title: Nasal screening for MRSA: different swabs--different results!
abstract: OBJECTIVE
  Swab-based nasal screening is commonly used to identify asymptomatic carriage of Staphylococcus aureus in patients. Bacterial detection depends on the uptake and release capacities of the swabs and on the swabbing technique itself. This study investigates the performance of different swab-types in nasal MRSA-screening by utilizing a unique artificial nose model to provide realistic and standardized screening conditions.
  
  
  METHODS
  An anatomically correct artificial nose model was inoculated with a numerically defined mixture of MRSA and Staphylococcus epidermidis bacteria at quantities of 4×10(2) and 8×10(2) colony forming units (CFU), respectively. Five swab-types were tested following a strict protocol. Bacterial recovery was measured for direct plating and after elution into Amies medium by standard viable count techniques.
  
  
  RESULTS
  Mean recovered bacteria quantities varied between 209 and 0 CFU for MRSA, and 365 and 0 CFU for S. epidermidis, resulting swab-type-dependent MRSA-screening-sensitivities ranged between 0 and 100%. Swabs with nylon flocked tips or cellular foam tips performed significantly better compared to conventional rayon swabs referring to the recovered bacterial yield (p<0.001). Best results were obtained by using a flocked swab in combination with Amies preservation medium. Within the range of the utilized bacterial concentrations, recovery ratios for the particular swab-types were independent of the bacterial species.
  
  
  CONCLUSIONS
  This study combines a realistic model of a human nose with standardized laboratory conditions to analyze swab-performance in MRSA-screening situations. Therefore, influences by inter-individual anatomical differences as well as diverse colonization densities in patients could be excluded. Recovery rates vary significantly between different swab-types. The choice of the swab has a great impact on the laboratory result. In fact, the swab-type contributes significantly to true positive or false negative detection of nasal MRSA carriage. These findings should be considered when screening a patient.
authors.affiliation: Institute of Medical Microbiology, Virology, and Hygiene, Rostock University Hospital, Rostock, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Warnke
authors.affiliation: Institute of Medical Microbiology, Virology, and Hygiene, Rostock University Hospital, Rostock, Germany; Department of Tropical Medicine at the Bernhard Nocht Institute, German Armed Forces Hospital Hamburg, Hamburg, Germany.
authors.forename: Hagen
authors.initials: H
authors.lastname: Frickmann
authors.affiliation: Department of Prosthodontics and Material Sciences, Rostock University Hospital, Rostock, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Ottl
authors.affiliation: Institute of Medical Microbiology, Virology, and Hygiene, Rostock University Hospital, Rostock, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Podbielski
mesh_terms: D001706:Biopsy / Q000379:methods*; D006801:Humans; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D008953:Models, Anatomic; D009297:Nasal Mucosa / Q000382:microbiology* / Q000473:pathology