Intestinal carriage of Staphylococcus aureus: how does its frequency compare with that of nasal carriage and what is its clinical impact?

Abstract

The bacterial species Staphylococcus aureus, including its methicillin-resistant variant (MRSA), finds its primary ecological niche in the human nose, but is also able to colonize the intestines and the perineal region. Intestinal carriage has not been widely investigated despite its potential clinical impact. This review summarizes literature on the topic and sketches the current state of affairs from a microbiological and infectious diseases' perspective. Major findings are that the average reported detection rate of intestinal carriage in healthy individuals and patients is 20% for S. aureus and 9% for MRSA, which is approximately half of that for nasal carriage. Nasal carriage seems to predispose to intestinal carriage, but sole intestinal carriage occurs relatively frequently and is observed in 1 out of 3 intestinal carriers, which provides a rationale to include intestinal screening for surveillance or in outbreak settings. Colonization of the intestinal tract with S. aureus at a young age occurs at a high frequency and may affect the host's immune system. The frequency of intestinal carriage is generally underestimated and may significantly contribute to bacterial dissemination and subsequent risk of infections. Whether intestinal rather than nasal S. aureus carriage is a primary predictor for infections is still ill-defined.

Bacteriocin-producing strains of Lactobacillus plantarum inhibit adhesion of Staphylococcus aureus to extracellular matrix: quantitative insight and implications in antibacterial therapy

“…With an aim to expand the application potential of these strains, it was envisaged that determination of the adhesion potential of the strains to the ECM would be pertinent, as adhesion to ECM molecules such as collagen and mucin is considered as a cardinal feature of probiotic strains (Lebeer et al, 2008). The ability of the pathogen S. aureus to colonize the intestine in conjunction with its ability to adhere to ECM molecules is a serious healthcare concern and has been reported to be responsible for various ailments (Acton et al, 2009;Bhalla et al, 2007;Foster et al, 2014;Gries et al, 2005;Hansen et al, 2006). In this context, probiotic LAB strains having a propensity to adhere onto the ECM such as collagen and mucin could bear interesting therapeutic potential to prevent invasion of the ECM by S. aureus.…”

“…Amongst the gut-colonizing pathogens, emerging literature reports have elucidated the detrimental implications of colonization by Staphylococcus aureus (Acton et al, 2009;Yan et al, 2014). S. aureus is known to be equipped with adhesins known as microbial surface component-recognizing adhesive matrix molecules for binding to ECM molecules such as collagen (Foster et al, 2014).…”

Does Colonization with Methicillin-Susceptible Staphylococcus aureus Protect against Nosocomial Acquisition of Methicillin-Resistant S. aureus?

“…However, we are confident that we have captured the majority of carriage by screening an additional body site (groin) in contrast to most previous studies cited above. Groin swab was chosen to detect patients with gastrointestinal MRSA carriage 39 and to increase the yield of nasal screening only. 40 We have previously determined at our institution that the addition of throat screening did not significantly improve the accuracy of detecting MRSA colonization.…”

Infection control of Staphylococcus aureus : spa typing to elucidate transmission

“…By including screening cultures from the throat the sensitivity of detecting colonization significantly increases and it has therefore been suggested that S. aureus screening programs should include sampling of the anterior nares as well as the throat (Mertz et al 2007). Other anatomical sites, e.g., the axilla, groin, skin and the intestinal tract, are also colonized with S. aureus (Acton et al 2009;Vento et al 2013) S. aureus nasal carriers are usually divided into three distinct groups (Gould & McKillop 1954;Kluytmans et al 1997). …”