Staphylococcus aureus colonization of healthy military service members in the United States and Afghanistan

BMC Infectious Diseases

Clinton K Murray³  Kristelle A Cheatle²  Miriam L Beckius²  Xin Yu²  Charles H Guymon⁴  Wendy Zera³  Michael L Landrum³  Charla C Tully²  Elizabeth A Rini²  Katrin Mende³  David W Cole¹  Tatjana P Calvano²  Todd J Vento³ 

[1] Blanch field Army Community Hospital, Fort Campbell, KY, USA;Brooke Army Medical Center/San Antonio Military Medical Center, Fort Sam Houston, 3551 Roger Brooke Drive, Fort Sam Houston, Texas 78234, TX, USA;Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, USA;United States Army Institute of Surgical Research, Fort Sam Houston, TX, USA

关键词: Colonization;    Staphylococcus aureus;    Military;    Doxycycline;    Malaria chemoprophylaxis;    Deployment;   

Others  :  1147050
DOI  :  10.1186/1471-2334-13-325

 received in 2013-01-01, accepted in 2013-07-15,  发布年份 2013

【 摘 要 】

Background

Staphylococcus aureus [methicillin-resistant and methicillin-susceptible (MRSA/MSSA)] is a leading cause of infections in military personnel, but there are limited data regarding baseline colonization of individuals while deployed. We conducted a pilot study to screen non-deployed and deployed healthy military service members for MRSA/MSSA colonization at various anatomic sites and assessed isolates for molecular differences.

Methods

Colonization point-prevalence of 101 military personnel in the US and 100 in Afghanistan was determined by swabbing 7 anatomic sites. US-based individuals had received no antibiotics within 30 days, and Afghanistan-deployed personnel were taking doxycycline for malaria prophylaxis. Isolates underwent identification and testing for antimicrobial resistance, virulence factors, and pulsed-field type (PFT).

Results

4 individuals in the US (4 isolates- 3 oropharynx, 1 perirectal) and 4 in Afghanistan (6 isolates- 2 oropharynx, 2 nare, 1 hand, 1 foot) were colonized with MRSA. Among US-based personnel, 3 had USA300 (1 PVL+) and 1 USA700. Among Afghanistan-based personnel, 1 had USA300 (PVL+), 1 USA800 and 2 USA1000. MSSA was present in 40 (71 isolates-25 oropharynx, 15 nare) of the US-based and 32 (65 isolates- 16 oropharynx, 24 nare) of the Afghanistan-based individuals. 56 (79%) US and 41(63%) Afghanistan-based individuals had MSSA isolates recovered from extra-nare sites. The most common MSSA PFTs were USA200 (9 isolates) in the US and USA800 (7 isolates) in Afghanistan. MRSA/MSSA isolates were susceptible to doxycycline in all but 3 personnel (1 US, 2 Afghanistan; all were MSSA isolates that carried tetM).

Conclusion

MRSA and MSSA colonization of military personnel was not associated with deployment status or doxycycline exposure. Higher S. aureus oropharynx colonization rates were observed and may warrant changes in decolonization practices.

【 授权许可】

   
2013 Vento et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Lyons C: Penicillin and its use in the war wounded. Am J Surg 1946, 72:315-318.
• [2]Heggers JP, Barnes ST, Robson MC, et al.: Microbial flora of orthopaedic war wounds. Mil Med 1969, 134:602-603.
• [3]Tong MJ: Septic complications of war wounds. JAMA 1972, 219:1044-1047.
• [4]Matsumoto T, Wyte SR, Moseley RV, et al.: Combat surgery in communication zone. I. war wound and bacteriology (preliminary report). Mil Med 1969, 134:655-665.
• [5]Yun HC, Branstetter JG, Murray CK: Osteomyelitis in military personnel wounded in Iraq and Afghanistan. J Trauma 2008, 64:S163-S168.
• [6]Roberts SS, Kazragis RJ: Methicillin-resistant Staphylococcus aureus infections in U.S. Service members deployed to Iraq. Mil Med 2009, 174:408-411.
• [7]Murray CK, Griffith ME, Mende K, et al.: Methicillin-resistant Staphylococcus aureus recovered from wounds in Iraq. J Trauma 2010, 69:S102-S108.
• [8]Co EM, Keen EF, Aldous WK: Prevalence of methicillin-resistant Staphylococcus aureus in a combat support hospital in Iraq. Mil Med 2011, 176:89-93.
• [9]Landrum ML, Neumann C, Cook C, et al.: The epidemiology of Staphylococcus aureus blood and skin and soft tissue infections from 2005–2010 in the US Military Health System. JAMA 2012, 308:50-59.
• [10]Ellis MW, Hospenthal DR, Dooley DP, Gray PJ, Murray CK: Natural history of community-acquired methicillin resistant Staphylococcus aureus colonization and infection in soldiers. Clin Infect Dis 2004, 39:971-979.
• [11]Morrison-Rodriguez S, Pacha L, Patrick J, Jordan N: Community-associated methicillin-resistant Staphylococcus aureus infections at an Army training installation. Epidemiol Infect 2010, 138:721-729.
• [12]Ellis MW, Griffith ME, Dooley DP, et al.: Targeted intranasal mupirocin to prevent colonization and infection by community-associated methicillin-resistant Staphylococcus aureus strains in Soldiers: a cluster randomized controlled trial. Antimicrob Agents Chemother 2007, 51:3591-3598.
• [13]Whitman TJ, Herlihy RK, Schlett CD, et al.: Chlorhexidine-impregnated cloths to prevent skin and soft-tissue infection in Marine recruits: a cluster-randomized, double-blind, controlled effectiveness trial. Infect Control Hosp Epidemiol 2010, 31:1207-1215.
• [14]Miller LR, Tan J, Eells SJ, Benitez E, Radner AB: Prospective investigation of nasal mupirocin, hexachlorophene body wash, and systemic antibiotics for prevention of recurrent community-associated methicillin-resistant Staphylococcus aureus infections. Antimicrob Agents Chemother 2012, 56:1084-1086.
• [15]Kallen AJ, Mu Y, Bulens S, et al.: Health care-associated invasive MRSA infections, 2005–2008. JAMA 2010, 304:641-648.
• [16]Mare CL, Eells SJ, Tan J, et al.: Risk factors for infection and colonization with community-associated methicillin-resistant Staphylococcus aureus in the Los Angeles County Jail: a case–control study. Clin Infect Dis 2010, 51:1248-1257.
• [17]Schechter-Perkins EM, Mitchell PM, Murray KA, Rubin-Smith JE, Weir S, Gupta K: Prevalence and predictors of nasal and extranasal staphylococcal colonization in patients presenting to the emergency department. Ann Emerg Med 2011, 57:492-499.
• [18]Baker SE, Brecher SM, Robillard E, Strymish J, Lawler E, Gupta K: Extranasal methicillin-resistant Staphylococcus aureus colonization at admission to an acute care Veterans Affairs hospital. Infect Control Hosp Epidemiol 2012, 31:42-46.
• [19]Chambers HF: The changing epidemiology of Staphylococcus aureus. Emerg Infect Dis 2001, 7:178-182.
• [20]Miller LG, Eells SJ, Taylor AR, et al.: Staphylococcus aureus colonization among household contacts of patients with skin infections: risk factors, strain discordance, and complex ecology. Clin Infect Dis 2012, 54:1523-1535.
• [21]Schwartz BS, Graber CJ, Diep BA, Basuino L, Perdreau-Remington F, Chambers HF: Doxycycline, not minocycline, induces its own resistance in multidrug-resistant, community-associated methicillin-resistant Staphylococcus aureus clone USA300. Clin Infect Dis 2009, 48:1483-1484.
• [22]McDougal LK, Steward CD, Killgore GE, et al.: Pulsed-field gel electrophoresis typing of oxacillin-resistant Staphylococcus aureus isolates from the United States: establishing a national database. J Clin Microbiol 2003, 41:5113-5120.
• [23]Tenover FC, Arbeit RD, Goering RV, et al.: Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995, 33:2233-2239.
• [24]Ide L, Lootens J, Thibo P: The nose is not the only relevant MRSA screening site. Clin Microbiol Infect 2009, 15:1192-1193.
• [25]Mertz D, Frei R, Periat N, et al.: Exclusive Staphylococcus aureus throat carriage: at-risk populations. Arch Intern Med 2009, 169:172-178.
• [26]Yang ES, Tan J, Eells S, Rieg G, Tagudar G, Miller LG: Body site colonization in patients with community-associated methicillin-resistant Staphylococcus aureus and other types of S. aureus skin infections. Clin Microbiol Infect 2010, 16:425-431.
• [27]Miller LG, Diep BA: Colonization, fomites, and virulence: rethinking the pathogenesis of community-acquired methicillin-resistant Staphylococcus aureus infection. Clin Infection Dis 2008, 46:752-760.
• [28]Nastaly P, Grinholc M, Bielawski KP: Molecular characteristics of community-associated methicillin-resistant Staphylococcus aureus strains for clinical medicine. Arch Microbiol 2010, 192:603-617.
• [29]McDougal LK, Fosheim GE, Nicholson A, et al.: Emergence of resistance among USA300 methicillin-resistant Staphylococcus aureus isolates causing invasive disease in the United State. Antimicrob Agents Chemother 2010, 54:3804-3811.
• [30]Lesens O, Haus-Cheymol R, Dubrous P, et al.: Methicillin-susceptible, doxycycline-resistant Staphylococcus aureus, Cote d’Ivoire. Emerg Infect Dis 2007, 13:488-490.
• [31]Fanelli M, Kupperman E, Lautenbach E, Edelstein PH, Margolis DJ: Antibiotics, acne and Staphylococcus aureus colonization. Arch Dermatol 2011, 147:917-921.
• [32]Tribble DR, Conger NG, Fraser S, et al.: Infection-associated clinical outcomes in hospitalized medical evacuees following traumatic injury- Trauma Infectious Disease Outcome Study (TIDOS). J Trauma supplement 2011, 71:S33-S42.
• [33]Hospenthal DR, Murray CK, Andersen RC, et al.: Guidelines for the prevention of infections associated with combat-related injuries: 2011 update. J Trauma supplement 2011, 71:S210-S234.
• [34]Murray CK, Obremskey WT, Hsu JR, et al.: Prevention of infections associated with combat-related extremity injuries. J Trauma supplement 2011, 71:S235-S257.
• [35]Brown KV, Murray CK, Clasper J: Infectious complications of combat-related extremity injuries in the British Military. J Trauma supplement 2010, 69:S109-S115.
• [36]Murray CK, Roop SA, Hospenthal DR, et al.: Bacteriology of war wounds at the time of injury. Mil Med 2006, 171:826-829.
• [37]Juan RS, Garcia-Reyne A, Caba P, et al.: Safety and efficacy of moxifloxacin monotherapy for treatment of orthopedic implant-related Staphylococcal infections. Antimicrob Agents Chemother 2010, 54:5161-5166.
• [38]Murray CK, Hospenthal DR, Kotwal RS, Butler FK: Providing prehospital antimicrobials to combat casualties. J Trauma supplement 2011, 71:S307-S313.