Trends in Microbiology
Volume 9, Issue 12, 1 December 2001, Pages 605-610
Journal home page for Trends in Microbiology

Review
What determines nasal carriage of Staphylococcus aureus?

https://doi.org/10.1016/S0966-842X(01)02254-5Get rights and content

Abstract

Nasal carriage of Staphylococcus aureus is an important risk factor for infection by this organism in both community and hospital settings; this article reviews the role of host and bacterial factors in carriage. A host genetic influence appears likely but the phenotypic determinants are unknown. Possibilities include variability in host adhesins, immune response or secretion of antimicrobial molecules. Colonization resistance by S. aureus, together with the observation that persistent carriers often carry a single strain whereas intermittent carriers can be colonized with unrelated strains over time, suggests that bacterial factors could also be involved.

Section snippets

A host genetic influence is likely

Longitudinal studies have demonstrated that three carriage patterns can be distinguished in the healthy adult population: ∼20% of individuals are persistent S. aureus carriers; ∼60% are intermittent carriers; and 20% are persistent non-carriers21. This is likely to be an over-simplification, not least because the duration of follow-up is often limited. The so-called persistent carrier state was called into question by one study that swabbed 17 persistent carriers over a 12-week period in 1988

Do S. aureus isolates associated with persistent or intermittent carriage differ?

The application of molecular-typing techniques to the longitudinal evaluation of S. aureus isolated from individuals with persistent or intermittent nasal carriage has received limited attention. A study of seven persistent carriers reported that each individual was colonized with a single clone of S. aureus over a one-year period50. Typing of isolates from healthy volunteers spanning a period of up to two and a half years using random amplification of polymorphic DNA (RAPD) analysis found 12

Summary

Box 1 summarizes the determinants that could influence carriage of S. aureus. Interruption of S. aureus carriage has been recognized as an important intervention in those individuals at high risk of nosocomial infection. The emergence of MRSA with reduced susceptibility to glycopeptides has further increased the need to avoid preventable S. aureus disease. Current efforts to interrupt carriage rely on the use of antibiotics, but this approach will ultimately fail unless drug development keeps

Questions for future research

  • Why does the pattern of carriage and site of S. aureus colonization differ from that of other human pathogens such as Streptococcus pneumoniae and Neisseria meningitidis?

  • MRSA is not commonly carried in the community at present, and it is possible that such strains have a biological disadvantage compared with susceptible counterparts in this setting. Will the same hold true for S. aureus strains with reduced susceptibility to glycopeptides?

  • Individuals who are at risk of invasive S. aureus

Acknowledgements

I.S. is funded by a Commonwealth Scholarship. FDL is supported by grants DA09656 and DA11868 from the National Institute on Drug Abuse and a Grant-In-Aid from the American Heart Association.

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