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Methicillin-resistant Staphylococcus aureus nasal carriage and infection among patients with diabetic foot ulcer.
Journal of Microbiology, Immunology and Infection ( IF 7.4 ) Pub Date : 2018-06-04 , DOI: 10.1016/j.jmii.2018.03.005 Shin-Yi Lin , Nai-Yu Lin , Yu-Yao Huang , Chi-Chun Hsieh , Yhu-Chering Huang
Journal of Microbiology, Immunology and Infection ( IF 7.4 ) Pub Date : 2018-06-04 , DOI: 10.1016/j.jmii.2018.03.005 Shin-Yi Lin , Nai-Yu Lin , Yu-Yao Huang , Chi-Chun Hsieh , Yhu-Chering Huang
PURPOSE
To evaluate the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) nasal carriage in patients with diabetic foot ulcer (DFU) in Taiwan, and to assess the concordance between colonizing and clinical MRSA isolates from the patients.
METHOD
A total of 354 nasal specimens were collected from 112 to 242 diabetic patients with and without foot ulcer, respectively. MRSA clinical isolates from DFU wound cultures were collected for comparison.
RESULTS
Nasal carriage rate of S. aureus and MRSA was similar between diabetic patients with and without foot ulcer (15.2% vs. 16.9% for S. aureus and 5.4% vs. 1.7% for MRSA). Nasal S. aureus colonization was an independent predictor for wound S. aureus infection (Odds ratio [OR]: 5.33, 95% confidence interval [CI]: 1.61-17.59), so did nasal MRSA colonization (OR: 19.09, 95% CI: 2.12-171.91). The levels of glycated hemoglobin, and the usage with immunosuppressant agent were associated with S. aureus nasal colonization while oral hypoglycemic agent usage a protective factor. Sequence type 59/staphylococcal chromosome cassette mec IV or V, the local endemic community-associated clone, accounted for 42% and 70% of the clinical and colonizing isolates, respectively. Six of 10 patients with paired colonizing and clinical isolates, either MRSA or methicillin-sensitive S. aureus, had a genetically identical strain from a single patient.
CONCLUSION
Less than one-fifth of patients with DFU have nasal S. aureus, including MRSA, colonization; however, the colonization is significantly associated with S. aureus diabetic foot infection. Screening for S. aureus colonizing status in DFU patients might have a potential clinical implication.
更新日期：2020-04-22
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