Abstract
BACKGROUND: Staphylococcus aureus (SA) enterotoxins have been suggested to have an impact on specific local IgE production in nasal polyps in patients with allergy. Hypothetically high level of the local IgE during long period maybe associated with methicillin-resistant Staphylococcus aureus (MRSA) formation in the upper respiratory tract in this enlarging group of children with allergy. The aim of the present investigation was to detect the amount of MRSA carriers among children with allergy: nasal polyposis (NP) and allergic rhinitis (AR). METHODS: Nasopharyngeal swabs for SA and MRSA and nasal tissue samples were taken from 1020 children (ages 2-3, 4-7, 8-12) with NP (456 persons) and AR (564 persons) and 980 healthy children (ages 2-12) enrolled for long-term study from 1999 through 2004. Patient's age, gender, diagnosis of allergy, therapy, IgE levels, and use of antibiotics was recorded. Antibiotic resistance of the strains was determined with the disc diffusion method. Nasal tissue samples were analyzed for total and specific IgE to SA. Nonlineal diagnosis system (NLS) method was used to support analysis and demonstration. RESULTS: The rates of nasal carriage of SA were found to be 15% (147/980) in the control group and 62% (632/1020) in patients with NP and AR. MRSA was found in 2% of control and in 29% of patients with NP and AR in 1999, 3% and 32% in 2000, 2% and 37% in 2001, 1% and 40% in 2002, 1% and 52% in 2003, and 1% and 66% patients in 2004. B1 MRSA strain was predominant. Children ages 4-7 years (p = 0.02), glucocorticoid use in NP (p = 0.02), rate of hospitalization (p = 0.005), and specific local IgE level (p = 0.001) were significantly associated with MRSA colonization. Results were confirmed by NLS in 79% of samples. CONCLUSION: The nasal carriage of MRSA in patients with nasal polyposis is high, undetectable, and growing. It is possible that allergy maybe the cause of nasal carriage of MRSA. Children with NP and AR are an unidentified and less well studied group at high risk for spreading MRSA in children's hospitals, day-care centers, and schools. NLS opens up possibilities for screening for MRSA carriers.
Published Version
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