Abstract
Swine production work is a risk factor for nasal carriage of livestock-associated (LA-) Staphylococcus aureus and also for skin and soft tissue infection (SSTI). However, whether LA-S. aureus nasal carriage is associated with increased risk of SSTI remains unclear. We aimed to examine S. aureus nasal carriage and recent (≤3 months prior to enrollment) SSTI symptoms among industrial hog operation (IHO) workers and their household contacts. IHO workers and their household contacts provided a nasal swab and responded to a questionnaire assessing self-reported personal and occupational exposures and recent SSTI symptoms. Nasal swabs were analyzed for S. aureus, including methicillin-resistant S. aureus (MRSA), multidrug-resistant-S. aureus (MDRSA), absence of scn (livestock association), and spa type. S. aureus with at least one indicator of LA was observed among 19% of 103 IHO workers and 6% of 80 household members. Prevalence of recent SSTI was 6% among IHO workers and 11% among 54 minor household members (0/26 adult household members reported SSTI). Among IHO workers, nasal carriers of MDRSA and scn-negative S. aureus were 8.8 (95% CI: 1.8, 43.9) and 5.1 (95% CI: 1.2, 22.2) times as likely to report recent SSTI as non-carriers, respectively. In one household, both an IHO worker and child reported recent SSTI and carried the same S. aureus spa type (t4976) intranasally. Prevalence of scn-negative S. aureus (PR: 5.0, 95% CI: 1.2, 21.4) was elevated among IHO workers who reported never versus always wearing a face mask at work. Although few SSTI were reported, this study of IHO workers and their household contacts is the first to characterize a relation between nasal carriage of antibiotic-resistant LA-S. aureus and SSTI. The direction and temporality of this relation and IHO workers’ use of face masks to prevent nasal carriage of these bacteria warrant further investigation.
Highlights
Over the past decade, animal-adapted strains of antibiotic-resistant Staphylococcus aureus have emerged globally among food-producing animals, as well as among people who have contact with food-producing animals [1]
Despite high prevalence of LA-S. aureus nasal carriage among individuals occupationallyexposed to livestock [1] and increasing prevalence among some non-exposed populations [8,11], it remains unclear whether LA-S. aureus nasal carriage is a risk factor for skin and soft tissue infection (SSTI)
LA-S. aureus appear to differ from hospital and community-associated strains in that they typically lack genetic factors associated with human infection, including Panton-Valentine leukocidin- (PVL-) encoding genes, enterotoxin-producing genes, and human immune evasion complex genes [13,14,15]
Summary
Animal-adapted strains of antibiotic-resistant Staphylococcus aureus have emerged globally among food-producing animals, as well as among people who have contact with food-producing animals [1]. LA-S. aureus appear to differ from hospital and community-associated strains in that they typically lack genetic factors associated with human infection, including Panton-Valentine leukocidin- (PVL-) encoding genes, enterotoxin-producing genes, and human immune evasion complex (e.g., scn) genes [13,14,15]. Their capacity for human-to-human transmission appears to be lower than many widespread community- and hospital-associated S. aureus CCs [16,17]. Identifying an association between SSTI and nasal carriage, which can be managed through decolonization interventions [25], could help efforts to prevent S. aureus exposure and associated infections among livestock workers and their household and community contacts
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