Abstract
Research indicates that Staphylococcus aureus colonization in the elderly with predisposing risks is associated with subsequent infection. However, the molecular epidemiology and risk factors for S. aureus colonization among residents and staff in nursing homes (NHs) in China remain unclear. A multicenter study was conducted in three NHs in Shanghai between September 2019 and October 2019. We explored the prevalence, molecular epidemiology, and risk factors for S. aureus colonization. All S. aureus isolates were characterized based on antimicrobial resistance, virulence genes, multilocus sequence typing (MLST), staphylococcus protein A (spa) typing, and staphylococcal cassette chromosome mec (SCCmec) typing. NH records were examined for potential risk factors for S. aureus colonization. S. aureus and methicillin-resistant S. aureus (MRSA) isolates were detected in 109 (100 residents and 9 staff, 19.8%, 109/551) and 28 (24 residents and 4 staff, 5.1%, 28/551) subjects among 496 residents and 55 staff screened, respectively. Compared to methicillin-susceptible S. aureus isolates, all 30 MRSA isolates had higher resistance rates to most antibiotics except minocycline, rifampicin, linezolid, vancomycin, and teicoplanin. Sequence type (ST) 1 (21.3%) was the most common sequence type, and t127 (20.5%) was the most common spa type among 122 S. aureus isolates. SCCmec type I (70%) was the dominant clone among all MRSA isolates. CC1 (26/122, 21.3%) was the predominant complex clone (CC), followed by CC398 (25/122, 20.5%), CC5 (20/122, 16.4%) and CC188 (18/122, 14.8%). Female sex (OR, 1.70; 95% CI, 1.04–2.79; P = 0.036) and invasive devices (OR, 2.19; 95% CI, 1.26–3.81; P = 0.006) were independently associated with S. aureus colonization.
Highlights
Staphylococcus aureus is a gram-positive bacterium known to secrete infection-related toxins and invasive enzymes such as hemolysin, Panton-Valentine leukocidin, plasma-coagulase, and enterotoxins [1]
This study was a descriptive study that focused on the risk factors for S aureus and Methicillin-resistant S. aureus (MRSA) carriage and epidemiological surveillance of S. aureus colonization in specimens sourced from nasal, axillary, and skin samples from residents in three Nursing homes (NHs) in Shanghai
Nasal carriage of S. aureus has been associated with subsequent infection [35], and carriers are an important source of infection spread in communities
Summary
Staphylococcus aureus is a gram-positive bacterium known to secrete infection-related toxins and invasive enzymes such as hemolysin, Panton-Valentine leukocidin, plasma-coagulase, and enterotoxins [1]. S. aureus often colonizes asymptomatically on different body sites in healthy individuals, which significantly increases the chances of infection by providing a pathogen reservoir [5]. Methicillin-resistant S. aureus (MRSA) was first reported at a hospital in England in 1961, and it quickly became an important global pathogen [6]. Old and frail adults receiving NH care are at a higher risk for S. aureus infection due to age-related immune senescence, accumulation of comorbid conditions, impaired mobility, and frequent hospital admissions [14]. Living in small NH facilities was independently associated with MRSA colonization among residents, as reported in a Brazilian study [13]. Gowns and gloves should be used during specific care activities, especially for residents with chronic skin issues such as pressure ulcers, which have a higher transmission risk [16]. It is necessary to evaluate the S. aureus colonization rate of NH staff as well
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