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. 1991 Aug;44(8):681–684. doi: 10.1136/jcp.44.8.681

Nasal, axillary, and perineal carriage of Staphylococcus aureus among women: identification of strains producing epidermolytic toxin.

S J Dancer 1, W C Noble 1
PMCID: PMC496765  PMID: 1890203

Abstract

Following two outbreaks of staphylococcal scalded skin syndrome in a maternity unit, 500 pregnant women attending an antenatal clinic were screened for carriage of epidermolytic toxin producing Staphylococcus aureus. Nasal, axillary, and perineal swabs were collected from women whose gestational ages ranged from 12-40 weeks. Isolates of S aureus were purified, phage typed, and tested for methicillin sensitivity and production of epidermolytic toxin. The results showed that 164 (33%) women carried S aureus; of these, 100 (61%) were from the nose and three (2%) from axillae, but 41 (25%) strains were isolated from the perineum alone. Screening for nasal carriage alone will therefore miss 25% of carriers. More than one strain of S aureus was identified in seven of 20 women with multiple site carriage. Three (2%) methicillin resistant strains were isolated during the survey, and five (3%) isolates produced epidermolytic toxin. Phage typing identified 63 (34%) strains as non-typable, but 50% of isolates typed either groups I, II or III, and a further 10% represented varying combinations of these and other phage groups. These results provide baseline information on S aureus in the community, and identification of methicillin resistant and toxin producing strains shows a reservoir of outbreak potential which could become relevant on hospital admission of such a carrier.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Arbuthnott J. P., Kent J., Noble W. C. The response of hairless mice to staphylococcal epidermolytic toxin. Br J Dermatol. 1973 May;88(5):481–485. doi: 10.1111/j.1365-2133.1973.tb15454.x. [DOI] [PubMed] [Google Scholar]
  2. Ayliffe G. A., Brightwell K. M., Collins B. J., Lowbury E. J., Goonatilake P. C., Etheridge R. A. Surveys of hospital infection in the Birmingham region. I. Effect of age, sex, length of stay and antibiotic use on nasal carriage of tetracycline-resistant Staphyloccus aureus and on post-operative wound infection. J Hyg (Lond) 1977 Oct;79(2):299–314. doi: 10.1017/s0022172400053110. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Black T. The bacterial flora of the skin and its relation to post-operative wound infection. Trans Soc Occup Med. 1966 Jan;16(1):18–23. doi: 10.1093/occmed/16.1.18. [DOI] [PubMed] [Google Scholar]
  4. Casewell M. W., Hill R. L. The carrier state: methicillin-resistant Staphylococcus aureus. J Antimicrob Chemother. 1986 Jul;18 (Suppl A):1–12. doi: 10.1093/jac/18.supplement_a.1. [DOI] [PubMed] [Google Scholar]
  5. Dancer S. J., Poston S. M., East J., Simmons N. A., Noble W. C. An outbreak of pemphigus neonatorum. J Infect. 1990 Jan;20(1):73–82. doi: 10.1016/s0163-4453(90)92434-m. [DOI] [PubMed] [Google Scholar]
  6. Dancer S. J., Simmons N. A., Poston S. M., Noble W. C. Outbreak of staphylococcal scalded skin syndrome among neonates. J Infect. 1988 Jan;16(1):87–103. doi: 10.1016/s0163-4453(88)96249-4. [DOI] [PubMed] [Google Scholar]
  7. Dimond R. L., Wolff H. H., Braun-Falco O. The staphylococcal scalded skin syndrome. An experimental histochemical and electron microscopic study. Br J Dermatol. 1977 May;96(5):483–492. doi: 10.1111/j.1365-2133.1977.tb07150.x. [DOI] [PubMed] [Google Scholar]
  8. Dowsett E. G., Petts D. N., Baker S. L., DeSaxe M. J., Coe A. E., Naidoo J., Noble W. C. Analysis of an outbreak of staphylococcal scalded skin syndrome: strategies for typing 'non-typable' strains. J Hosp Infect. 1984 Dec;5(4):391–397. doi: 10.1016/0195-6701(84)90007-0. [DOI] [PubMed] [Google Scholar]
  9. Goldberg N. S., Ahmed T., Robinson B., Ascensao J., Horowitz H. Staphylococcal scalded skin syndrome mimicking acute graft-vs-host disease in a bone marrow transplant recipient. Arch Dermatol. 1989 Jan;125(1):85–87. [PubMed] [Google Scholar]
  10. HARE R., RIDLEY M. Further studies on the transmission of Staph. aureus. Br Med J. 1958 Jan 11;1(5062):69–73. doi: 10.1136/bmj.1.5062.69. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Hargiss C., Larson E. The epidemiology of Staphylococcus aureus in a newborn nursery from 1970 through 1976. Pediatrics. 1978 Mar;61(3):348–353. [PubMed] [Google Scholar]
  12. Henning C., Hillborgh U., Lindvall K., Marqvardsen O., Sellers J., Wåhlin S., Ransjö U. Comparison of Staphylococcus aureus carriage and skin infection rates in hospital and office employees. J Hyg (Lond) 1979 Dec;83(3):437–444. doi: 10.1017/s0022172400026279. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Kaplan M. H., Chmel H., Hsieh H. C., Stephens A., Brinsko V. Importance of exfoliatin toxin A production by Staphylococcus aureus strains isolated from clustered epidemics of neonatal pustulosis. J Clin Microbiol. 1986 Jan;23(1):83–91. doi: 10.1128/jcm.23.1.83-91.1986. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Kapral F. A. Staphylococcus aureus: some host-parasite interactions. Ann N Y Acad Sci. 1974 Jul 31;236(0):267–276. doi: 10.1111/j.1749-6632.1974.tb41497.x. [DOI] [PubMed] [Google Scholar]
  15. Lidwell O. M., Brock B., Shooter R. A., Cooke E. M., Thomas G. E. Airborne infection in a fully air-conditioned hospital. IV. Airborne dispersal of Staphylococcus aureus and its nasal acquisition by patients. J Hyg (Lond) 1975 Dec;75(3):445–474. doi: 10.1017/s0022172400024505. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Lyell A. Toxic epidermal necrolysis (the scalded skin syndrome): a reappraisal. Br J Dermatol. 1979 Jan;100(1):69–86. doi: 10.1111/j.1365-2133.1979.tb03571.x. [DOI] [PubMed] [Google Scholar]
  17. MILLIAN S. J., BALDWIN J. N., RHEINS M. S., WEISER H. H. Studies on the incidence of coagulase-positive staphylococci in a normal unconfined population. Am J Public Health Nations Health. 1960 Jun;50:791–798. doi: 10.2105/ajph.50.6_pt_1.791. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Melish M. E., Glasgow L. A. The staphylococcal scalded-skin syndrome. N Engl J Med. 1970 May 14;282(20):1114–1119. doi: 10.1056/NEJM197005142822002. [DOI] [PubMed] [Google Scholar]
  19. NOBLE W. C., WILLIAMS R. E., JEVONS M. P., SHOOTER R. A. SOME ASPECTS OF NASAL CARRIAGE OF STAPHYLOCOCCI. J Clin Pathol. 1964 Jan;17:79–83. doi: 10.1136/jcp.17.1.79. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Noble W. C. Skin carriage of the Micrococcaceae. J Clin Pathol. 1969 May;22(3):249–253. doi: 10.1136/jcp.22.3.249. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Noble W. C., Valkenburg H. A., Wolters C. H. Carriage of Staphylococcus aureus in random samples of a normal population. J Hyg (Lond) 1967 Dec;65(4):567–573. doi: 10.1017/s002217240004609x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. PARKER M. T., TOMLINSON A. J., WILLIAMS R. E. Impetigo contagiosa; the association of certain types of Staphylococcus aureus and of Streptococcus pyogenes with superficial skin infections. J Hyg (Lond) 1955 Dec;53(4):458–473. doi: 10.1017/s0022172400000966. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Piemont Y., Rasoamananjara D., Fouace J. M., Bruce T. Epidemiological investigation of exfoliative toxin-producing Staphylococcus aureus strains in hospitalized patients. J Clin Microbiol. 1984 Mar;19(3):417–420. doi: 10.1128/jcm.19.3.417-420.1984. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Polakoff S., Richards I. D., Parker M. T., Lidwell O. M. Nasal and skin carriage of Staphylococcus aureus by patients undergoing surgical operation. J Hyg (Lond) 1967 Dec;65(4):559–566. doi: 10.1017/s0022172400046088. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Ramamurti D. V., Kanz E. The staphylococcus outside the hospital. I. The occurrence of staphylococcal phage types in the extra-hospital environment. Zentralbl Bakteriol Orig B. 1972 Dec;156(4):399–405. [PubMed] [Google Scholar]
  26. Richardson J. F., Marples R. R. Another strain of methicillin-resistant Staphylococcus aureus epidemic in London. Lancet. 1988 Sep 24;2(8613):748–749. doi: 10.1016/s0140-6736(88)90224-3. [DOI] [PubMed] [Google Scholar]
  27. Sarkany I., Gaylarde C. C. Bacterial colonisation of the skin of the newborn. J Pathol Bacteriol. 1968 Jan;95(1):115–122. doi: 10.1002/path.1700950113. [DOI] [PubMed] [Google Scholar]
  28. Solberg C. O. A study of carriers of Staphylococcus aureus with special regard to quantitative bacterial estimations. Acta Med Scand Suppl. 1965;436:1–96. [PubMed] [Google Scholar]
  29. WILLIAMS R. E. Healthy carriage of Staphylococcus aureus: its prevalence and importance. Bacteriol Rev. 1963 Mar;27:56–71. doi: 10.1128/br.27.1.56-71.1963. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. WILLIAMS R. E., JEVONS M. P., SHOOTE R. A., THOM B. T., NOBLE W. C., LIDWELL O. M., WHITE R. C., TAYLOR G. W. Isolation for the control of staphylococcal infection in surgical wards. Br Med J. 1962 Aug 4;2(5300):275–282. doi: 10.1136/bmj.2.5300.275. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. WOLINSKY E., LIPSITZ P. J., MORTIMER E. A., Jr, RAMMELKAMP C. H., Jr Acquisition of staphylococci by newborns. Direct versus indirect transmission. Lancet. 1960 Sep 17;2(7151):620–622. doi: 10.1016/s0140-6736(60)91693-7. [DOI] [PubMed] [Google Scholar]
  32. de Azavedo J., Arbuthnott J. P. Prevalence of epidermolytic toxin in clinical isolates of Staphylococcus aureus. J Med Microbiol. 1981 Aug;14(3):341–344. doi: 10.1099/00222615-14-3-341. [DOI] [PubMed] [Google Scholar]

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