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Multiple-strain colonization in nasal carriers of Staphylococcus aureus
A A Votintseva1, R R Miller, R Fung
1Nuffield Department of Clinical Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom.
Abstract:
Staphylococcus aureus is a commensal that can also cause invasive infection. Reports suggest that nasal cocolonization occurs rarely, but the resources required to sequence multiple colonies have precluded its large-scale investigation. A staged protocol was developed to maximize detection of mixed-spa-type colonization while minimizing laboratory resources using 3,197 S. aureus-positive samples from a longitudinal study of healthy individuals in Oxfordshire, United Kingdom. Initial typing of pooled material from each sample identified a single unambiguous strain in 89.6% of samples. Twelve single-colony isolates were typed from samples producing ambiguous initial results. All samples could be resolved into one or more spa types using the protocol. Cocolonization point prevalence was 3.4 to 5.8% over 24 months of follow-up in 360 recruitment-positives. However, 18% were cocolonized at least once, most only transiently. Cocolonizing spa types were completely unrelated in 56% of samples. Of 272 recruitment-positives returning ≥12 swabs, 166 (61%) carried S. aureus continuously but only 106 (39%) carried the same single spa type without any cocolonization; 31 (11%) switched spa type and 29 (11%) had transient cocarriage. S. aureus colonization is dynamic even in long-term carriers. New unrelated cocolonizing strains could increase invasive disease risk, and ongoing within-host evolution could increase invasive potential, possibilities that future studies should explore.
Insights
Nasal Staphylococcus aureus (S. aureus) colonization is dynamic, with many individuals experiencing transient mixed-strain infections. This suggests a higher prevalence of S. aureus cocolonization than previously thought, potentially impacting disease risk.
Area of Science:
- Microbiology
- Epidemiology
- Genetics
Background:
- Staphylococcus aureus is a common bacterium that can cause serious infections.
- Nasal cocolonization with multiple S. aureus strains is thought to be rare due to the high cost of genetic analysis.
- Understanding S. aureus colonization dynamics is crucial for public health.
Purpose of the Study:
- To develop a resource-efficient protocol for detecting mixed-strain Staphylococcus aureus (S. aureus) nasal cocolonization.
- To investigate the prevalence and dynamics of S. aureus cocolonization in a healthy population over 24 months.
Main Methods:
- A staged protocol was developed to maximize detection of mixed spa-type S. aureus colonization.
- 3,197 S. aureus-positive samples from a longitudinal study in Oxfordshire, UK, were analyzed.
- Pooled DNA was initially typed, followed by single-colony typing for ambiguous results.
Main Results:
- The protocol successfully identified one or more spa types in all samples.
- Point prevalence of S. aureus cocolonization ranged from 3.4% to 5.8%, with 18% experiencing it at least once, often transiently.
- In long-term carriers, 61% continuously carried S. aureus, but only 39% carried a single spa type without cocolonization.
Conclusions:
- Staphylococcus aureus nasal colonization is highly dynamic, even in long-term carriers.
- Transient cocolonization with unrelated S. aureus strains is more common than previously reported.
- Increased detection of cocolonization may reveal new insights into invasive disease risk and bacterial evolution.
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