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Journal of Clinical Microbiology, September 2007, p. 2979-2984, Vol. 45, No. 9
0095-1137/07/$08.00+0     doi:10.1128/JCM.00855-07
Copyright © 2007, American Society for Microbiology. All Rights Reserved.

Nasal Staphylococcus aureus Carriage Is Not a Risk Factor for Lower-Airway Infection in Young Cystic Fibrosis Patients

Institute of Medical Microbiology,¹ Department of Pediatrics, University Hospital Muenster, Muenster, Germany,⁴ Children's Hospital, University of Duisburg-Essen, Essen, Germany,² Division of Respiratory Medicine, Hospital for Sick Children, Toronto, Ontario, Canada,³ Clemenshospital Muenster, Muenster, Germany,⁵ University Hospital Duesseldorf, Duesseldorf, Germany,⁶ Department of Public Health, Hamburg University of Applied Sciences, Hamburg, Germany⁷

Received 23 April 2007/ Returned for modification 12 June 2007/ Accepted 16 July 2007

Staphylococcus aureus is one of the first pathogens which often persistently infect the airways of cystic fibrosis (CF) patients. Nasal S. aureus carriage is a risk factor for S. aureus infections in non-CF patients. Topical treatment strategies successfully eradicate nasal S. aureus carriage, thereby decreasing S. aureus infection. A prospective longitudinal multicenter study was conducted to assess whether nasal carriage represents a risk factor for S. aureus colonization of the oropharynx in young CF patients. Cross-sectional analysis revealed a significantly higher prevalence of S. aureus-positive nasal (28/80 [35%] versus 20/109 [18%]; P < 0.01) and oropharyngeal (35/80 [44%] versus 20/109 [18%]; P < 0.001) cultures in children with CF compared to a control group. The first site of S. aureus detection was the nose in 6 patients and the oropharynx in 14 patients, respectively. Longitudinal analysis demonstrated a significantly higher S. aureus prevalence (61/62 [98%] versus 47/62 [76%]; P < 0.001) and persistence (46/62 [74%] versus 31/62 [50%]; P < 0.01) in the oropharynx than in the nose. In CF patients, the oropharynx, and not the nose, was the predominant site of S. aureus infection and persistence. Hence, it is unlikely that CF patients will benefit from topical treatment strategies to eradicate nasal carriage.

Published ahead of print on 25 July 2007.