title: Concordance of nasal and diabetic foot ulcer staphylococcal colonization.
abstract: Nasal carriage of Staphylococcus aureus (SA) is an important risk factor for surgical site infections. The goal of this study was to investigate the concordance between nasal and diabetic foot ulcer (DFU) SA carriage. Seventy-nine subjects with DFUs were assessed for nasal and DFU colonization with SA, including methicillin-resistant SA (MRSA). Twenty-five (31.6%) subjects had nares colonization with SA; 29 (36.7%) had DFU colonization with SA. Seven (8.8%) subjects had nares colonization with MRSA, and 7 (8.8%) had DFU colonization with MRSA. Ulcer duration was associated with MRSA presence (P = 0.01). Sensitivity and specificity of positive nasal SA colonization with positive DFU colonization were 41% and 74%. We found substantial discordance between SA strains colonizing DFU and the nasal cavity. The poor positive predictive values for SA isolation in a DFU based on nasal carriage suggests that SA colonization of a DFU by endogenous SA strains cannot be assumed.
authors.affiliation: Department of Internal Medicine, The University of Iowa, Iowa City, IA, USA.
authors.forename: Ambar
authors.initials: A
authors.lastname: Haleem
authors.affiliation: Carver College of Medicine, The University of Iowa, Iowa City, IA, USA.
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Schultz
authors.affiliation: Carver College of Medicine, The University of Iowa, Iowa City, IA, USA.
authors.forename: Kristopher P
authors.initials: KP
authors.lastname: Heilmann
authors.affiliation: Carver College of Medicine, The University of Iowa, Iowa City, IA, USA.
authors.forename: Cassie L
authors.initials: CL
authors.lastname: Dohrn
authors.affiliation: Department of Internal Medicine, The University of Iowa, Iowa City, IA, USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Diekema
authors.affiliation: College of Nursing, The University of Iowa, Iowa City, IA, USA. Electronic address: sue-gardner@uiowa.edu.
authors.forename: Sue E
authors.initials: SE
authors.lastname: Gardner
mesh_terms: D000328:Adult; D000368:Aged; D002353:Carrier State / Q000382:microbiology*; D017719:Diabetic Foot / Q000382:microbiology*; D005260:Female; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification; D008875:Middle Aged; D009296:Nasal Cavity / Q000382:microbiology*; D013203:Staphylococcal Infections / Q000382:microbiology*; D013211:Staphylococcus aureus / Q000302:isolation & purification*
keywords: Diabetic foot; Foot ulcer; Staphylococcal colonization