Undetected carriage explains apparent Staphylococcus aureus acquisition in a non-outbreak healthcare setting

Price, James R, Yokoyama, Maho, Cole, Kevin, Sweetman, Jonathan, Behar, Laura, Stoneham, Simon, Cantillon, Daire, Waddell, Simon J, Hyde, Jonathan, Alam, Ruhina, Crook, Derrick, Paul, John and Llewelyn, Martin J (2021) Undetected carriage explains apparent Staphylococcus aureus acquisition in a non-outbreak healthcare setting. Journal of Infection, 83 (3). pp. 332-338. ISSN 0163-4453

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Abstract

Objectives
Previous studies have been unable to identify patient or staff reservoirs for the majority of the nosocomial S. aureus acquisitions which occur in the presence of good infection control practice. We set out to establish the extent to which undetected pre-existing carriage explains apparent nosocomial S. aureus acquisition.

Methods
Over two years elective cardiothoracic admissions were screened for S. aureus carriage before and during hospital admission. Routine screening (nose/groin/wound sampling), was supplemented by sampling additional body sites (axilla/throat/rectum) and culture-based methods optimised to detect fastidious phenotypes (small colony variants, cell wall deficient variants) and molecular identification by PCR.

Results
35% of participants (53/151) were S. aureus carriers according to routine pre-healthcare screening; increasing to 42% (63/151) when additional body sites and enhanced cultures were employed. 71% (5/7) of apparent acquisitions were explained by pre-existing carriage using augmented measures. Enhanced culture identified a minority of colonised individuals (3/151 including 1 MRSA carrier) who were undetected by routine and additional screening cultures. 4/14 (29%) participants who became culture-negative during admission had S. aureus genomic material detected at discharge.`

Conclusions
Conventional sampling under-estimates carriage of S. aureus and this explains the majority of apparent S. aureus acquisitions among elective cardiothoracic patients.

Item Type: Article
Keywords: Staphylococcus aureus, acquisition, concealed carriage
Schools and Departments: Brighton and Sussex Medical School > Global Health and Infection
SWORD Depositor: Mx Elements Account
Depositing User: Mx Elements Account
Date Deposited: 30 Jul 2021 07:35
Last Modified: 01 Sep 2021 09:31
URI: http://sro.sussex.ac.uk/id/eprint/100841

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