Trends in Microbiology
ReviewWhat determines nasal carriage of Staphylococcus aureus?
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
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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?
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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?
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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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