title: Serial home-based self-collection of anterior nasal swabs to detect Staphylococcus aureus carriage in a randomized population-based study in Germany.
abstract: OBJECTIVE
  Participant-collected serial nasal swabs would be a cost-efficient feature of prospective population-based microbiological studies. We examined the feasibility of serial anterior nasal self-swabbing for Staphylococcus aureus detection in a prospective population-based study in Braunschweig, Germany, and assessed the impact of three interventions on participation and compliance.
  
  
  METHODS
  Two thousand twenty-six inhabitants were selected randomly from the resident registries and asked to self-collect a nasal swab monthly from July 2012 to January 2013 and return it by mail. The swabs were tested for the presence of S. aureus. Participation and compliance were assessed in four study groups (incremental cash incentive, participation in a lottery, reminder by mail, and control group without incentive or reminder).
  
  
  RESULTS
  Baseline participation was highest in the cash incentive group (24%; 123/504) and lowest in the reminder group (16%; 83/509). Approximately 90% of the participants in all groups returned the swabs each month, demonstrating high compliance irrespective of the intervention. Laboratory analyses showed that most swabs were usable for bacteriological studies. S. aureus was detected at the expected frequency of 20-27%.
  
  
  CONCLUSIONS
  Home-based serial nasal self-swabbing proved to be feasible and highly acceptable and promises to be a cost-efficient tool for large-scale prospective population-based studies on bacterial infection or colonization.
authors.affiliation: Department of Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstraße 7, 38124 Braunschweig, Germany; TWINCORE Centre for Experimental and Clinical Infection Research, Hannover, Germany. Electronic address: manas.akmatov@helmholtz-hzi.de.
authors.forename: Manas K
authors.initials: MK
authors.lastname: Akmatov
authors.affiliation: Department of Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstraße 7, 38124 Braunschweig, Germany.
authors.forename: Jaishri
authors.initials: J
authors.lastname: Mehraj
authors.affiliation: Department of Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstraße 7, 38124 Braunschweig, Germany.
authors.forename: Anja
authors.initials: A
authors.lastname: Gatzemeier
authors.affiliation: Department of Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstraße 7, 38124 Braunschweig, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Strömpl
authors.affiliation: Robert Koch Institute, Wernigerode, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Witte
authors.affiliation: Department of Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstraße 7, 38124 Braunschweig, Germany.
authors.forename: Gérard
authors.initials: G
authors.lastname: Krause
authors.affiliation: Department of Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstraße 7, 38124 Braunschweig, Germany; TWINCORE Centre for Experimental and Clinical Infection Research, Hannover, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Pessler
mesh_terms: D000328:Adult; D002353:Carrier State; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009297:Nasal Mucosa / Q000382:microbiology*; D010349:Patient Compliance; D011159:Population Surveillance; D011446:Prospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology*; D013211:Staphylococcus aureus / Q000302:isolation & purification*; D011795:Surveys and Questionnaires
keywords: Germany; Nasal swabs; Population-based studies; Prospective studies; Self-swabbing; Staphylococcus aureus