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Published in: BMC Infectious Diseases 1/2013

Open Access 01-12-2013 | Research article

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

Authors: Todd J Vento, Tatjana P Calvano, David W Cole, Katrin Mende, Elizabeth A Rini, Charla C Tully, Michael L Landrum, Wendy Zera, Charles H Guymon, Xin Yu, Miriam L Beckius, Kristelle A Cheatle, Clinton K Murray

Published in: BMC Infectious Diseases | Issue 1/2013

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Abstract

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.
Literature
1.
go back to reference Lyons C: Penicillin and its use in the war wounded. Am J Surg. 1946, 72: 315-318. 10.1016/0002-9610(46)90321-2.CrossRefPubMed Lyons C: Penicillin and its use in the war wounded. Am J Surg. 1946, 72: 315-318. 10.1016/0002-9610(46)90321-2.CrossRefPubMed
2.
go back to reference Heggers JP, Barnes ST, Robson MC, et al: Microbial flora of orthopaedic war wounds. Mil Med. 1969, 134: 602-603.PubMed Heggers JP, Barnes ST, Robson MC, et al: Microbial flora of orthopaedic war wounds. Mil Med. 1969, 134: 602-603.PubMed
3.
go back to reference Tong MJ: Septic complications of war wounds. JAMA. 1972, 219: 1044-1047. 10.1001/jama.1972.03190340050011.CrossRefPubMed Tong MJ: Septic complications of war wounds. JAMA. 1972, 219: 1044-1047. 10.1001/jama.1972.03190340050011.CrossRefPubMed
4.
go back to reference 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.PubMed 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.PubMed
5.
go back to reference Yun HC, Branstetter JG, Murray CK: Osteomyelitis in military personnel wounded in Iraq and Afghanistan. J Trauma. 2008, 64: S163-S168. 10.1097/TA.0b013e318160868c.CrossRefPubMed Yun HC, Branstetter JG, Murray CK: Osteomyelitis in military personnel wounded in Iraq and Afghanistan. J Trauma. 2008, 64: S163-S168. 10.1097/TA.0b013e318160868c.CrossRefPubMed
6.
go back to reference Roberts SS, Kazragis RJ: Methicillin-resistant Staphylococcus aureus infections in U.S. Service members deployed to Iraq. Mil Med. 2009, 174: 408-411.CrossRefPubMed Roberts SS, Kazragis RJ: Methicillin-resistant Staphylococcus aureus infections in U.S. Service members deployed to Iraq. Mil Med. 2009, 174: 408-411.CrossRefPubMed
7.
go back to reference Murray CK, Griffith ME, Mende K, et al: Methicillin-resistant Staphylococcus aureus recovered from wounds in Iraq. J Trauma. 2010, 69: S102-S108. 10.1097/TA.0b013e3181e44b57.CrossRefPubMed Murray CK, Griffith ME, Mende K, et al: Methicillin-resistant Staphylococcus aureus recovered from wounds in Iraq. J Trauma. 2010, 69: S102-S108. 10.1097/TA.0b013e3181e44b57.CrossRefPubMed
8.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
9.
go back to reference 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. 10.1001/jama.2012.7139.CrossRefPubMed 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. 10.1001/jama.2012.7139.CrossRefPubMed
10.
go back to reference 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. 10.1086/423965.CrossRefPubMed 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. 10.1086/423965.CrossRefPubMed
11.
go back to reference 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. 10.1017/S0950268810000142.CrossRefPubMed 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. 10.1017/S0950268810000142.CrossRefPubMed
12.
go back to reference 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. 10.1128/AAC.01086-06.CrossRefPubMedPubMedCentral 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. 10.1128/AAC.01086-06.CrossRefPubMedPubMedCentral
13.
go back to reference 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. 10.1086/657136.CrossRefPubMed 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. 10.1086/657136.CrossRefPubMed
14.
go back to reference 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. 10.1128/AAC.01608-10.CrossRefPubMedPubMedCentral 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. 10.1128/AAC.01608-10.CrossRefPubMedPubMedCentral
15.
go back to reference Kallen AJ, Mu Y, Bulens S, et al: Health care-associated invasive MRSA infections, 2005–2008. JAMA. 2010, 304: 641-648. 10.1001/jama.2010.1115.CrossRefPubMed Kallen AJ, Mu Y, Bulens S, et al: Health care-associated invasive MRSA infections, 2005–2008. JAMA. 2010, 304: 641-648. 10.1001/jama.2010.1115.CrossRefPubMed
16.
go back to reference 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. 10.1086/657067.CrossRef 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. 10.1086/657067.CrossRef
17.
go back to reference 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. 10.1016/j.annemergmed.2010.11.024.CrossRefPubMed 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. 10.1016/j.annemergmed.2010.11.024.CrossRefPubMed
18.
go back to reference 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.CrossRef 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.CrossRef
20.
go back to reference 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. 10.1093/cid/cis213.CrossRefPubMedPubMedCentral 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. 10.1093/cid/cis213.CrossRefPubMedPubMedCentral
21.
go back to reference 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. 10.1086/598510.CrossRefPubMed 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. 10.1086/598510.CrossRefPubMed
22.
go back to reference 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. 10.1128/JCM.41.11.5113-5120.2003.CrossRefPubMedPubMedCentral 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. 10.1128/JCM.41.11.5113-5120.2003.CrossRefPubMedPubMedCentral
23.
go back to reference 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.PubMedPubMedCentral 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.PubMedPubMedCentral
24.
go back to reference Ide L, Lootens J, Thibo P: The nose is not the only relevant MRSA screening site. Clin Microbiol Infect. 2009, 15: 1192-1193. 10.1111/j.1469-0691.2009.02954.x.CrossRefPubMed Ide L, Lootens J, Thibo P: The nose is not the only relevant MRSA screening site. Clin Microbiol Infect. 2009, 15: 1192-1193. 10.1111/j.1469-0691.2009.02954.x.CrossRefPubMed
25.
go back to reference Mertz D, Frei R, Periat N, et al: Exclusive Staphylococcus aureus throat carriage: at-risk populations. Arch Intern Med. 2009, 169: 172-178. 10.1001/archinternmed.2008.536.CrossRefPubMed Mertz D, Frei R, Periat N, et al: Exclusive Staphylococcus aureus throat carriage: at-risk populations. Arch Intern Med. 2009, 169: 172-178. 10.1001/archinternmed.2008.536.CrossRefPubMed
26.
go back to reference 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. 10.1111/j.1469-0691.2009.02836.x.CrossRefPubMed 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. 10.1111/j.1469-0691.2009.02836.x.CrossRefPubMed
27.
go back to reference 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. 10.1086/526773.CrossRef 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. 10.1086/526773.CrossRef
28.
go back to reference 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. 10.1007/s00203-010-0594-4.CrossRefPubMed 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. 10.1007/s00203-010-0594-4.CrossRefPubMed
29.
go back to reference 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. 10.1128/AAC.00351-10.CrossRefPubMedPubMedCentral 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. 10.1128/AAC.00351-10.CrossRefPubMedPubMedCentral
30.
go back to reference 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. 10.3201/eid1303.060729.CrossRefPubMedPubMedCentral 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. 10.3201/eid1303.060729.CrossRefPubMedPubMedCentral
31.
go back to reference Fanelli M, Kupperman E, Lautenbach E, Edelstein PH, Margolis DJ: Antibiotics, acne and Staphylococcus aureus colonization. Arch Dermatol. 2011, 147: 917-921. 10.1001/archdermatol.2011.67.CrossRefPubMedPubMedCentral Fanelli M, Kupperman E, Lautenbach E, Edelstein PH, Margolis DJ: Antibiotics, acne and Staphylococcus aureus colonization. Arch Dermatol. 2011, 147: 917-921. 10.1001/archdermatol.2011.67.CrossRefPubMedPubMedCentral
32.
go back to reference 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. 10.1097/TA.0b013e318221162e.CrossRef 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. 10.1097/TA.0b013e318221162e.CrossRef
33.
go back to reference 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.CrossRef 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.CrossRef
34.
go back to reference Murray CK, Obremskey WT, Hsu JR, et al: Prevention of infections associated with combat-related extremity injuries. J Trauma supplement. 2011, 71: S235-S257.CrossRef Murray CK, Obremskey WT, Hsu JR, et al: Prevention of infections associated with combat-related extremity injuries. J Trauma supplement. 2011, 71: S235-S257.CrossRef
35.
go back to reference Brown KV, Murray CK, Clasper J: Infectious complications of combat-related extremity injuries in the British Military. J Trauma supplement. 2010, 69: S109-S115. 10.1097/TA.0b013e3181e4b33d.CrossRef Brown KV, Murray CK, Clasper J: Infectious complications of combat-related extremity injuries in the British Military. J Trauma supplement. 2010, 69: S109-S115. 10.1097/TA.0b013e3181e4b33d.CrossRef
36.
go back to reference Murray CK, Roop SA, Hospenthal DR, et al: Bacteriology of war wounds at the time of injury. Mil Med. 2006, 171: 826-829.CrossRefPubMed Murray CK, Roop SA, Hospenthal DR, et al: Bacteriology of war wounds at the time of injury. Mil Med. 2006, 171: 826-829.CrossRefPubMed
37.
go back to reference 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. 10.1128/AAC.00027-10.CrossRef 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. 10.1128/AAC.00027-10.CrossRef
38.
go back to reference Murray CK, Hospenthal DR, Kotwal RS, Butler FK: Providing prehospital antimicrobials to combat casualties. J Trauma supplement. 2011, 71: S307-S313.CrossRef Murray CK, Hospenthal DR, Kotwal RS, Butler FK: Providing prehospital antimicrobials to combat casualties. J Trauma supplement. 2011, 71: S307-S313.CrossRef
Metadata
Title
Staphylococcus aureus colonization of healthy military service members in the United States and Afghanistan
Authors
Todd J Vento
Tatjana P Calvano
David W Cole
Katrin Mende
Elizabeth A Rini
Charla C Tully
Michael L Landrum
Wendy Zera
Charles H Guymon
Xin Yu
Miriam L Beckius
Kristelle A Cheatle
Clinton K Murray
Publication date
01-12-2013
Publisher
BioMed Central
Published in
BMC Infectious Diseases / Issue 1/2013
Electronic ISSN: 1471-2334
DOI
https://doi.org/10.1186/1471-2334-13-325

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