Nasal carriage of staphylococcus aureus in rural China: Molecular epidemiology and antimicrobial susceptibility

This study investigated the prevalence of nasal carriage, molecular characteristics, antimicrobial resistance (AMR) patterns, and phylogenetic relationships of Staphylococcus aureus among healthy individuals in rural communities in China.

Nasal swabs were obtained from 646 asymptomatic residents across 10 villages. All S. aureus isolates underwent antimicrobial susceptibility testing and whole-genome sequencing. Comprehensive genomic analyses were performed to predict antibiotic resistance genes and to determine multilocus sequence typing (MLST), spa types, and Staphylococcal Cassette Chromosome mec (SCCmec) classifications, along with other molecular features. Phylogenetic relationships were inferred using single-nucleotide polymorphism (SNP)-based analysis.

From 646 nasal swabs collected from healthy individuals in rural communities, 48 S. aureus isolates were recovered. Among these, 16.67% (8/48) isolates were identified as methicillin-resistant S. aureus (MRSA), resulting in an overall MRSA carriage rate of 1.24% (8/646); 75% (36/48) of the isolates were identified as multidrug-resistant, and the resistance rates to penicillin and erythromycin were relatively high, at 95.83% (46/48) and 91.67% (44/48) respectively. In total, 23 spa types and 12 MLSTs were identified, with t34, ST398, and ST59 being the most prevalent. Dominant MRSA clones included ST59-t437-IVa and ST9-t899-XII. Phylogenetic analysis revealed close genetic relatedness between local isolates and strains of porcine origin or those previously reported in Germany, indicating potential interspecies and transboundary transmission pathways.

The findings highlighted a concerning S. aureus AMR burden among healthy rural populations in China and provided molecular evidence supporting the existence of animal-environment-human transmission routes. These results underscored critical gaps in current One Health frameworks and called for urgent, integrated interventions to mitigate the complex and interconnected nature of AMR threats.