Dynamics of acquisition and loss of carriage of Staphylococcus aureus strains in the community: The effect of clonal complex
Miller RR., Walker AS., Godwin H., Fung R., Votintseva A., Bowden R., Mant D., Peto TEA., Crook DW., Knox K.
Background: Staphylococcus aureus nasal carriage increases infection risk. However, few studies have investigated S. aureus acquisition/loss over > 1 year, and fewer still used molecular typing. Methods: 1123 adults attending five Oxfordshire general practices had nasal swabs taken. 571 were re-swabbed after one month then every two months for median two years. All S. aureus isolates were spa-typed. Risk factors were collected from interviews and medical records. Results: 32% carried S. aureus at recruitment ( < 1% MRSA). Rates of spa-type acquisition were similar in participants S. aureus positive (1.4%/month) and negative (1.8%/month, P=0.13) at recruitment. Rates were faster in those carrying clonal complex (CC)15 (adjusted (a). P=0.03) or CC8 (including USA300) (aP=0.001) at recruitment versus other CCs. 157/274 (57%) participants S. aureus positive at recruitment returning ≥12 swabs carried S. aureus consistently, of whom 135 carried the same spa-type. CC22 (including EMRSA-15) was more prevalent in long-term than intermittent spa-type carriers (aP=0.03). Antibiotics transiently reduced carriage, but no other modifiable risk factors were found. Conclusions: Both transient and longer-term carriage exist; however, the approximately constant rates of S. aureus gain and loss suggest that 'never' or truly 'persistent' carriage are rare. Long-term carriage varies by strain, offering new explanations for the success of certain S. aureus clones. © 2014 The Authors.