Multi-site and nasal swabbing for carriage of Staphylococcus aureus: what does a single nose swab predict?

J Hosp Infect. 2017 Jul;96(3):232-237. doi: 10.1016/j.jhin.2017.01.015. Epub 2017 Jan 30.

Abstract

Background: Carriage of Staphylococcus aureus is a risk for infections. Targeted decolonization reduces postoperative infections but depends on accurate screening.

Aim: To compare detection of S. aureus carriage in healthy individuals between anatomical sites and nurse- versus self-swabbing; also to determine whether a single nasal swab predicted carriage over four weeks.

Methods: Healthy individuals were recruited via general practices. After consent, nurses performed multi-site swabbing (nose, throat, and axilla). Participants performed nasal swabbing twice-weekly for four weeks. Swabs were returned by mail and cultured for S. aureus. All S. aureus isolates underwent spa typing. Persistent carriage in individuals returning more than three self-swabs was defined as culture of S. aureus from all or all but one self-swabs.

Findings: In all, 102 individuals underwent multi-site swabbing; S. aureus carriage was detected from at least one site from 40 individuals (39%). There was no difference between nose (29/102, 28%) and throat (28/102, 27%) isolation rates: the combination increased total detection rate by 10%. Ninety-nine patients returned any self-swab, and 96 returned more than three. Nasal carriage detection was not significantly different on nurse or self-swab [28/99 (74%) vs 26/99 (72%); χ2: P=0.75]. Twenty-two out of 25 participants with first self-swab positive were persistent carriers and 69/71 with first self-swab negative were not, giving high positive predictive value (88%), and very high negative predictive value (97%).

Conclusion: Nasal swabs detected the majority of carriage; throat swabs increased detection by 10%. Self-taken nasal swabs were equivalent to nurse-taken swabs and predicted persistent nasal carriage over four weeks.

Keywords: Carriage; Multi-site screening; Staphylococcus aureus; spa typing.

Publication types

  • Comparative Study
  • Evaluation Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Carrier State / diagnosis*
  • Female
  • Healthy Volunteers
  • Humans
  • Male
  • Middle Aged
  • Molecular Typing
  • Specimen Handling / methods*
  • Staphylococcal Infections / diagnosis*
  • Staphylococcus aureus / classification
  • Staphylococcus aureus / genetics
  • Staphylococcus aureus / isolation & purification*
  • Young Adult