Dynamics of acquisition and loss of carriage of Staphylococcus aureus strains in the community: The effect of clonal complex

Miller, Ruth R.; Walker, A Sarah; Godwin, Heather; Fung, Rowena; Votintseva, Antonina A.; Bowden, Rory; Mant, David; Peto, Tim E. A.; Crook, Derrick W.; Knox, Kyle

doi:10.1016/j.jinf.2013.12.013

Cited by 42 publications

(65 citation statements)

References 36 publications

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“…In our study, we did not detect a temporal signal within households due to the relatively large number of SNPs at each sampling time point, thus precluding timing of persistence. While both studies provide evidence for long-term persistence of successful S. aureus clones, it should be noted that these stand in contrast to rapid changes in individual colonization based on spa typing alone (40). The observed high SNP diversity in individuals has direct implications for epidemiological transmission studies, including in the health care setting, when patients become infected with their colonizing bacteria.…”

Section: Discussionmentioning

confidence: 99%

Evolutionary Dynamics of Pandemic Methicillin-Sensitive Staphylococcus aureus ST398 and Its International Spread via Routes of Human Migration

Uhlemann

McAdam

Sullivan

et al. 2017

mBio

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Methicillin-susceptible Staphylococcus aureus (MSSA) accounts for the majority of S. aureus infections globally, and yet surprisingly little is known about its clonal evolution. We applied comparative whole-genome sequencing (WGS) analyses to epidemiologically and geographically diverse ST398-MSSA, a pandemic lineage affecting both humans and livestock. Bayesian phylogenetic analysis predicted divergence of human-associated ST398-MSSA ~40 years ago. Isolates from Midwestern pigs and veterinarians differed substantially from those in New York City (NYC). Pig ST398 strains contained a large region of recombination representing imports from multiple sequence types (STs). Phylogeographic analyses supported the spread of ST398-MSSA along local cultural and migratory links between parts of the Caribbean, North America, and France, respectively. Applying pairwise single-nucleotide polymorphism (SNP) distances as a measure of genetic relatedness between isolates, we observed that ST398 not only clustered in households but also frequently extended across local social networks. Isolates collected from environmental surfaces reflected the full diversity of colonizing individuals, highlighting their potentially critical role as reservoirs for transmission and diversification. Strikingly, we observed high within-host SNP variability compared to our previous studies on the dominant methicillin-resistant Staphylococcus aureus (MRSA) clone USA300. Our data indicate that the dynamics of colonization, persistence, and transmission differ substantially between USA300-MRSA and ST398-MSSA. Taken together, our study reveals local and international routes of transmission for a major MSSA clone, indicating key impacts of recombination and mutation on genetic diversification and highlighting important ecological differences from epidemic USA300. Our study demonstrates extensive local and international routes of transmission for a major MSSA clone despite the lack of substantial antibiotic resistance.

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Section: Discussionmentioning

confidence: 99%

Evolutionary Dynamics of Pandemic Methicillin-Sensitive Staphylococcus aureus ST398 and Its International Spread via Routes of Human Migration

Uhlemann

McAdam

Sullivan

et al. 2017

mBio

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“…Moreover, SANC exhibits complex dynamics within individuals, with acquisition and loss of S. aureus occurring 8 . Classifications of carriage states differ widely.…”

Section: Introductionmentioning

confidence: 99%

Multi-site and nasal swabbing for carriage of Staphylococcus aureus : what does a single nose swab predict?

Young

Votintseva

Foster

et al. 2017

Journal of Hospital Infection

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SummaryBackgroundCarriage of Staphylococcus aureus is a risk for infections. Targeted decolonization reduces postoperative infections but depends on accurate screening.AimTo compare detection of S. aureus carriage in healthy individuals between anatomical sites and nurse- versus self-swabbing; also to determine whether a single nasal swab predicted carriage over four weeks.MethodsHealthy individuals were recruited via general practices. After consent, nurses performed multi-site swabbing (nose, throat, and axilla). Participants performed nasal swabbing twice-weekly for four weeks. Swabs were returned by mail and cultured for S. aureus. All S. aureus isolates underwent spa typing. Persistent carriage in individuals returning more than three self-swabs was defined as culture of S. aureus from all or all but one self-swabs.FindingsIn all, 102 individuals underwent multi-site swabbing; S. aureus carriage was detected from at least one site from 40 individuals (39%). There was no difference between nose (29/102, 28%) and throat (28/102, 27%) isolation rates: the combination increased total detection rate by 10%. Ninety-nine patients returned any self-swab, and 96 returned more than three. Nasal carriage detection was not significantly different on nurse or self-swab [28/99 (74%) vs 26/99 (72%); χ2: P = 0.75]. Twenty-two out of 25 participants with first self-swab positive were persistent carriers and 69/71 with first self-swab negative were not, giving high positive predictive value (88%), and very high negative predictive value (97%).ConclusionNasal swabs detected the majority of carriage; throat swabs increased detection by 10%. Self-taken nasal swabs were equivalent to nurse-taken swabs and predicted persistent nasal carriage over four weeks.

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“…Indeed, the first swabs taken by the 95 participants gave point prevalence for S. aureus carriage of 54.7 %. This is considerably higher than the point prevalence of 32 and 32.5 %, from two recent studies that sampled geographically distinct adult populations in England (recruited via general practitioners) (Gamblin et al , 2013; Miller et al , 2014). The reasons for the higher carriage rate are not clear, although our cohort had a number of risk factors previously associated with higher carriage, including a high proportion of young adults, and contact with healthcare systems (the veterinary hospital) and livestock (Wertheim et al , 2005; Mollema et al , 2010; Verkade et al , 2013).…”

Section: Discussionmentioning

confidence: 71%

“…Screening and decolonization of methicillin-resistant S. aureus (MRSA) carriers before and during hospital admission are performed to reduce the rate of nosocomial MRSA infection (Huang et al , 2013). Detection of carriage is also important for population-level studies of S. aureus carriage and molecular epidemiology (Miller et al , 2014; Votintseva et al , 2014). Carriage is detected by taking a swab of the anterior nares or by multi-site swabbing (axilla, groin and nasal swabs).…”

Section: Introductionmentioning

confidence: 99%

Validation of self-administered nasal swabs and postage for the isolation of Staphylococcus aureus

Harrison

Gleadall

et al. 2016

Journal of Medical Microbiology

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Staphylococcus aureus carriers are at higher risk of S. aureus infection and are a reservoir for transmission to others. Detection of nasal S. aureus carriage is important for both targeted decolonization and epidemiological studies. Self-administered nasal swabbing has been reported previously, but the effects of posting swabs prior to culture on S. aureus yield have not been investigated. A longitudinal cohort study was performed in which healthy volunteers were recruited, trained in the swabbing procedure and asked to take weekly nasal swabs for 6 weeks (median: 3 weeks, range 1–6 weeks). Two swabs were taken at each sampling episode and randomly assigned for immediate processing on arrival to the laboratory (Swab A) or second class postage prior to processing (Swab B). S. aureus was isolated using standard methods. A total of 95 participants were recruited, who took 944 swabs (472 pairs) over a median of 5 weeks. Of these, 459 swabs were positive for S. aureus. We found no significant difference (P=0.25) between 472 pairs of nasal self-swabs processed immediately or following standard postage from 95 study participants (51.4 % vs. 48.6 %, respectively). We also provide further evidence that persistent carriers can be detected by two weekly swabs with high degrees of sensitivity [92.3 % (95 % CI 74.8–98.8 %)] and specificity [95.6 % (95 % CI 84.8–99.3 %)] compared with a gold standard of five weekly swabs. Self-swabbing and postage of nasal swabs prior to processing has no effect on yield of S. aureus, and could facilitate large community-based carriage studies.

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Dynamics of acquisition and loss of carriage of Staphylococcus aureus strains in the community: The effect of clonal complex

Cited by 42 publications

References 36 publications

Evolutionary Dynamics of Pandemic Methicillin-Sensitive Staphylococcus aureus ST398 and Its International Spread via Routes of Human Migration

Evolutionary Dynamics of Pandemic Methicillin-Sensitive Staphylococcus aureus ST398 and Its International Spread via Routes of Human Migration

Multi-site and nasal swabbing for carriage of Staphylococcus aureus : what does a single nose swab predict?

Validation of self-administered nasal swabs and postage for the isolation of Staphylococcus aureus

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