Staphylococcal nasal carriage in medical students with varying clinical exposure

Molecular identification and antimicrobial susceptibility of Staphylococcus aureus nasal isolates from medical students in Cartagena, Colombia

Staphylococcus aureus (SA) remains a major cause of nosocomial and community-acquired infections worldwide. Nasal carriage of this bacterium among hospital personnel constitutes an important source for nosocomial infections. A cross-sectional study enrolling the whole medical student population (n=387) of the School of Medicine at the Universidad de Cartagena, Colombia, was conducted to evaluate the carriage rates of both methicillin sensitive- and methicillin resistant-SA, the frequency of Panton-Valentine leukocidin genes in the isolates, and risk factors associated with carriage in this selected population. After signing an informed consent, participants completed a survey related to possible risk factors for colonization, and nasal swabs were collected from anterior nares. Staphylococcus aureus strains isolated from carriers were subjected to DNA extraction and PCR assays to determine the presence of MecA and Panton-Valentine leukocidin genes. Typing of the staphylococcal chromosomal cassette was performed for methicillin resistant strains. Molecular analysis was performed for only one strain per carrier. Prevalence of carriage for methicillin sensitive- and methicillin resistant-SA was 25% and 1.6% respectively. Most of the methicillin resistant isolates carried the staphylococcal chromosomal cassette type IV and the genes for Panton-Valentine leukocidin. To determine carrier types among medical students, each participant was subjected to four additional swabs, each taken two weeks apart. 9.8% persistent carriers, 53.1% intermittent carriers, and 37.1% non-carriers of SA were found. There was no association between risk factors analyzed and carriage of the bacterium. The study was conducted from April to September 2009 and found a persistent carriage of methicillin resistant-SA strains bearing the genes for Panton-Valentine leukocidin among medical students, evidencing the potential contribution of this portion of healthcare personnel either to the spread or introduction of these strains into the healthcare environment.

Screening of Staphylococcus aureus nasal strains isolated from medical students for toxin genes

Three hundred twenty-one students (156 students with no clinical exposure and 165 students with clinical exposure) were screened for nasal colonization by Staphylococcus aureus; 20.9% of students were S. aureus nasal carriers, and 40.3% of S. aureus isolates harbored toxin genes. The most prevalent genes were tst (15.0 %) and sec (13.4 %). Isolates with multiple genes were only found among clinical students (p = 0.045). Six of 11 PFGE clones were positive for toxin genes. Methicillin-resistant (MRSA) isolates were only detected in the clinical students (4.5 %). The exposure of students to the hospital environment neither radically increased S. aureus nasal carriage, nor the frequency of clinically important toxin gene presence, but it could have influenced the positive selection of toxigenic MRSA strains.

Molecular typing of nasal carriage isolates of Staphylococcus aureus from an Irish university student population based on toxin gene PCR, agr locus types and multiple locus, variable number tandem repeat analysis

Forty-eight Staphylococcus aureus isolates collected from a young, healthy, Irish university student population from 1995 to 2004 were screened for 16 enterotoxin (SE) and enterotoxin-like (SEl) genes (sea-see, seg-sei, selj-selo, selq, selu), and for the toxic shock toxin syndrome toxin-1 gene, tst. All of the isolates harboured at least one SE or SEl gene and 66.7 % possessed a classical SE gene (sea, seb, sec), the commonest being the seb gene. Most of the isolates (85.4 %) had a complete egc locus (selo, selm, sei, seln, seg). The intergenic sei-seln region of the egc locus was typed by PCR-RFLP in 34 isolates, 15 possessing pseudogenes psient1 and psient2 and 19 having the selu gene. The seh and sell genes, the selk-selq gene combination, and the tst gene were each found in <15 % of isolates. The agr genotype distribution was agr type III, 37.5 %; agr type I, 35.4 %; agr type II, 25 %; and agr type IV, 2.1 %. There was no association between SE-SEl genotype and agr type. All tst gene-positive isolates were of agr type III and harboured a classical SE gene. Multiple locus, variable number tandem repeat analysis (MLVA) produced 47 different patterns. While the sdr locus was present in all isolates, half of them lacked one or two of the sdr gene amplimers. Twenty isolates harboured the bbp gene, its presence being associated with agr type III, but not with the SE-SEl gene profile. The agr types of isolates were associated with MLVA subclusters. Selective MLST analysis revealed seven novel sequence types and a new aroE allele. Five clonal clusters (CCs), including CCs comprising major pandemic clones CC30, CC5 and CC22 and minor lineages CC6 and CC9, and three singletons were identified.

Nasal carriage of pathogenic bacteria in medical students: effects of clinic exposure on prevalence and antibiotic susceptibility

Staphylococcus aureus is a major cause of community-acquired and nosocomial infections worldwide. One important source of this pathogen for nosocomial infections is the nasal carriage of S. aureus among hospital personnel. There are only a few studies investigating the carriage of S. aureus in a community of medical students. Oral and nasal flora of 179 medical students with varying clinical exposures were determined. Oral cultures revealed no nosocomial pathogen and nasal cultures showed an increasing rate of S. aureus carriage with increasing clinical exposure. Methicillin resistance also demonstrated a tendency toward increasing with increasing clinical exposure.

Staphylococcus aureus nasal carriage in a student community: prevalence, clonal relationships, and risk factors

OBJECTIVE

To evaluate the prevalence and risk factors of nasal Staphylococcus aureus (SA) in the community.

DESIGN

Cross-sectional study.

SETTING

Wake Forest University, Winston-Salem, North Carolina.

PARTICIPANTS

Four hundred fifty students were screened for nasal SA carriage during the fall of 2000, 2001, and 2002.

METHODS

Students were screened by nose swabs. A self-administered questionnaire collected information on demographics and medical history. Antibiotic testing and PFGE were performed on isolates. Risk factors were determined by logistic regression analysis.

RESULTS

Of 450 volunteers, 131 (29%) were SA carriers. Antibiotic resistance was high for azithromycin (26%) and low for ciprofloxacin (1%), tetracycline (5%), mupirocin (1%), and methicillin (2%). PFGE patterns were not associated with carriage. Age, male gender, white race, medical student, allergen injection therapy, chronic sinusitis, rheumatoid arthritis, hospitalization for 6 months or less, and use of antibiotics were associated with carrier status by univariate analysis. Stepwise multivariate logistic regression led to a best fitting model with older age (OR, 1.04; CI95, 1.005-1.079), male gender (OR, 1.50; CI95, 0.982-2.296), and chronic sinusitis (OR, 2.71; CI95, 0.897-8.195) as risk factors. Antibiotic use (< 4 weeks) (OR, 0.41; CI95, 0.152-1.095) and allergen injection therapy (OR, 0.41; CI95, 0.133-1.238) were protective. Analyses of carriers revealed candidate factors for persistent carriage to be nasal SA colonization rate and male gender. Factors for azithromycin resistance were non-medical students and antibiotic use in the past 6 months.

CONCLUSION

Older male volunteers suffering from chronic sinusitis and not taking antibiotics were at higher risk for carrying SA.

Possible virulence factors of Staphylococcus aureus in a mouse septic model

Twenty clinical isolates of Staphylococcus aureus were examined to elucidate the virulence factors which are directly related to lethality in a mouse septic model. Heat or formalin treatment of the organism abolished the lethal activity of the live organism during challenge intravenously administered via the tail vein. Nevertheless, injection of ten times concentrated culture supernatant fluid (SUP) showed lethal activity in the mouse. However, there was no lethality when SUP was heated at 60 degrees C for 15 min. To examine variations of SUP lethality among strains, we collected 20 strains of S. aureus from four different hospitals. Then, we compared several factors for SUP lethality, which were the extracellular toxins and enzymes, such as toxic shock syndrome toxin 1, enterotoxin A, B, D, and hemolysins (alpha,beta,gamma), and also cytotoxic activity to human polymorphonuclear leukocytes and Vero cells. No difference was found among these factors except cytotoxic activity to Vero cells. Furthermore, we compared two strains in a mouse septic model according to the grade of bacteremia and lethal events. We found that mortality was higher with challenge by the strain whose SUP was lethal in comparison to the strain whose SUP was not lethal, even though the viable bacteria counts in the septic blood in both strains were not significantly different. This strongly supports the possibility that extracellular products, not the cell wall components, of S. aureus play the key role in the lethal event in this mouse septic model. In addition, among the extracellular products, those which have cytotoxic activity to Vero cells may contribute to the lethality in sepsis caused by S. aureus in this murine model.

Nasal carriage of Staphylococcus aureus in Australian (pre-clinical and clinical) medical students

The nasal carriage of Staphylococcus aureus in 808 Australian medical students was studied. Five groups of students experienced varying degrees of clinical exposure in a hospital environment ranging from 0 to 42 months. The overall percentage of carriers among the five groups did not vary. However, with increasing clinical exposure there was a decrease in the percentage of isolates sensitive to all antibiotics tested, and an increase in the carriage of S. aureus resistant to three or more antibiotics. No carriers of methicillin-resistant S. aureus (MRSA) were detected. The comparative rates of S. aureus carriage between female and male students varied. The relevance of medical students as nasal carriers of S. aureus in the hospital environment today is discussed.

The prevalence, antibiotic susceptibility and phage-type of nasally carried Staphylococcus aureus in the Dublin community

A study was undertaken to determine the distribution, antibiotic susceptibility and phage type pattern of nasally-carried Staphylococcus aureus in the community. Coagulase-positive staphylococci were isolated from 180 of 440 individuals. The rate was higher in the inner city and among young adults and middle-aged males. The isolates were examined for phage-type patterns and antibiotic susceptibility. Most (60.6%) of the isolates were typable either at Routine Test Dilution (RTD) or at 100 RTD. Most belonged to phage group I (53.2%) and phage group III (21.1%). Susceptibility to penicillin and ampicillin was low at 12.3 and 15.5% respectively. All were susceptible to vancomycin. Methicillin-resistance was unexpectedly low at 0.6% whereas tetracycline and erythromycin resistance were in line with recent trends at 4.5 and 2.7%. The rate of multiple resistance was low at 2.3%.

Multiply antibiotic-resistant Staphylococcus epidermidis in patients, staff and environment--a one-week survey in a bone marrow transplant unit

The distribution of Staphylococcus epidermidis resistant to ciprofloxacin and/or gentamicin was studied in an isolation unit for patients undergoing bone marrow transplantation. During 1 week all such strains colonizing patients or staff members or found on the clothes of staff or in the air were investigated. Antibiograms and plasmid profiles were used for epidemiological typing. Thirty-one different antibiograms were found. A few strains were widely spread and dominated quantitatively. Staff colonization was 23%, but contamination of their clothes was 82%. Two strains which colonized three of the patients were widely spread in the air. They were found in the corridor and in every patient room, even where the patient was not colonized. The main source of the environmental contamination seems to have been patients. Possible routes of infection were direct airborne transmission as well as passive transfer via staff.