Nasal Carriage of Staphylococcus aureus: Associated Risks and Preventive Measures

  • H. F. L. Wertheim
  • J. A. J. W. Kluytmans
Conference paper


Humans are a natural reservoir for Staphylococcus aureus. This micro-organism is a frequent cause of clinically important infections, including bacteremia, metastatic abscesses, septic arthritis, pneumonia, osteomyelitis, and wound infections [1]. Many of these infections are nosocomial and lead to increased hospital stay, antibiotic use, costs, and mortality [2]. Due to an increasing number of infections caused by methicillin-resistant S. aureus (MRSA) strains, which are now most often multi-resistant, therapy has become problematic. Even more worrying is the fact that recently the first vancomycin-resistant S. aureus has been cultured in the United States [3]. Therefore, prevention of staphylococcal infections is of the uttermost importance.


Surgical Site Infection Peritoneal Dialysis Patient Nasal Carriage Surgical Site Infection Rate Aureus Infection 
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  1. 1.
    Lowy F (1998) Staphylococcus aureus infections. N Engl J Med 339: 520–532PubMedCrossRefGoogle Scholar
  2. 2.
    Van den Bergh MF, Kluytmans JA, van Hout BA, et al (1996) Cost-effectiveness of perioperative mupirocin nasal ointment in cardiothoracic surgery. Infect Control Hosp Epidemiol 17: 786–792CrossRefGoogle Scholar
  3. 3.
    Anonymous (2002) Public Health Dispatch: Vancomycin-resistant Staphylococcus aureus; Pennsylvania, 2002. MMWR Morb Mortal Wkly Rep 51: 902Google Scholar
  4. 4.
    Kluytmans JA, Mouton JW, Van den Bergh MF, et al (1996) Reduction of surgical-site infections in cardiothoracic surgery by elimination of nasal carriage of Staphylococcus aureus. Infect Control Hosp Epidemiol 17: 780–785PubMedCrossRefGoogle Scholar
  5. 5.
    Kluytmans JA, van Belkum A, Verbrugh HA (1997) Nasal carriage of Staphylococcus aureus: epidemiology, underlying mechanisms, and associated risks. Clin Microbiol Rev 10: 505–520PubMedGoogle Scholar
  6. 6.
    Nouwen JL, van Belkum A, Verbrugh HA (2001) Determinants of Staphylococcus aureus nasal carriage. Neth J Med 59: 126–133PubMedCrossRefGoogle Scholar
  7. 7.
    Cole AM, Tahk S, Oren A, et al (2001) Determinants of Staphylococcus aureus nasal carriage. Clin Diagn Lab Immunol 8: 1064–1069PubMedGoogle Scholar
  8. 8.
    Cole AM, Dewan P, Ganz T (1999) Innate antimicrobial activity of nasal secretions. Infect Immun 67: 3267–3275PubMedGoogle Scholar
  9. 9.
    Peacock SJ, de Silva I, Lowy FD (2001) What determines nasal carriage of Staphylococcus aureus? Trends Microbiol 9: 605–610PubMedCrossRefGoogle Scholar
  10. 10.
    Wertheim HFL, Kleef M, Vos MC, Verbrugh H, Fokkens W (2002) Nosepicking and nasal carriage of Staphylococcus aureus. ICAAC Abstract Book. ASM Press, Herndon K456 (abst)Google Scholar
  11. 11.
    von Eiff C, Becker K, Machka K, Stammer H, Peters G (2001) Nasal carriage as a source of Staphylococcus aureus bacteremia. Study Group. N Engl J Med 344: 11–16Google Scholar
  12. 12.
    Wertheim HFL, Vos MC, Ott A, et al (2002) Mupirocin prophylaxis for nosocomial Staphylococcus aureus infections in non-surgical patients. ICAAC Abstract Book. ASM Press, Herndon, K-460 (abst)Google Scholar
  13. 13.
    Jensen AG, Wachmann CH, Poulsen KB, et al (1999) Risk factors for hospital-acquired Staphylococcus aureus bacteremia. Arch Intern Med 159: 1437–1444PubMedCrossRefGoogle Scholar
  14. 14.
    Nguyen MH, Kauffman CA, Goodman RP, et al (1999) Nasal carriage of and infection with Staphylococcus aureus in HIV- infected patients. Ann Intern Med 130: 221–225PubMedCrossRefGoogle Scholar
  15. 15.
    Pujol M, Pena C, Pallares R, et al (1996) Nosocomial Staphylococcus aureus bacteremia among nasal carriers of methicillin-resistant and methicillin-susceptible strains. Am J Med 100: 509–516PubMedCrossRefGoogle Scholar
  16. 16.
    Selvey LA, Whitby M, Johnson B (2000) Nosocomial methicillin-resistant Staphylococcus aureus bacteremia: is it any worse than nosocomial methicillin-sensitive Staphylococcus aureus bacteremia? Infect Control Hosp Epidemiol 21: 645–648PubMedCrossRefGoogle Scholar
  17. 17.
    Doebbeling BN (1994) Nasal and hand carriage of Staphylococcus aureus in healthcare workers. J Chemother 6 (suppl) 2: 11–17Google Scholar
  18. 18.
    Hudson IR (1994) The efficacy of intranasal mupirocin in the prevention of staphylococcal infections: a review of recent experience. J Hosp Infect 27: 81–98PubMedCrossRefGoogle Scholar
  19. 19.
    Doebbeling BN, Breneman DL, Neu HC, et al (1993) Elimination of Staphylococcus aureus nasal carriage in health care workers: analysis of six clinical trials with calcium mupirocin ointment. The Mupirocin Collaborative Study Group. Clin Infect Dis 17: 466–474Google Scholar
  20. 20.
    Bommer J, Vergetis W, Andrassy K, et al (1995) Elimination of Staphylococcus aureus in hemodialysis patients. Asaio J 41: 127–131PubMedGoogle Scholar
  21. 21.
    Cookson BD (1998) The emergence of mupirocin resistance: a challenge to infection control and antibiotic prescribing practice. J Antimicrob Chemother 41: 11–18PubMedCrossRefGoogle Scholar
  22. 22.
    Fung S, O’Grady S, Kennedy C, et al (2000) The utility of polysporin ointment in the eradication of methicillin-resistant Staphylococcus aureus colonization• a pilot study. Infect Control Hosp Epidemiol 21: 653–655PubMedCrossRefGoogle Scholar
  23. 23.
    Soto NE, Vaghjimal A, Stahl-Avicolli A, et al (1999) Bacitracin versus mupirocin for Staphylococcus aureus nasal colonization. Infect Control Hosp Epidemiol. 20: 351–353PubMedCrossRefGoogle Scholar
  24. 24.
    Parras F, Guerrero MC, Bouza E, et al (1995) Comparative study of mupirocin and oral cotrimoxazole plus topical fusidic acid in eradication of nasal carriage of methicillin-resistant Staphylococcus aureus. Antimicrob Agents Chemother 39: 175–179PubMedCrossRefGoogle Scholar
  25. 25.
    Quickel KE Jr, Selden R, Caldwell JR, Nora NF, Schaffner W (1971) Efficacy and safety of topical lysostaphin treatment of persistent nasal carriage of Staphylococcus aureus. Appl Microbiol 22: 446–450PubMedGoogle Scholar
  26. 26.
    Carson CF, Cookson BD, Farrelly HD, Riley TV (1995) Susceptibility of methicillin-resistant Staphylococcus aureus to the essential oil of Melaleuca alternifolia. J Antimicrob Chemother 35: 421–424PubMedCrossRefGoogle Scholar
  27. 27.
    Hill RL, Casewell MW (2000) The in-vitro activity of povidone-iodinecream against Staphylococcus aureus and its bioavailability in nasal secretions. J Hosp Infect 45: 198–205PubMedCrossRefGoogle Scholar
  28. 28.
    Chow JW, Yu VL (1989) Staphylococcus aureus nasal carriage in hemodialysis patients. Its role in infection and approaches to prophylaxis. Arch Intern Med 149: 1258–1262Google Scholar
  29. 29.
    Uehara Y, Nakama H, Agematsu K, et al (2000) Bacterial interference among nasal inhabitants: eradication of Staphylococcus aureus from nasal cavities by artificial implantation of Corynebacterium sp. J Hosp Infect 44: 127–133PubMedCrossRefGoogle Scholar
  30. 30.
    Kalmeijer MD, Coertjens H, Van Nieuwland-Bollen PM, et al (2002) Surgical site infections in orthopedic surgery: the effect of mupirocin nasal ointment in a double-blind, randomized, placebo-controlled study. Clin Infect Dis 35: 353–358PubMedCrossRefGoogle Scholar
  31. 31.
    Perl TM, Cullen JJ, Wenzel RP, et al (2002) Intranasal mupirocin to prevent postoperative Staphylococcus aureus infections. N Engl J Med 346: 1871–1877PubMedCrossRefGoogle Scholar
  32. 32.
    Boelaert JR (1994) Staphylococcus aureus infection in haemodialysis patients. Mupirocin as a topical strategy against nasal carriage: a review. J Chemother 6 (suppl 2): 19–24PubMedGoogle Scholar
  33. 33.
    Boelaert JR, De Smedt RA, De Baere YA, et al (1989) The influence of calcium mupirocin nasal ointment on the incidence of Staphylococcus aureus infections in haemodialysis patients. Nephrol Dial Transplant 4: 278–281PubMedGoogle Scholar
  34. 34.
    Zimmerman SW, Ahrens E, Johnson CA, et al (1991) Randomized controlled trial of prophylactic rifampin for peritoneal dialysis-related infections. Am J Kidney Dis 18: 225–231PubMedGoogle Scholar
  35. 35.
    Perez-Fontan M, Garcia-Falcon T, Rosales M, et al (1993) Treatment of Staphylococcus aureus nasal carriers in continuous ambulatory peritoneal dialysis with mupirocin: long-term results. Am J Kidney Dis 22: 708–712PubMedGoogle Scholar
  36. 36.
    Bloom BS, Fendrick AM, Chernew ME, Patel P (1996) Clinical and economic effects of mupirocin calcium on preventing Staphylococcus aureus infection in hemodialysis patients: a decision analysis. Am J Kidney Dis 27: 687–694PubMedCrossRefGoogle Scholar
  37. 37.
    Davey P, Craig AM, Hau C, Malek M (1999) Cost-effectiveness of prophylactic nasal mupirocin in patients undergoing peritoneal dialysis based on a randomized, placebo-controlled trial. J Antimicrob Chemother 43: 105–112PubMedCrossRefGoogle Scholar
  38. 38.
    Mupirocin Study Group (1996) Nasal mupirocin prevents Staphylococcus aureus exit-site infection during peritoneal dialysis. J Am Soc Nephrol 7: 2403–2408Google Scholar
  39. 39.
    Shinefield H, Black S, Fattom A, et al (2002) Use of a Staphylococcus aureus conjugate vaccine in patients receiving hemodialysis. N Engl J Med 346: 491–496PubMedCrossRefGoogle Scholar

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© Springer-Verlag Berlin Heidelberg 2003

Authors and Affiliations

  • H. F. L. Wertheim
  • J. A. J. W. Kluytmans

There are no affiliations available

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