Carriage of Staphylococcus Aureus Among Portuguese Nursing Students: A Longitudinal Cohort Study over Four Years of Education

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2017 Dec 1

PMID 29190721

Citations 9

Authors

Teresa Conceicao

Herminia de Lencastre

Marta Aires-de-Sousa

Affiliations

Soon will be listed here.

Abstract

Background: Staphylococcus aureus is a major human pathogen that can colonize healthy people mainly in the anterior nares. The aim of the present study was to evaluate S. aureus nasal colonization over time among Portuguese nursing students, including methicillin-resistant S. aureus (MRSA).

Methods And Findings: In this longitudinal cohort study, we collected 280 nasal swabs from nursing students at 14 time points over four years of schooling (2012-2016). The isolates were characterized by pulsed-field gel electrophoresis (PFGE), spa typing, multilocus sequence typing (MLST), and SCCmec typing for MRSA. Among 47 students, 20 (43%) carried methicillin-susceptible S. aureus (MSSA) at admission, but none was colonized with MRSA. A total of 19 students (40%) became colonized after exposure during the nursing training, out of which five carried MRSA. Overall, 39 students (83%) had S. aureus detected at least once during the study period. Among the 97 MSSA isolates, most (65%) belonged to four clones: PFGE A-ST30 (21%), B-ST72 (20%), C-ST508 (13%), and D-ST398 (11%). Three of the five MRSA carriers were colonized with the predominant clone circulating in Portuguese hospitals (ST22-IVh) and two with ST3162-II. Colonization of nursing students was highly dynamic with continuous appearance of strains with distinct PFGE types in the same individual.

Conclusions: A considerable proportion of students became colonized by S. aureus, including MRSA, during the nursing education, evidencing this population represents an important reservoir of S. aureus. Therefore, education on infection control measures in nursing schools is of major importance.

Citing Articles

Colonization of methicillin-resistant Staphylococcus aureus among healthcare students: an integrative review.

Oliveira E, Carvalho A, Ferreira A, Moura L, Valle A, Freitas D Sao Paulo Med J. 2021; 139(6):607-614.

PMID: 34787295 PMC: 9634839. DOI: 10.1590/1516-3180.2020.0564.R2.22042021.

Whole-genome analysis uncovers loss of blaZ associated with carriage isolates belonging to methicillin-resistant Staphylococcus aureus (MRSA) clone ST5-VI in Cape Verde.

Wysocka M, Monteiro T, de Pina C, Goncalves D, de Pina S, Ludgero-Correia A J Glob Antimicrob Resist. 2021; 26:77-83.

PMID: 34052522 PMC: 8440226. DOI: 10.1016/j.jgar.2021.04.018.

Nasal Carriage by among Healthcare Workers and Students Attending a University Hospital in Southern Brazil: Prevalence, Phenotypic, and Molecular Characteristics.

Danelli T, Duarte F, de Oliveira T, da Silva R, Alfieri D, Goncalves G Interdiscip Perspect Infect Dis. 2020; 2020:3808036.

PMID: 33343658 PMC: 7732402. DOI: 10.1155/2020/3808036.

Methicillin-Resistant ST80 Clone: A Systematic Review.

Mairi A, Touati A, Lavigne J Toxins (Basel). 2020; 12(2).

PMID: 32075074 PMC: 7076798. DOI: 10.3390/toxins12020119.

One Health Approach Reveals the Absence of Methicillin-Resistant in Autochthonous Cattle and Their Environments.

Correia S, Silva V, Garcia-Diez J, Teixeira P, Pimenta K, Pereira J Front Microbiol. 2020; 10:2735.

PMID: 31921000 PMC: 6930173. DOI: 10.3389/fmicb.2019.02735.

References

Okuma K, Iwakawa K, Turnidge J, Grubb W, Bell J, OBrien F . Dissemination of new methicillin-resistant Staphylococcus aureus clones in the community. J Clin Microbiol. 2002; 40(11):4289-94. PMC: 139674. DOI: 10.1128/JCM.40.11.4289-4294.2002. View

Berthelot P, Grattard F, Fascia P, Martin I, Mallaval F, Ros A . Is nasal carriage of methicillin-resistant Staphylococcus aureus more prevalent among student healthcare workers?. Infect Control Hosp Epidemiol. 2004; 25(5):364-5. DOI: 10.1086/503498. View

Wertheim H, Melles D, Vos M, van Leeuwen W, van Belkum A, Verbrugh H . The role of nasal carriage in Staphylococcus aureus infections. Lancet Infect Dis. 2005; 5(12):751-62. DOI: 10.1016/S1473-3099(05)70295-4. View

Balci Akpinar R, Celebioglu A, Uslu H, Uyanik M . An evaluation of the hand and nasal flora of Turkish nursing students after clinical practice. J Clin Nurs. 2009; 18(3):426-30. DOI: 10.1111/j.1365-2702.2008.02514.x. View

Orlin I, Rokney A, Onn A, Glikman D, Peretz A . Hospital clones of methicillin-resistant are carried by medical students even before healthcare exposure. Antimicrob Resist Infect Control. 2017; 6:15. PMC: 5260124. DOI: 10.1186/s13756-017-0175-2. View

Hawkins G, Stewart S, Blatchford O, Reilly J . Should healthcare workers be screened routinely for meticillin-resistant Staphylococcus aureus? A review of the evidence. J Hosp Infect. 2011; 77(4):285-9. DOI: 10.1016/j.jhin.2010.09.038. View

Aires de Sousa M, de Lencastre H, Sanches I, Kikuchi K, Totsuka K, Tomasz A . Similarity of antibiotic resistance patterns and molecular typing properties of methicillin-resistant Staphylococcus aureus isolates widely spread in hospitals in New York City and in a hospital in Tokyo, Japan. Microb Drug Resist. 2001; 6(3):253-8. DOI: 10.1089/mdr.2000.6.253. View

Amorim M, Faria N, Oliveira D, Vasconcelos C, Cabeda J, Mendes A . Changes in the clonal nature and antibiotic resistance profiles of methicillin-resistant Staphylococcus aureus isolates associated with spread of the EMRSA-15 clone in a tertiary care Portuguese hospital. J Clin Microbiol. 2007; 45(9):2881-8. PMC: 2045296. DOI: 10.1128/JCM.00603-07. View

Aires de Sousa M, Conceicao T, Simas C, de Lencastre H . Comparison of genetic backgrounds of methicillin-resistant and -susceptible Staphylococcus aureus isolates from Portuguese hospitals and the community. J Clin Microbiol. 2005; 43(10):5150-7. PMC: 1248511. DOI: 10.1128/JCM.43.10.5150-5157.2005. View

10.

Bettin A, Causil C, Reyes N . Molecular identification and antimicrobial susceptibility of Staphylococcus aureus nasal isolates from medical students in Cartagena, Colombia. Braz J Infect Dis. 2012; 16(4):329-34. DOI: 10.1016/j.bjid.2012.06.017. View

11.

Rioux C, Armand-Lefevre L, Guerinot W, Andremont A, Lucet J . Acquisition of methicillin-resistant Staphylococcus aureus in the acute care setting: incidence and risk factors. Infect Control Hosp Epidemiol. 2007; 28(6):733-6. DOI: 10.1086/516664. View

12.

Conceicao T, Coelho C, Silva I, de Lencastre H, Aires-de-Sousa M . Staphylococcus aureus in former Portuguese colonies from Africa and the Far East: missing data to help fill the world map. Clin Microbiol Infect. 2015; 21(9):842.e1-842.e10. DOI: 10.1016/j.cmi.2015.05.010. View

13.

Dulon M, Peters C, Schablon A, Nienhaus A . MRSA carriage among healthcare workers in non-outbreak settings in Europe and the United States: a systematic review. BMC Infect Dis. 2014; 14:363. PMC: 4094410. DOI: 10.1186/1471-2334-14-363. View

14.

Kluytmans J, van Belkum A, Verbrugh H . Nasal carriage of Staphylococcus aureus: epidemiology, underlying mechanisms, and associated risks. Clin Microbiol Rev. 1997; 10(3):505-20. PMC: 172932. DOI: 10.1128/CMR.10.3.505. View

15.

Vranic S, Puskar M . Staphylococcus aureus carriage among medical students. Med Glas (Zenica). 2012; 9(2):325-9. View

16.

Almeida S, Nunes S, Paulo A, Faria N, de Lencastre H, Sa-Leao R . Prevalence, risk factors, and epidemiology of methicillin-resistant Staphylococcus aureus carried by adults over 60 years of age. Eur J Clin Microbiol Infect Dis. 2014; 34(3):593-600. DOI: 10.1007/s10096-014-2267-8. View

17.

Carmona-Torre F, Torrellas B, Rua M, Yuste J, Del Pozo J . Staphylococcus aureus nasal carriage among medical students. Lancet Infect Dis. 2017; 17(5):477-478. DOI: 10.1016/S1473-3099(17)30188-3. View

18.

Syafinaz A, Nur Ain N, Nadzirahi S, Fatimah J, Shahram A, Nasir M . Staphylococcus aureus Nasal Carriers Among Medical Students in A Medical School. Med J Malaysia. 2013; 67(6):636-8. View

19.

Espadinha D, A Faria N, Miragaia M, Lito L, Melo-Cristino J, de Lencastre H . Extensive dissemination of methicillin-resistant Staphylococcus aureus (MRSA) between the hospital and the community in a country with a high prevalence of nosocomial MRSA. PLoS One. 2013; 8(4):e59960. PMC: 3617237. DOI: 10.1371/journal.pone.0059960. View

20.

Guclu E, Yavuz T, Tokmak A, Behcet M, Karali E, Ozturk O . Nasal carriage of pathogenic bacteria in medical students: effects of clinic exposure on prevalence and antibiotic susceptibility. Eur Arch Otorhinolaryngol. 2006; 264(1):85-8. DOI: 10.1007/s00405-006-0160-5. View