i kod onih koji su imali češća oštećenja kože. Kod ispitanika kod kojih je od mikroorganizama izoliran samo zlatni stafilokok, više je kolonizata zlatnog stafilokoka izolirano ljeti u odnosu na jesen. Također, u ovoj skupini ispitanika zamijećen je veći udio kolonizata zlatnog stafilokoka u aksili ispitanika kojima su brisevi uzeti tijekom pandemije. Rezultati istraživanja pokazali su da su ispitanici tijekom pandemije češće dezinficirali ruke i koristili zajedničku opremu, te da su rjeđe koristili teretanu.
Zaključak: Istraživanjem su dokazane određene razlike u kliconoštvu zlatnim stafilokokom kod sportaša koji prakticiraju kontaktni u odnosu na one koji prakticiraju nekontaktni sport. Pronađene su i razlike u kliconoštvu u odnosu na higijensko-epidemiološke prakse, kao i na godišnja dobe te na period prije i tijekom pandemije COVID-19. Potvrđena je hipoteza da će kolonizacija zlatnim stafilokokom biti najučestalija u nosu. Dobiveni rezultati u skladu su s podacima iz svjetske literature, a poseban doprinos istraživanja je mogućnost promjena pristupa sportašima s obzirom na kontaktnost sporta temeljem dobivenih rezultata. |
| Abstract (english) | Introduction: Human skin is normally inhabited by various microorganisms, yet in certain cases they can cause a clinically manifest infection. Due to its pathogenic potential, this thesis put the lens on Staphylococcus aureus (S. aureus). Athletes are a specific population that has an increased risk of infection due to higher frequency of skin injury and environmental conditions. The coronavirus disease 2019 (COVID-19) pandemic has led to major changes in training modalities, as well as in hygiene and epidemiological postulates. The main aim of the thesis was to determine the difference in S. aureus carriage rates in relation to contact/non-contact sports and the onset of the COVID-19 pandemic, as well as to determine the existence of significant differences in adhering to hygienic-epidemiological measures before and during the pandemic.
Aims and hypotheses: The main aim of the thesis was to analyse S. aureus colonisation rates in athletes before and during the COVID-19 pandemic in relation to the level of contact pertinent for the sport they practice, as well as their hygienic lifestyle habits. There were two additional sub-aims: 1) to determine if there is a signficant correlation between S. aureus carriage and hygiene factors explored by the survey, and 2) to determine eventual seasonal difference between S. aureus carriers. H1: In contact sports, there will be a higher percentage of respondents colonized with S. aureus. H2: S. aureus infection will be more frequent in the upper respiratory system than in the axillary region. H3: Carriage rates (assessed on an ordinary scale) will positively correlate with the inadequate implementation of the hygiene postulates, as well as with the degree of contact of a particular sport. H4: There will be a significant seasonal difference and a difference between the pre-pandemic and pandemic periods in carriage rates, regardless of the level of contact of the sport itself. H5: Adherence to hygiene postulates will be higher in the group of respondents during the COVID-19 pandemic than before pandemic.
Materials and methods: A cross-sectional study with convenient sampling approach was conducted on 197 respondents – athletes who practice contact and non-contact sports – in the period before and during the COVID-19 pandemic. The respondents were divided into two main groups according to the predominant type of contact of the sport they practice, and additionally with regard to the period related to the pandemic. After study participants signed the informed consent and filled out the survey which determined the hygienic-epidemiological
habits, they were subjected to microbiological swabbing of the vestibule of the nose, pharynx and axilla. Upon analysing these samples (which included standard laboratory processing and advanced analytical technologies such as MALDI-TOF), statistical analysis was performed with the use of descriptive and inferential statistics methods – such as the t-test, the Wilcoxon rank sum test, the Levene test of the sum of variances, the Shapiro-Wilk test, the Brunner-Munzel generalized version of the Wilcoxon test, Fisher's exact test with ordinal scaling, as well as other statistical methods.
Results: A total of 49.75% of respondents practiced contact sports, and 50.25% non-contact sports. The microorganism of interest, S. aureus, was isolated in 40.1% of all subjects – 58% of athletes who engage in contact sports and 42% of athletes who engage in non-contact sports (p = 0.071). S. aureus was isolated in 48% of men compared to 27.6% of women, which was a statistically significant difference (p = 0.0047). This bacterium was primarily isolated from the vestibule of the nose (i.e., 64.56% of the total number of carriers). Methicillin-resistant S. aureus (MRSA) was isolated in 1.01% of the total number of subjects. Apart from this bacterial agent, other microorganisms were also isolated. Furthermore, S. aureus was more frequently isolated from the axillae of participants who used the gym more often and those who disinfected their hands less often, as well as from the nasal samples of subjects who shared bandage material more often and those who presented with more frequent skin damage. In subjects who harboured only S. aureus as a potentially pathogenic microflora, higher carriage rates were seen in summer compared to autumn season. Also, in this group of subjects, a higher proportion of S. aureus carriage was observed in the axillae of subjects whose swabs were taken during the pandemic period. The results of the study showed that, during the COVID-19 pandemic, respondents disinfected their hands more often and used shared equipment, and that they used the gym less often.
Conclusion: This thesis revealed certain differences in S. aureus carriage rates in athletes who practice contact sports in comparison to those who practice non-contact sports. Differences in microorganism carriage rates were also observed in relation to hygienic-epidemiological practices, seasons of the year, and the pre- or post-COVID-19 pandemic period. The hypothesis that colonization with S. aureus will be most frequently observed in the nose was confirmed. |
