Staphylococcus aureus Nasal Carriage in a Student Community Prevalence, Clonal Relationships, and Risk Factors

Abstract

Objective: To evaluate the prevalence and risk factors of nasal Staphylococcus aureus (SA) in the community.Design: Cross-sectional study.Setting: Wake Forest University, Winston-Salem, North Carolina.Participants: Four hundred fifty students were screened for nasal SA carriage during the fall of 2000, 2001, and 2002.Methods: Students were screened by nose swabs. A self-administered questionnaire collected information on demographics and medical history. Antibiotic testing and PFGE were performed on isolates. Risk factors were determined by logistic regression analysis.Results: Of 450 volunteers, 131 (29%) were SA carriers. Antibiotic resistance was high for azithromycin (26%) and low for ciprofloxacin (1%), tetracycline (5%), mupirocin (1%), and methicillin (2%). PFGE patterns were not associated with carriage. Age, male gender, white race, medical student, allergen injection therapy, chronic sinusitis, rheumatoid arthritis, hospitalization for 6 months or less, and use of antibiotics were associated with carrier status by univariate analysis. Stepwise multivariate logistic regression led to a best fitting model with older age (OR, 1.04; CI₉₅, 1.005-1.079), male gender (OR, 1.50; CI₉₅, 0.982-2.296), and chronic sinusitis (OR, 2.71; CI₉₅, 0.897-8.195) as risk factors. Antibiotic use (< 4 weeks) (OR, 0.41; CI₉₅, 0.152-1.095) and allergen injection therapy (OR 0.41; CI₉₅, 0.133-1.238) were protective. Analyses of carriers revealed candidate factors for persistent carriage to be nasal SA colonization rate and male gender. Factors for azithromycin resistance were non-medical students and antibiotic use in the past 6 months.Conclusion: Older male volunteers suffering from chronic sinusitis and not taking antibiotics were at higher risk for carrying SA.