title: Prevalence, risk factors and sequelae of Staphylococcus aureus carriage in diabetes: the Fremantle Diabetes Study Phase II.
abstract: OBJECTIVE
  To determine the prevalence and associates of Staphylococcus aureus and methicillin-resistant S. aureus (MRSA) carriage in community-based diabetes, and their relationship to hospitalization with S. aureus infection.
  
  
  METHODS
  A cross-sectional subset of 660 Fremantle Diabetes Study Phase II patients (mean±SD age 65.1±11.5years, 53.1% males) had nasal/axillary swabs as part of biennial review. Serum 25-hydroxyvitamin D (25(OH)D) concentrations were measured in 358 patients. Those with positive swabs were invited back for a repeat swab. Hospitalizations with S. aureus infections were ascertained from validated data linkage. Multiple logistic regression was used to identify associates of carriage, and Cox proportional hazards modelling was used to determine predictors of subsequent hospitalization.
  
  
  RESULTS
  258 patients (39.1%) were positive for S. aureus and eight (3.1%) carried MRSA. S. aureus carriage was independently associated with being married/in a de facto relationship and inversely with older age and being born overseas (P≤0.043). Repeat swabs in 137 patients (53.1% of those with an initially positive swab) grew S. aureus in 113 (82.5%). Five of eight MRSA-positive patients were re-swabbed, and four were MRSA-positive. Independent predictors of hospitalization with staphylococcal infection after the initial swab were S. aureus carriage (hazard ratio (95% CI) 5.42 (1.49-19.79)), prior hospitalization with S. aureus (4.84 (1.19-19.63)) and Aboriginality (7.20 (1.91-27.17) (P≤0.027). Serum 25(OH)D was not associated with S. aureus carriage or subsequent hospitalization.
  
  
  CONCLUSIONS
  S. aureus and MRSA carriage in our patients was consistent with previous general population studies. There were no diabetes-specific risk factors. Persistent colonization may underlie the increased risk of hospitalization with S. aureus.
authors.affiliation: Infectious Diseases Department, Fremantle Hospital, Fremantle, Western Australia, Australia.
authors.forename: Julie
authors.initials: J
authors.lastname: Hart
authors.affiliation: University of Western Australia, School of Medicine and Pharmacology, Fremantle Hospital, Fremantle, Western Australia, Australia; Department of Endocrinology and Diabetes, Fremantle Hospital, Fremantle, Western Australia, Australia.
authors.forename: Emma J
authors.initials: EJ
authors.lastname: Hamilton
authors.affiliation: University of Western Australia, School of Medicine and Pharmacology, Fremantle Hospital, Fremantle, Western Australia, Australia; Department of Endocrinology and Diabetes, Fremantle Hospital, Fremantle, Western Australia, Australia.
authors.forename: Ashley
authors.initials: A
authors.lastname: Makepeace
authors.affiliation: University of Western Australia, School of Medicine and Pharmacology, Fremantle Hospital, Fremantle, Western Australia, Australia.
authors.forename: Wendy A
authors.initials: WA
authors.lastname: Davis
authors.affiliation: University of Western Australia, School of Medicine and Pharmacology, Fremantle Hospital, Fremantle, Western Australia, Australia.
authors.forename: Erin
authors.initials: E
authors.lastname: Latkovic
authors.affiliation: Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; Department of Clinical Biochemistry, PathWest Laboratory Medicine, Nedlands, Western Australia, Australia.
authors.forename: Ee Mun
authors.initials: EM
authors.lastname: Lim
authors.affiliation: Infectious Diseases Department, Fremantle Hospital, Fremantle, Western Australia, Australia.
authors.forename: John R
authors.initials: JR
authors.lastname: Dyer
authors.affiliation: University of Western Australia, School of Medicine and Pharmacology, Fremantle Hospital, Fremantle, Western Australia, Australia. Electronic address: tim.davis@uwa.edu.au.
authors.forename: Timothy M E
authors.initials: TM
authors.lastname: Davis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000382:microbiology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000382:microbiology; D005260:Female; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008498:Medical Record Linkage; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification; D008875:Middle Aged; D009297:Nasal Mucosa / Q000382:microbiology*; D015995:Prevalence; D016016:Proportional Hazards Models; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D013211:Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification*; D014504:Urban Health; D014904:Western Australia / Q000453:epidemiology; D055815:Young Adult
keywords: Hospitalization; Methicillin resistant; Nasal carriage; Staphylococcus aureus; Type 2 diabetes; Vitamin D