Effect of Electronic Cigarettes on the Carriage of Selected Organisms in the Nasal and Oral Cavity in Comparison to Tobacco Smokers and Non-smokers

Abstract

Introduction: The use of Electronic Cigarettes (ECs) has been increased over the last years but their long term effects on health and microbiota has not yet been explored fully. Aim: To examine the oral and nasal microbial profile and antibiotics susceptibility in the ECs users, smokers and non-smokers and to assess the microbial contamination of the ECs juice. Materials and Methods: Nasal and oral swabs were collected from 30 non-smokers, 30 tobacco smokers and 30 from candidates who have been using ECs for more than six months. Nasal Methicillin Susceptible Staphylococcus aureus (MSSA) and Methicillin Resistant Staphylococcus aureus (MRSA), and oral Streptococcus viridans and Candida albicans were isolated and identified using standard laboratory methods. ECs juice was also cultured to test for microbial presence and the antibiogram for all isolated bacteria was carried out by disc diffusion or broth dilution methods according to Clinical and Laboratory Standard Institute (CLSI) guidelines. The statistical analysis was performed with Stata Statistical Software: Release 13. Results: MSSA was isolated from 9 (30%) non-smokers, 5 (16.7%) ECs users and 2 (6.7%) smokers, respectively. Only 1 (3.3%) MRSA was isolated from a smoker. Streptococcus viridians was detected in 14 (46.7%) non-smokers, 9 (30%) ECs user and 5 (16.7%) smokers. Candida albicans was isolated from 7 (23.3%) smokers, 3 (10%) ECs users and in 1 (3.3%) non-smokers. When both groups of ECs users and smokers were compared to non-smokers; the statistical intergroups difference in carriage of MSSA and Streptococcus viridans using Chi-Square test was only significant in the smokers group (p-value <0.05), while the difference in carriage of MRSA and Candida albicans in both ECs users and smokers was not statistically significant compared to non-smokers (p-value <0.05). The cultures of ECs juices showed no growth. The highest resistance among MSSA isolates was for fusidic acid (43.8%) and the least was for mupirocin and linezolid (0%). Among Streptococcus viridans, the highest resistance was to penicillin (68%) and the least was for vancomycin (7.1%). Conclusion: The effect of ECs on carriage of MSSA and Streptococcus viridans commensals was not significant compared to non-smokers. Therefore, ECs might be less harmful on microbiota compared to tobacco smoking.