We searched Pubmed with the following search terms: “Staphylococcus aureus”, “colonisation”, “carriage”, “nose”, “nasal”, “vestibulum nasi”, “mucosa”, “nasal”, “nosocomial”, “epidemiology”, “determinants”, “risk factor”, “treatment”, and “infection”. The following limits were used: English language, abstract, and human studies. We identified additional articles by searching the reference lists of existing articles.
ReviewThe role of nasal carriage in Staphylococcus aureus infections
Introduction
Staphylococcus aureus is both a human commensal and a frequent cause of clinically important infections (figure 1).1 Although the prevalence of meticillin-resistant S aureus (MRSA) is still very low in northern European countries,2 there is a worldwide increase in the number of infections caused by MRSA. Vancomycin is one of the last therapeutic options available for MRSA infections. The recent isolation of vancomycin-resistant MRSA strains in the USA is a major cause for concern.3 Therefore, the prevention of staphylococcal infections and reduction of the spread and emergence of MRSA are essential.
The association between S aureus nasal carriage and staphylococcal disease was first reported by Danbolt in 1931, who studied furunculosis.4 The increasing incidence of penicillin-resistant S aureus hospital infections since 1947 emphasised the need for a better understanding of the pathogenesis of staphylococcal disease. Subsequently, numerous studies confirmed Danbolt's finding.5, 6, 7, 8, 9 A causal relation between S aureus nasal carriage and infection is supported by the fact that the nasal S aureus strain and the infecting strain share the same phage type or genotype.8, 10 Furthermore, nasal application of an antistaphylococcal drug temporarily decolonises the nose and other body sites, which prevents infection.11
Our knowledge of the mechanisms, risks, and treatment of S aureus nasal carriage has greatly expanded over the past decade. Table 1 presents an overview of major events in S aureus research. Here, we focus on the latest insights into the determinants of S aureus nasal carriage and the risks of infection associated with S aureus nasal carriage. Most studies were done in western countries, so conclusions drawn can not always be generalised.
Section snippets
S aureus nasal carriage patterns
S aureus colonises the skin and mucosae of human beings and several animal species.5 Although multiple body sites can be colonised in human beings, the anterior nares of the nose is the most frequent carriage site for S aureus.5 Extra-nasal sites that typically harbour the organism include the skin, perineum, and pharynx.5, 23, 24, 25 Other carriage sites including the gastrointestinal tract,5, 26 vagina,27 and axillae5, 25, 28 harbour S aureus less frequently (figure 2).
Most studies on S aureus
Community-acquired infections
Most studies regarding the risks of acquiring S aureus infections in the community concern skin and soft tissue infections. Several, mostly older, studies investigated the relation between S aureus nasal carriage and skin infections,121 including furunculosis,122, 123 impetigo,124 sycosis barbae,10, 122, 125 and stye.126 On average, 80% (range 42–100%) of those with skin lesions were S aureus nasal carriers, and 65% (range 29–88%) had the same phage type in the nose and lesion.
In one large
Conclusions
Many studies have been published on S aureus nasal carriage—a Pubmed search with the terms “Staphylococcus aureus” and “nasal” gives 1383 hits. Based on these studies and the results of contradicting twin studies183, 184 a simple Mendelian trait probably does not explain the different S aureus nasal carrier states.38, 48 The repeated exposure to S aureus in the (household) environment is considered to be an important determinant of S aureus nasal carriage, probably more important than the
Search strategy and selection criteria
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Studies on staphylococci. III Further observations on bacteriophage typing of Staphylococcus aureus
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The role of staphylococcal infection in beat disorders of miners
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MSCRAMM-mediated adherence of microorganisms to host tissues
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Multilocus sequence typing for characterization of methicillin-resistant and methicillin-susceptible clones of Staphylococcus aureus
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The changing epidemiology of Staphylococcus aureus?
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Infection with vancomycin-resistant Staphylococcus aureus containing the vanA resistance gene
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Carriage patterns of Staphylococcus aureus in a healthy non-hospital population of adults and children
Ann Hum Biol
Effect of mupirocin treatment on nasal, pharyngeal, and perineal carriage of Staphylococcus aureus in healthy adults
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Perineal carriage of Staph. aureus
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Gastrointestinal carriage of methicillin-resistant Staphylococcus aureus
J Clin Microbiol
Vaginal colonization with Staphylococcus aureus in healthy women: a review of four studies
Ann Intern Med
Nasal, axillary, and perineal carriage of Staphylococcus aureus among women: identification of strains producing epidermolytic toxin
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Carriage of Staphylococcus aureus among 104 healthy persons during a 19-month period
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Follow-up of Staphylococcus aureus nasal carriage after 8 years: redefining the persistent carrier state
J Clin Microbiol
Increased infection rates in heavy nasal carriers of coagulase-positive staphylococci
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Predicting the Staphylococcus aureus nasal carrier state: derivation and validation of a “culture rule”
Clin Infect Dis
Typing of Staphylococcus aureus colonising human nasal carriers by pulsed-field gel electrophoresis
J Med Microbiol
Carriage of Staphylococcus aureus in random samples of a normal population
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Determinants of acquisition and carriage of Staphylococcus aureus in infancy
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Prevalence of methicillin-resistant and methicillin-susceptible Staphylococcus aureus in the community
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Determinants of Staphylococcus aureus nasal carriage
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Nasal carriage of Staphylococcus aureus in hospital personnel and the normal population and antibiotic resistance of the isolates
Mikrobiyol Bul
Rates of carriage of methicillin-resistant and methicillin-susceptible Staphylococcus aureus in an outpatient population
Infect Control Hosp Epidemiol
Cited by (1970)
The role of staphyloxanthin in the regulation of membrane biophysical properties in Staphylococcus aureus
2024, Biochimica et Biophysica Acta - BiomembranesStaphylococcus aureus colonisation and strategies for decolonisation
2024, The Lancet Microbe